Ethical Considerations in Nutrition: Are We What We Eat?

March 12, 2021

March 10, 2021

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00:00Good evening friends.
00:01Welcome to the Yale School of Medicine
00:03Program for Biomedical Ethics or
00:05Evening Ethics seminar series.
00:06That slide of Sam.
00:07If you could put back the slide,
00:09we were just looking at for a moment.
00:11I would like to just point out to the
00:13folks tonight we have a terrific talk
00:15coming up from Sarah Hall the 1st,
00:17just to give you guys a chance
00:19to take a look.
00:21We have a lot of old friends
00:22on this call and some new ones.
00:24We do these seminars once or twice
00:26a month in the evening and you
00:28are almost welcome to join us.
00:30And you can see here the upcoming talks.
00:32They have several later added
00:34since we first published our
00:35schedule some months back,
00:36and these will be of this schedule.
00:38Of course will be available on our website.
00:40Bio medical ethics at Yale.
00:42But you can also see here.
00:43We've got some wonderful talks coming up.
00:45I'd like to now introduce
00:47our speaker for tonight,
00:48but to let you know the way this lays out.
00:51For those of you who are new is that we
00:53will have a talk for about 45 minutes,
00:56plus or minus π or speaker tonight after,
00:58which will have a Q&A portion.
00:59And I invite you at that point
01:01to submit your questions.
01:03Through the Q&A on the zoom and then
01:05I'll ask your questions to Doctor Hull
01:07and we will have a hard stop at 6:30.
01:12I want to thank Doctor
01:14Hall for coming tonight.
01:15We've been looking forward
01:16to this talk for some time,
01:18so let me introduce her Doctor.
01:20Sarah Hall is well, among other things,
01:23one of the associate directors of
01:25the Program for Biomedical Ethics,
01:27Sarazen Assistant professor of
01:28Clinical Medicine here at Yale.
01:30She's also one of the favorite instructors
01:32at the medical school in cardiology.
01:34She teaches a course in the medical students.
01:37It's very popular.
01:38She's a gifted teacher,
01:39and she's also a wonderful bioethicist
01:41Senator undergraduate work in Harvard,
01:43where she received an AB
01:45and biochemical Sciences.
01:46And then also studied some French.
01:48She got her MD and her MBA or
01:51Master of Biomedical Ethics at
01:52Penn and our ethics work there.
01:55She was mentored by our
01:57old friend are Kaplan.
01:58She then did her medical residency at Penn,
02:01came to Yale to do a cardiology fellowship
02:03where she developed in particular
02:05expertise in echocardiography and now she
02:07serves on our cardiology faculty here.
02:09In addition to her work in echocardiography
02:12in her teaching of cardiology,
02:13she also serves as a consultant
02:16for the transplant team in
02:18Advanced Heart failure team.
02:20So Sarah is an important part of
02:21the clinical endeavors here at Yale.
02:23She's also an important part
02:24of the bioethics program here,
02:25and I'm very pleased that she's going
02:27to speak to us tonight on some of the
02:30ethical issues related to a plant based diet.
02:33Vera,
02:33thank you so much for doing this.
02:35We are very grateful and with
02:36that I'm going to turn this
02:38over to Doctor Sarah Home.
02:41Thank you so much Mark for that very
02:43kind introduction. I'm just going
02:44to go ahead and share my screen.
02:50Alright, can everyone say,
02:52well, I guess you looks fine,
02:55perfect alright so so as as Mark
02:59said today I would like to talk
03:02to you about some of the various
03:06ethical considerations in nutrition,
03:08specifically what I will argue are in fact
03:12the moral imperatives of transitioning
03:15Tord more plant based nutrition.
03:20So I'm just going to start off by declaring
03:23that I have no conflicts of interest,
03:25although I should clarify.
03:26I'm sorry I'm just trying to set up
03:29my screen here that despite having
03:31no financial conflicts of interest,
03:33I do have a great deal of confluence
03:35of interest in that area in this area,
03:38and what I mean by that is that
03:40I'm deeply concerned about the
03:41welfare of both people and animals.
03:44I'm passionate about heart health and
03:46I'm passionate about delicious food.
03:47So and I think all of these things are.
03:50Very relevant to the arguments
03:52that I'm going to make tonight.
03:55I should also note that when I speak
03:57about we on a societal level or society,
04:01unless I state otherwise,
04:02I'm speaking from an American
04:04or Western frame of reference,
04:06but I will attempt to be as
04:08clear as possible going forward.
04:13Alright, so first I'd like us to sort
04:16of walk through some of the common
04:19philosophical arguments that I typically
04:21hear that argue in favor of continuing
04:23to eat a Western diet that is very
04:26heavy in animal product consumption,
04:28and then try to show you why I think
04:31these arguments are fundamentally
04:33flawed and why we we need to
04:36change the way that we eat first.
04:39Animals exist only as means to an end.
04:42That is to say our end as humans.
04:45Because only humans are beings that
04:47have possessed the sufficient dignity to
04:50warrant being considered ends in ourselves.
04:52We evolved to eat animals
04:54and it's only natural.
04:56We need to eat meat to be healthy.
04:59And nutritional choices are purely
05:01a matter of personal choice as
05:03they do not affect other people.
05:05So let's start with some of
05:07the animal rights arguments.
05:09As many of you probably already know,
05:11and this was touched upon during professor
05:14singers talk earlier this season,
05:15and I do apologize that there
05:17may be some overlap,
05:19but I also realize there may be people
05:21here who didn't hear that talk.
05:24The meat industry is really rife
05:26with examples of cruelty well
05:27far beyond slaughter itself.
05:29I'd just like to post here a
05:32trigger warning that I'm about
05:34to show a few graphic images.
05:36So I just want to make sure that
05:38everyone's adequately prepared.
05:41So the practice of debeaking is something
05:43that's widely done in the poultry industry.
05:46You can see here it is. It's pretty.
05:49It's pretty gruesome that basically
05:51the tips of the beaks of birds
05:53used in poultry farming are cut
05:55off with a guillotine like device,
05:57and that's done primarily as a money
06:00saving endeavour because it because when
06:02poultry are in crowded conditions they
06:04get stressed and they fight and they can
06:06injure and even kill each other that way
06:09and too and that causes financial loss.
06:12And because the financial.
06:14Bottom line is.
06:15Really, the only bottom line in much of
06:19the food and the factory farming industry.
06:23That's why this procedure is done,
06:25but it's a very painful procedure.
06:27It often leads to disability
06:29and can sometimes even lead to
06:31death in these birds actually.
06:32But but since it leads to less
06:34death than not debeaking,
06:36it's done,
06:37even though again with no anesthesia
06:39or pain medication of any kind.
06:42Our check calling is another practice that's
06:44in the not so much the poultry industry,
06:48but the egg industry specifically because
06:50only female chicks grow up to produce eggs.
06:53Male chicks are therefore useless.
06:55So in egg and in the egg industry,
06:58often the male chicks are killed
07:01either shortly after birth,
07:02either through suffocation by being placed
07:05in a bag like you can see on the left,
07:09or by being ground up alive as there.
07:13Conveyed into a grinder,
07:14much like you see on the
07:15conveyor belt on the right,
07:17because it costs too much
07:18money to care for the man,
07:20it's cheaper to kill them.
07:23Gestation crates are how many commercial
07:26South spend their lives in a crate,
07:29often too small for them even to turn
07:33around in, but with enough access
07:36such that their piglets can can.
07:40Can feed and so that they can grow
07:42up and this is how many factory
07:44pigs just spend their entire lives.
07:49And cyclic pregnancy is the
07:51practice of the dairy industry.
07:53A lot of people I think aren't
07:56aware that just like most ma'am,
07:59are all mammals really not female
08:01mammals just don't lactate indefinitely.
08:03Female mammals need to be pregnant
08:05and give birth in order to lactate.
08:08And cows are no exception.
08:10So in order for cows to produce
08:13an adequate amount of milk,
08:15there cyclically impregnated,
08:16typically about once a year.
08:19And their babies are taken away
08:21from them shortly after birth.
08:23Even though cows from very
08:25strong bond with their calves.
08:27So that because that that milk is valuable
08:31and it can be sold for money to us.
08:34And again because maximizing profits is
08:36that the number One Financial imperative of
08:39Agri business or factory factory farming,
08:42I should say.
08:44That that's how it's done.
08:46And then this happens in a cycle until
08:49cows are considered spent and can't
08:52give anymore milk and then typically
08:55their their slaughtered after that.
08:58So what are the relevant
09:00ethical arguments at play here?
09:03I think very simply we can start from
09:05a welfare ethics framework applying
09:07the principle of nonmaleficence
09:09that that certainly those of
09:11you in health care at this talk
09:13tonight have understand very well,
09:14but I think it's really kind
09:16of intuitive for everyone,
09:18which is basically the idea that
09:20since animals clearly have the
09:22ability to feel pain or suffer and
09:24not only is that just simply obvious,
09:26that's also been well documented.
09:28That,
09:28based on this alone that there's
09:31a strong argument to be made that.
09:33Their suffering should be minimized.
09:37I would also argue that going beyond that,
09:40animals have to some degree at
09:42least an intrinsic value rather
09:45than simply instrumental value.
09:47That is to say that their value will
09:50beans as ends in themselves worthy
09:52of dignity if not full autonomy,
09:55rather than simply being things
09:58that are at our disposal.
10:01Because why is it that that we
10:03think that only humans are ends
10:05in itself in ourselves?
10:06Is it based on our ability to form
10:09relationships and to express empathy
10:10by exhibiting pro social behavior?
10:12Is it based on our superior intelligence
10:15because it seems to me that these are
10:17the things that intuitively we used
10:19to argue for this sort of speciesism,
10:22where humans have have sort of these these
10:24rights that far extend beyond animal rights,
10:27and,
10:27well,
10:27I'm certainly not trying to argue that
10:30animals necessarily have to have an.
10:32Equal legal or moral standing to people,
10:34but that they are deserving of some
10:37recognition of intrinsic value.
10:38Based on the fact that they too
10:40share much of this in common with us.
10:43That's not just my feeling,
10:45although I think that many people
10:47who know animals would understand
10:49this intuitively to be true.
10:51But this is actually been
10:52studied somewhat extensively.
10:53I'll be at less extensively in
10:55farm animals because of some of
10:57the ethical controversies that
10:59creates then another intelligent
11:00animals like primates.
11:02For example,
11:02and so this is,
11:04this is a table from a review
11:06that was published in 2019.
11:08I don't expect you to read
11:10through the whole table,
11:11but it's just to illustrate the
11:13various physical cognitive capacities
11:15that several different farm animals
11:17have been demonstrated to possess.
11:19And more importantly,
11:20this table here describes
11:22some of the socio cognitive
11:24capacities that animals possess,
11:26including most notably the ability
11:29to distinguish between between
11:31different and recognize humans.
11:33Recognize other animals of their own species.
11:36The ability to communicate
11:38within their species,
11:40and also with humans the ability to
11:43learn both from again other members
11:46of their species an from humans.
11:49Um, and you know,
11:51these are the very things that I think
11:54make us unique and special and worthy
11:56individuals as people and animals
11:58really share a lot of those traits with us.
12:02Um, this study,
12:04which was actually just published
12:07last month in a psychology Journal.
12:11Demonstrated that pigs actually
12:13can be trained to play video games.
12:15Moving a joystick with their snout,
12:17and I think that this quote is
12:20really particularly salient to
12:22to this argument that I'm making,
12:24so I'm going to read it to you.
12:27Their high level there being the
12:29pigs social motivation to perform
12:31the task was also noteworthy.
12:33Although food rewards associated with
12:34the task were likely a motivating factor,
12:37the social contact the pigs
12:39experience with their trainer also
12:41appeared to be very important.
12:42Occasionally,
12:43equipment failures resulted in non
12:45reward following correct responses,
12:46meaning that food was not given.
12:49On these occasions the pigs continued
12:51to make correct responses when
12:53rewarded only with verbal and tactile
12:55reinforcement from the experimenter
12:57who is also their primary caretaker.
12:59So I think here you can see there's
13:01there's really quite a striking
13:03similarity between how pigs interact
13:05with their caretaker and how dogs,
13:07for example,
13:08interact with their caretakers.
13:09Anyone who's had a dog here can can
13:12understand that you know you don't
13:15just have to give a dog treats to
13:17to make it happier to make it obey.
13:20The dogs are very responsive
13:22to verbal and tactile stimuli.
13:24And it's it's one of the things
13:27that makes us value them so much,
13:30and and indeed grant them a great
13:33degree of dignity as companion animals.
13:36Because because dogs,
13:37another companion,
13:38animals actually do enjoy legal
13:40protections against cruelty in our country,
13:43and I would submit that there's
13:45some degree of willful ignorance
13:47that we need to maintain in order
13:50to make this this really artificial
13:53distinction between.
13:54Dogs and other companion animals
13:56and pigs and other farm animals.
13:59And, you know, in in.
14:00In Western society we we just have
14:03this task to understanding that
14:05it would be barbaric to treat dogs
14:07the way that we treat pigs.
14:10And so you know, it's hypocritical for us to,
14:13for Westerners to criticize other
14:15cultures for their treatment of dogs
14:17in cultures where they do eat dogs
14:19when factory farming is really quite
14:22problematic to animals that possess
14:24really remarkably similar traits.
14:25And capacities for intelligence
14:27and sophisticated emotional
14:28relationships. And this.
14:30This paradox has prompted the
14:32hashtag friends, not food movement,
14:34that some people may be familiar with,
14:37but it's just again to illustrate
14:39that these these rich relationships
14:41can happen with both companion
14:44animals and with farm animals.
14:47Aren't so some of you are undoubtedly
14:49saying look Doc, that's great.
14:51You're obviously this bleeding heart.
14:53Animal lover, which OK guilty as charged.
14:56But you know that's humans
14:58are supposed to eat meat.
15:00We have canine teeth and incisors and
15:02you know that that's how we evolve.
15:05We're supposed to eat meat,
15:07and so I'm going to do it.
15:10So let me take you through some of
15:12my counter arguments to that to show
15:15you why that line of thinking is.
15:18Is a little bit problematic.
15:20So first of all, humans evolved.
15:22Humans are not carnivores.
15:23We evolved as omnivores.
15:25So yes, we did evolve eating meat,
15:27although we evolved eating a lot
15:29of plant based matter as well.
15:32Another something that I hear
15:33commonly is well,
15:34caveman didn't get heart attacks
15:36and they hate meat, so it's fine,
15:39and that's often the justification for
15:41the so called paleo diet or Paleolithic diet,
15:43which is a diet that is that is typically
15:46as practiced very meat heavy diet.
15:49That's sort of promoted as a as
15:51an ancestral diet of sorts that
15:53that is choose processed foods,
15:55which in that sense it's a good thing,
15:58but really tends to be quite heavy on meat,
16:01but that's that, really.
16:02Looking to a Paleolithic way of
16:05eating really is not applicable in
16:07the modern world for several reasons.
16:09First,
16:10humans evolved under the pressure
16:11of food scarcity,
16:12so we evolved where food was hard to get.
16:15We had to spend a lot of energy getting food.
16:18We now do not live in an environment
16:21of food scarcity.
16:22We live in an environment of food,
16:24Sir plus,
16:25and in fact we often have to
16:27actively avoid eating too much.
16:28Whether that's you know,
16:30the coworker pressuring us to have a cookie
16:33that you know that he or she brought in,
16:35not getting snacks that are being hawked
16:38when you go to the movie theater.
16:40Really,
16:40where where?
16:41There are constant pressures to
16:43eat and eat more,
16:45and so that's not really applicable here.
16:49Furthermore,
16:49the Hunter gatherer lifestyle
16:51required a significant amount of
16:52physical effort to obtain food,
16:54particularly to obtain meat,
16:55so you know when I,
16:57when I see the paleo diet is expressed
16:59by eating two hamburgers and no bun,
17:01that's not.
17:02That's not really a Paleolithic
17:04way of eating at all.
17:05In fact,
17:06I don't think you can really
17:08argue that you're eating meat
17:09in an ancestral way in any way.
17:12In less you are hunting and butchering
17:14any meat that you eat yourself
17:16or with a family member or close
17:18friend using only Paleolithic tools.
17:20And again,
17:21I just must stress that the amount
17:23of physical activity it required
17:25in order to eat meat at all is just
17:28not at all present in modern day
17:31meeting, so that's not really
17:32a fair comparison either.
17:36Furthermore, prehistoric humans were
17:38mainly threatened by predators and
17:40infectious diseases which typically
17:41killed them well before they could
17:43develop atherosclerotic cardiovascular
17:45disease and cancer, which of course,
17:47are the number one killers today of Americans
17:51and in the Western world in general.
17:55This so evolutionary pressure therefore
17:57led us to develop very robust immune
17:59systems in order to promote effective
18:02wound healing and to help us fight infection.
18:05Because these were our
18:07main evolutionary threats.
18:09Unfortunately,
18:09the modern consequences of this
18:12is a significant propensity for
18:14chronic inflammation,
18:15which incidentally is a major.
18:20Risk factor in the development of
18:22coronary disease as well as cancer.
18:26So I think if you're going to really make
18:29an evolutionary argument for eating meat,
18:31even if it is really eating in the way
18:34that our Paleolithic ancestors did I
18:37think you also have to ask yourself what.
18:40What are my life goals?
18:42Because if your goal really is
18:44purely an evolutionary goal,
18:45your evolutionary telos, right?
18:47Your purpose is simply to live long
18:49enough such that your offspring
18:51can survive past childhood.
18:52And now you've successfully
18:54passed on your genes.
18:55You fulfilled your genetic destiny
18:57and you don't need to live anymore
19:00so you know you have most of your
19:02kids by the time you're 2025,
19:04then by the time you're 40 or 45,
19:07they're adults.
19:08They can have their own kids.
19:10You are done.
19:11You don't need to live any longer.
19:13Setting aside the fact that very rarely
19:16are 20 year olds even close to being well,
19:19I shouldn't say that.
19:20But 20 year olds are rarely in fully
19:23independent in modern life, right?
19:25But even more importantly,
19:27that that's that's not most people's goals.
19:29When people come to me,
19:31they're not looking to survive
19:33just long enough such that their
19:35offspring can survive an their
19:37genetic destiny can be fulfilled.
19:39People want to live well past
19:41their reproductive years,
19:42double that time at least,
19:44and not just living past
19:45their reproductive years,
19:46but living with a really robust functional
19:49status both physically and mentally.
19:51So I would argue that you know,
19:53looking tored,
19:54an evolutionary pattern of eating
19:56really is not applicable in.
19:57In the modern world,
19:59with our modern invite.
20:00Mental food abundance and with
20:02our modern goal of living well
20:05past our evolutionary imperatives.
20:08So with that,
20:09let's turn to talking about
20:11cardiovascular health and why
20:12shifting toward a plant based diet
20:14is really crucial for promoting that,
20:17which again, as I said,
20:18is features very largely in
20:20my confluence of interest.
20:22As of course, a cardiologist.
20:24So we know that the consumption
20:26of animal based foods strongly
20:28strongly promotes Atheros sclerosis
20:30or plaque deposition in the arteries
20:32of the heart and frankly in the
20:35arteries everywhere else as well.
20:36And we know that this is mediated
20:39not just by high levels of kolesov
20:41of high intake of saturated fat which
20:44promotes high levels of LDL or bad
20:47cholesterol which leads to plaque deposition.
20:49But it also promotes inflammation,
20:51which is another key factor in the in
20:54the progression of atherosclerotic plaque.
20:56It's these two things working together.
20:58That that really accelerate the
21:00growth and the instability of black.
21:02And we also know that a whole food plant
21:06based diet and by this I mean whole food,
21:09meaning unprocessed or
21:10minimally processed foods.
21:11So I do not mean vegan sugar
21:13cookies when I talk about a
21:15plant based diet going forward,
21:17this is actually the only diet that's
21:20been shown not only to prevent or
21:22slow the progression of black,
21:24but actually to reverse plaque
21:26and in certain cases when it's.
21:28Adhere to very strictly and this
21:31is a diet and
21:32I will make references to this.
21:35You know, throughout my talk,
21:37this is a diet that is predominantly
21:40composed of fruits, vegetables,
21:41whole grains, nuts, seeds,
21:43beans and legumes among other food sources.
21:46And really minimizes, if not excludes,
21:48animal based sources of food.
21:51So let's talk about inflammation.
21:53So as I said, the whole food plant
21:55based or a whole food plant based diet
21:58offers many anti inflammatory benefits
22:00beyond its effects on the lipid profile,
22:03meaning effects on lowering cholesterol.
22:06So the whole whole food plant based diet has
22:09been shown to decrease insulin resistance.
22:11So why do we care about that?
22:14So insulin resistance is really
22:16a hallmark of type 2 diabetes,
22:18which is quite.
22:19It's really an epidemic in the
22:21Western world and it's mostly it's
22:23typically a lifestyle disease and a
22:26feature of it is unlike type one,
22:28diabetes where you don't make
22:29enough insulin with type 2 diabetes.
22:32Typically the problem isn't so much
22:34that you're not making enough insulin,
22:36although that.
22:37It can progress to issues like
22:39that in later stages,
22:41but is that your body itself
22:43you're the cells of your body
22:45aren't responsive to the insulin,
22:47and so with decreased insulin
22:49resistance comes hyperglycemia,
22:50because despite the secretion of insulin,
22:53your blood glucose levels are too
22:54high and we know that hyperglycemia
22:56is proinflammatory and causes
22:58arterial inflammation,
22:59which again is a critical factor
23:02in the development of plaque.
23:05We also know that a whole food
23:07plant based diet promotes a healthy
23:09body weight which in turn also
23:12helps to lower inflammation,
23:14obesity or the accumulation of fat
23:16cells is not simply this passive
23:18process where you're just storing
23:20extra fat but actually fat cells are
23:23very metabolically active and can
23:25be and have been implicated in the
23:28secretion of inflammatory cytokines.
23:30A whole food plant based diet
23:32also is of course associated with
23:34increased fiber intake.
23:35Fiber is only found in plant based
23:37food as well as phytonutrients or plant
23:39based nutrients that have antioxidant
23:41and anti-inflammatory properties.
23:44And finally,
23:44a plant based diet has been
23:46shown to have really salubrious
23:48interactions with the gut microbiome,
23:51which is has become a pretty hot
23:53topic in medicine over the past
23:56decade or so in terms of the
23:58gut brain connection and the gut
24:01body connection and ascentia Lee,
24:03the eating eating a plant based diet
24:06promotes healthier gut flora that
24:09are less inflammatory as opposed to
24:11a diet high in meat which has been.
24:14Associated with gut flora that
24:17promote higher levels of inflammation.
24:19So this is a diagram from a systematic
24:22review that that summarizes some
24:24of the findings that we found.
24:27I'm not going to take everyone
24:29through this this whole thing,
24:31but suffice it to say that there is
24:34there is a very complex interaction
24:36between the gut and the brain.
24:39Hormonal regulation,
24:40regulation of inflammatory factors,
24:41regulation of metabolism,
24:42and this has really important
24:44effects on overall health outcomes
24:46as summarized here,
24:47including decreasing all cause mortality.
24:50Decrease in risk for obesity,
24:51cardiometabolic disease,
24:52diabetes, and a decreased risk
24:54for certain types of cancer.
24:55And, of course, these are the outcomes
24:59associated with a plant based diet.
25:01To go into a little bit more detail here.
25:06There are several different outcomes
25:07that have been shown to be improved
25:10with the whole food plant based diet.
25:12For example, a vegetarian diet which
25:14does allow for dairy and egg but
25:16not meat has been shown in a meta.
25:19Recent meta analysis has been shown
25:21to confer a 25% relative risk
25:23reduction in ischemic heart disease,
25:24which is heart disease from
25:26blockages in the heart,
25:27arteries or coronary disease,
25:28as well as an 8% relative risk
25:31reduction in total cancer of vegan diet.
25:33In this same meta analysis was shown to
25:36confer actually 15% relative risk reduction.
25:38In total cancer.
25:40Furthermore,
25:40a whole food plant based diet has also
25:43been associated with neuroprotection that
25:45it may confer against cognitive aging.
25:48So talking about living well into old age,
25:51not just being physically well,
25:53cancer free and free of heart disease,
25:56but actually being more robust
25:58from a cognitive standpoint,
25:59I, I think, is very appealing.
26:02Probably for most people,
26:03and certainly for most
26:05people in this audience.
26:06And it's thought that that's
26:08primarily mediated through the
26:10consumption of monounsaturated fat.
26:12Which is the kind of fat that's found
26:14in plant based foods such as nuts,
26:16avocados and olive oil.
26:18So here's some data and again,
26:20the charts are small.
26:22I don't expect you to read them.
26:24I'm going to summarize them for you,
26:27but this is a snippet of data from
26:29the Harvard Women's Health Study.
26:31They did a cognitive substudy of
26:33individuals age 65 and older,
26:35which ended up being slightly
26:37over 6000 women,
26:38and they found that the the
26:40people with the highest,
26:41the women with the highest two
26:43quintiles of saturated fat consumption
26:45and the lowest two quintiles of
26:48monounsaturated fat consumption.
26:49These individuals were found to
26:51have increase or have found to have
26:53accelerated decline in cognition
26:55and memory when they were studied
26:57over four years.
26:59Conversely,
26:59those women with the highest
27:01quintile of monounsaturated fatty
27:03acid consumption actually had
27:04the best verbal memory and global
27:06cognitive trajectory.
27:07So eating plant based diet is
27:09not just good for your heart,
27:12but it is good for your mind as well.
27:17Alright, so that's all well and good, right?
27:20But then of course the questions.
27:23Well, what about when I'm not getting?
27:25Don't I need to eat meat to be healthy
27:29because I need it for protein, right?
27:32That's that's what I that's what
27:34I hear a lot.
27:35There's a very common misconception
27:37that a plant based diet does not have,
27:40cannot allow for adequate protein intake.
27:43That's simply not true.
27:44First,
27:45there's a widespread misconception
27:46that we need to consume.
27:48Far more protein than we actually do.
27:51In fact,
27:52the recommendation is only .8
27:54grams per kilogram per day.
27:56Which comes out to about 45
27:58grams of protein for
28:00125 pound woman and 80
28:02grams for a 220 pound man.
28:04So many plant based foods contain
28:07significant amounts of protein,
28:08and I'm going to show you
28:10just some examples here.
28:12Tofu or edamame soy products
28:14they contain anywhere from 11:50
28:15grams of protein per 3.5 ounces,
28:17and that's a very small serving.
28:20Again, these are all small servings that
28:22have pretty significant protein content,
28:24lentils or 18 grams for just one cooked Cup.
28:27A Cup is typically 8 ounces,
28:29not huge beans and chickpeas.
28:31So think hummus, right.
28:33Delicious spread goes great on.
28:35Pretty much everything.
28:3615 grams of protein per cooked Cup,
28:38nutritional yeast,
28:39some personal favorite of mine.
28:40It's inactivated yeast and it kind
28:42of has a nutty, cheesy taste.
28:44Very, very umami that that you can
28:47again put on almost anything that
28:49contains 14 grams of protein per oz.
28:51Nuts and seeds 5 to 7 grams
28:53of protein per oz.
28:55So, and this is just a small sampling,
28:57really.
28:58There are quite a lot of plant based foods
29:00that contain more than enough protein,
29:03and it adds up quickly,
29:04so that's really that's that's.
29:06As long as you're eating a somewhat
29:08varied diet and not eating the same
29:11thing everyday in tiny quantities,
29:12usually protein is not a
29:14concern with a plant based diet.
29:17There are some other nutrients
29:19that that often you hear people
29:21expressed concern about as well.
29:23Iron.
29:24It is true that excuse me, heme iron,
29:27which is the type of iron found in meat,
29:30is more easily absorbed than non heme iron,
29:33which is the type that's found in plants.
29:36Unfortunately heme iron also
29:38it has proinflammatory effects,
29:39so going back to those effects on
29:42increasing risk of cardiovascular disease,
29:44disease and cancer problem and
29:46vegans can easily compensate.
29:48By eating a higher quantity of iron
29:50when it's in its non heme form,
29:52and this can be found in tofu,
29:55lentils, beans, nuts and seeds.
29:57Calcium is another concern.
29:58If I don't drink milk, I'm not getting.
30:01Calcium not true.
30:02Calcium is actually abundant in soy,
30:06lentils, beans, nuts, seeds,
30:08grains, leafy greens,
30:10and my personal favorite cruciferous
30:13vegetables, which includes broccoli,
30:15kale, cauliflower,
30:16arugula and Brussels sprouts.
30:19Omega-3 fatty acids.
30:21We typically think of fish when we
30:23think of a mega threes, but actually LA,
30:26which is a building block,
30:28is found in flaxseed,
30:30chia seeds, walnuts in soybeans,
30:32and you can take an algae oil
30:34supplement to get dij and EPA directly.
30:37Finally,
30:38I should mention that B12 is
30:40absent in strict vegan diet,
30:42so that must be supplemented and that
30:45can either be done through a multi
30:48vitamin or through a fortified foods.
30:50And is typically not difficult
30:54in today's environment.
30:56So alright,
30:57what about then effects on other people?
31:00Because I've taken you through
31:02the effects on animals,
31:03I've taken you through,
31:05hopefully debunking notions
31:06about evolutionary imperatives,
31:07and hopefully I've made a compelling
31:10argument about the health benefits of
31:12predominantly whole food plant based diet.
31:15But even if you don't find
31:17any of those things
31:18compelling, you know you don't have
31:21concerns about your own health.
31:23You know animals don't really just.
31:25You're not convinced by that.
31:28But you do care about other people
31:33and justice and the planet well.
31:36The the factory farming industry.
31:39The meat industry actually has a
31:42lot of really significant effects
31:44on other people and on the planet.
31:47So first I'd like to point out that
31:50consuming animal products leaves a
31:52very significant carbon footprint
31:54and I've taken this figure from The
31:58Economist which just illustrates
32:00the carbon footprint of the average
32:02American diet and notes that
32:05if vegetarian diet cuts it by.
32:08Let's say 40% and a 2/3 vegan diet,
32:10which they indicate here is going
32:12vegan for about 2/3 of your meal.
32:14So even if going all the way vegan
32:16is sounds like a stretch for you,
32:19which that is admittedly hard
32:20in our current food system.
32:22But even eating vegan most of
32:24the time or becoming vegetarian
32:26has it has an enormous impact.
32:29And you can see here even
32:31if you're not ready to,
32:33even if the environment is
32:35your number one concern,
32:36and you're not ready to be vegetarian,
32:39look,
32:39this is just a comparison of
32:41the different carbon footprints
32:43of eating different products,
32:45both animal based and plant base,
32:47and you can see the just absolutely
32:50profound carbon footprint of beef eating
32:52compared to really any other foods,
32:54including other meats.
32:56And that's from a number of factors from.
32:59Land use change to farming practices,
33:02you know.
33:03I,
33:03I think that most in less you been
33:06living under a Rock You you've
33:08heard about the accelerating
33:10deforestation in the Amazon.
33:12Basically,
33:13rainforests,
33:13like the Amazon are being burned to make
33:16way for more cattle ranching to satisfy
33:19the ever growing human appetite for beef.
33:22And so it's not again,
33:24not just affect on people through climate
33:26change and adverse planetary health,
33:28but also effects on biodiversity
33:30and other wildlife.
33:31So its effect is really
33:34quite far reaching profound.
33:36And you know a lot of times when
33:39you hear about climate change.
33:40It seems like an incredibly
33:42daunting problem where it's like,
33:44how can I personally make
33:45an effect make a change?
33:47That's going to have a significant effect,
33:49while the biggest thing that
33:50you can do is not have children,
33:53or have or have one fewer
33:54child than you wanted to have.
33:56'cause as you can see here,
33:58that's fewer humans that are
34:00consuming resources on this planet.
34:01But short of that,
34:02looking at some other options,
34:04eating a plant based diet
34:06actually has a huge impact.
34:07On your carbon footprint,
34:08it's it's close to double the impact of
34:11replacing a typical car with a hybrid,
34:12which is kind of a people think of that
34:15is a really big deal and a great step,
34:17and it is.
34:20But you can really have a huge
34:22impact again by transitioning
34:23to a plant based diet,
34:24even if even if not all the
34:26way like I showed you before.
34:28Even if it's just cutting beef
34:31that makes a huge difference.
34:33So what about other effects on
34:37others besides climate change?
34:39So the current meat industry
34:41has a lot of really problematic
34:44practices that go well beyond
34:46animal welfare and animal cruelty.
34:49It's been well documented as in this
34:52Atlantic article shown here and many
34:55others that the farm industry and
34:57factory farming have a longstanding
35:00issue of poor treatment of factory workers,
35:03who incidentally are disproportionately
35:05people of color and immigrants.
35:08It's been documented that they have high
35:11rates of injury and infection because
35:14just like animals that are packed
35:16and overcrowded in these factory farms,
35:19workers are packed and overcrowded
35:21in the production lines in these
35:24factories not given adequate
35:26time even for bathroom breaks,
35:28rushed injuries happen with
35:30cutting infection spread easily
35:31because even before the pandemic,
35:33people were in really close quarters
35:36with each other and it's it's.
35:39It's it's a real problem.
35:41Adding to these problems is that is
35:43the problem of antibiotic resistance,
35:46so it's common practice in the farm
35:48industry to feed farm animals.
35:51Low doses of antibiotics in order
35:53to both to prevent infection,
35:55because in those crowded living conditions
35:57that they live in in order to save
36:00money infection spread very easily.
36:02And it's also been shown that antibiotics
36:05can increase the rate of growth.
36:07It's thought that that's also due due
36:10to interactions with the gut microbiome,
36:12and altering the gut flora that.
36:15Promote that tend to have pro
36:17obesity effects.
36:18But unfortunately that just promotes
36:21the development of antibiotic
36:23resistant organisms that can then
36:25spread and make their way into
36:28the food chain and affect us and.
36:30Infectious disease specialists
36:32will tell you that antibiotic
36:34resistance is a major threat to us,
36:36and if we don't change our ways and practice,
36:40better stewardship of antibiotics,
36:42it's going to become a much bigger
36:45issue than than it already is.
36:47Also,
36:48I'm not going to spend a lot of
36:50time on this because everyone
36:52is sick of hearing about covid,
36:54but it does bear repeating that
36:56the practices of crowding animals
36:58very tightly together increases the
37:00risk of zoonotic pandemics and not
37:03just things like kovid that that
37:04have been potentially linked to
37:06wet market practices where animals
37:08are also crowded together.
37:09But we've also seen epidemics of
37:11bird flu and swine flu coming
37:13from poultry farms and pig farms,
37:15so this is again not just theoretical, it's.
37:18It's an actual issue that that
37:20affects other people very adversely.
37:25And finally, I'd like to address
37:27some some social justice arguments
37:29in favor of moving as a society.
37:32Tord more plant based nutrition.
37:36So we know and again this has been
37:38very well documented that insufficient
37:41education about access to and affordability
37:44of healthy foods disproportionately
37:46affects people of color and individuals
37:50of low socioeconomic status.
37:52For example, in this study
37:55that that's referenced below.
37:57And this is actually reviewed
37:59that quoted this study.
38:01I should say, looked at the distribution
38:03of food deserts in Baltimore.
38:05So food deserts are typically
38:07defined as areas where there is no
38:10grocery store nearby that with fresh
38:12produce only convenience stores were
38:14typically you can only access really
38:17processed foods that have low nutrient
38:20density and high caloric density.
38:23That they.
38:24This study found that there was
38:26high availability of healthy
38:28foods in 68% of predominantly
38:30white neighborhoods in Baltimore,
38:31but in only 19% of predominantly
38:33black neighborhoods.
38:34So this is just one example of too
38:37many to count of the structural racism
38:41that currently exists in our society.
38:44And we know that that nutritious food,
38:47or the lack thereof,
38:48is a major social determinant of health,
38:51and this explains many disparities in
38:54terms of both cardiovascular disease
38:57and cardiovascular risk factors.
38:59For those of you in the audience
39:01who are healthcare providers,
39:03I think what this really means
39:05is that we have a duty to counsel
39:08our patients accordingly,
39:09and it can seem very daunting
39:11because living in a system where
39:13you don't have access,
39:15it's it's hard to know how much
39:17impact our counseling will have.
39:19But at the very least,
39:21our counseling patients can at least
39:23start to overcome that education gap.
39:26However, that's not going to be enough,
39:28and society at large,
39:29I argue,
39:30has a duty to ensure better early education,
39:33because this needs to happen in childhood
39:35and it's it's not just going to be,
39:38you know,
39:38adult cardiologists like me
39:40talking to patients they should
39:41be getting education much earlier,
39:43because that's when those healthy
39:45behaviors should be starting.
39:47We need to ensure lifelong access
39:50to healthy plant based food and
39:52that that's going to mean more,
39:54more pointed and mindful public advocacy,
39:57including pushing back against
39:58the heavy lobbying currently from.
40:00The meat and dairy industry, for example.
40:04And you know a lot of times I hear.
40:07Well, what about personal responsibility?
40:09Personal responsibility is
40:10extremely important.
40:11I'm not arguing against
40:12personal responsibility at all.
40:14You know.
40:15Ultimately,
40:15it is up to us what we put in our mouths.
40:19But I think that we also have to
40:21understand that personal responsibility
40:23is predicated on resource equity,
40:25and it's it's really hard to call
40:27a poor diet a problem of personal
40:30responsibility in someone who does
40:32not have access to transportation.
40:34Or access to healthy food and
40:36has not been educated about the
40:38importance of healthy food.
40:39So that's really the responsibility
40:41of those of us who do have more
40:44power and privilege to overcome
40:45those systemic
40:46barriers to do to healthy eating.
40:50And in that vein, I would argue therefore,
40:53that nutrition equity really is a moral
40:56imperative from adjusted standpoint.
40:57And from the standpoint of a fair
41:01distribution of resources in in a
41:03society where structural racism
41:05continues to be a huge problem.
41:08Alright, So what is stopping us?
41:10I think many of us have heard talks about
41:14current problems in in the way our system
41:17is set up in the way society set up.
41:20We've all heard about problems and we
41:22haven't heard enough about solutions,
41:24so I'm certainly not proposing
41:26that I can fix this problem,
41:28but I do want to propose how we
41:31can think about this problem,
41:33how we can frame reframe this
41:36problem and how we can start to.
41:38Taking steps together to to
41:41address this problem.
41:42So I would argue that one of the
41:45things that keeps us from enacting
41:46change on a personal end of societal
41:49level is simply inertia and denial.
41:51People saying, well,
41:52you know what Doc I've been meaning
41:55eating meat all my life, and I'm healthy.
41:58That you know, again, anecdote is not data.
42:02Winston Churchill.
42:02It's well known that he smoked all his
42:06life and he lived to a ripe old age,
42:09but no one would argue that that
42:12means that smoking is not incredibly
42:14detrimental to lung health,
42:16to heart health,
42:17and and is incredibly dangerous from
42:20the standpoint of markedly increasing
42:22your risk of a large number of cancers.
42:25Just because people are healthy
42:27at the moment.
42:29The point in time in which
42:31are counseling them,
42:32but that doesn't mean that
42:33they don't have fatty streaks,
42:35and atherosclerotic plaques that
42:36are building up,
42:37and in fact if they eat a western diet,
42:40they probably do.
42:41And so I think it's important to
42:44to overcome that cognitive barrier.
42:46I think another cognitive barrier
42:47that that I encounter is just
42:49this idea of nihilism,
42:50which is or the sense that you know
42:53what it doesn't matter what I do,
42:55because it's not going to make a
42:57difference in the grand scheme of things.
42:59I'm just one person and that's
43:01fair in and of itself.
43:03But I think we have to keep in mind
43:05that society does not change unless
43:07individuals within society change.
43:09So if you're going to stick
43:10with this nihilistic point,
43:12then you also have to concede
43:13that voting doesn't matter,
43:15and I hope this last election has.
43:17Showing people that voting really
43:19really matters and it's and it doesn't.
43:22It's not so much that any one
43:24person's vote matters so much,
43:26but when enough people vote,
43:28it does make a difference.
43:30And So what I'm asking you to do
43:32is to vote with your wallet and to
43:35vote with your plate when it comes
43:38to making nutritional changes,
43:40cognitive dissonance,
43:40or the idea that people find it
43:43easier to when people's beliefs and
43:45their behaviors have a conflict.
43:47People are more likely to change
43:49their beliefs to suit their
43:51behaviors than the other way around.
43:53Or as I stated here,
43:55you know what I know.
43:57I'm a good person and I eat meat
44:00and therefore it can't be that bad.
44:02And you know, that's fair.
44:04I I get that and I think that for
44:06clinicians it's especially problematic
44:08because I think sometimes that can
44:10prevent us from counseling effectively.
44:12Because if in our heads we don't
44:15believe that we can change and we have.
44:18Such a degree of cognitive dissonance
44:20that it's not a problem I'm I'm
44:22concerned that that may prevent us
44:24from counseling patients effectively.
44:27And taking this even one step further,
44:29do we have a duty as those of us who
44:31are physicians or other clinicians,
44:34other health care workers?
44:35Do we have a dirt duty to serve
44:38as role models?
44:39And that's not to say that
44:41we have to be perfect, but,
44:43at least to undertake some movement.
44:45Tord eating,
44:46a healthier diet or having a
44:48healthier lifestyle in general?
44:49Such that, where,
44:50where,
44:50on the same page is our patients
44:52one where counseling them?
44:54We don't want to counsel people
44:56to do something that we ourselves
44:58aren't willing to do.
45:02So how can we do better at this?
45:06I'm going to suggest that we need a bit
45:09of a reframe in order to address this
45:12very real issue of cognitive dissonance.
45:15And first I would just say that
45:18I think we need to accept that
45:21imperfection is the human condition.
45:23I don't say that as an excuse
45:26to avoid accountability,
45:27but rather as a motivation to spur change.
45:33Discipline is not the
45:35same thing as masochism.
45:37So what do I mean by that?
45:39I think a lot of people think that eating
45:42a healthy diet is all about willpower,
45:45and willpower is going to be important
45:47sometimes, but willpower is not a strategy.
45:49A strategy is setting up an environment
45:51where the default is healthy eating
45:53and it's easier to do the right thing.
45:55Whether that's for yourself
45:57or for other people,
45:58so it's about setting yourself up
46:00for success and what that means is,
46:02you know, buying healthier food
46:04to keep it home so that you're
46:06not tempted by unhealthy food.
46:08Whether that's changing the food
46:09that served at our conferences,
46:11or at least the food that was served at
46:13our conferences before this pandemic.
46:18I think we need to reject this
46:20false dichotomy of healthy
46:21food versus delicious food.
46:22I hear this a lot from patients
46:24as well that you know the choices
46:26are you either eat healthy and
46:28it's boring, and it's bland,
46:29and it's rabbit food and doc.
46:31I don't want to do that or you know,
46:34I just really like food and and
46:36good food isn't good for you.
46:38And and I think nothing could be
46:40further from the truth I posted here.
46:42A picture of my my one of my
46:44favorite Thanksgiving dishes,
46:45which is a cashew cheese,
46:46stuffed butternut squash topped with.
46:48Walnuts and cranberries.
46:50It's absolutely delicious and some
46:52of my loved ones who may be in the
46:55audience have made this before.
46:57But suffice it to say that that
47:00you can have comfort food.
47:02You can have nourishing food.
47:05You can have delicious food that
47:07is also healthy food and so
47:10it's not about denying yourself.
47:12It's not about asceticism or masochism.
47:16And finally,
47:17I'd like to exhort everyone to embrace
47:19a model of incremental change and
47:22not making perfect the enemy of good.
47:25So what are the things that we can do
47:28to move toward this incremental change?
47:31Again implementing slow changes?
47:33So lots of people when they
47:36want to change their diet.
47:37It's going to be really hard for most people,
47:40my patients or otherwise friends
47:42colleagues to go from a standard
47:44omnivore Western diet to a fully
47:46whole food plant based diet.
47:48So there are slow steps that people can
47:51take to move toward a healthier diet.
47:53Meatless Monday,
47:54right?
47:54Just going vegetarian one day of the week,
47:57eating normal diet every other day,
47:59just trying it out.
48:00Dipping your toe in the water because
48:02it's too intimidating otherwise.
48:04Fine flexitarian eating a plant based
48:07diet when it's possible and practical
48:10and when it's not not Pasco vegetarian,
48:12so I think that's a diet
48:15that's quite easy to follow.
48:17That's basically a vegetarian
48:19diet that also allows for fish.
48:23And free hint is the term that
48:25I've heard more recently and that
48:27basically describes that's less
48:28of a health initiative and more
48:30of an environmental initiative.
48:32But the idea of not eating meat and
48:34less it's otherwise going to be thrown away.
48:37And because there's a carbon
48:39footprint involved in food waste,
48:40people who are freegan typically
48:42endorse a vegan lifestyle,
48:43except if food is going to be thrown out,
48:46so there's not one way to to
48:48make dietary changes,
48:49and these are just some ideas,
48:51but the point is, what?
48:53What works for one person won't
48:55work for another,
48:56and being creative and being on the
48:58same page can be really helpful.
49:00And again,
49:01don't make perfect the enemy of good.
49:03If it's too hard, try something easier.
49:06I think again,
49:06those of us that are clinicians
49:08and I do apologize for some degree
49:10of clinician bias,
49:11but I think that our obligations of
49:14clinical as clinicians are higher
49:15so that's why I do keep coming back
49:18to this. But I think that we really
49:20need to recommit ourselves to patient
49:21counseling to overcome the education gap,
49:23particularly in those groups
49:25that are at higher risk of of
49:27less education at an early age.
49:29I actually had an epiphany about
49:31this maybe a year and a half ago
49:33at the I think the one of the last
49:36conferences I went to before the.
49:38The pandemic hit.
49:40And you know it was just talk after talk.
49:43Just presenting such compelling data about
49:46the health benefits of a plant based diet.
49:48Ann and I realized I really had not been
49:51spending enough time counseling my patients.
49:54Not to say that I didn't
49:56counsel patients about diet,
49:57but it wasn't always a priority.
49:59I know, doc.
50:00Mercurio has mentioned this at at
50:02Pryor talks and you know he and I
50:04are working on a project looking
50:06at time allocation in physician
50:08workflow because I think one of the
50:10main barriers to this is insufficient
50:12time because counseling does take
50:13time and I think allocating more
50:16physician time for counseling is
50:17going to be crucial in this effort.
50:19But I also think we need to realize that
50:22it's not going to be just physicians,
50:24it has to be a whole team.
50:27It has to be nurses and aips and
50:29dietitians and to that end I've
50:31actually been working with teams.
50:33At Yale,
50:34both on the inpatient side and the
50:37outpatient side about setting up plant
50:40based nutrition programs here such
50:42that we can provide patients both with
50:45better education and and with with
50:49better options about about healthier.
50:52Healthier eating options
50:54on an inpatient level.
50:56I think that all of us,
50:58to the extent that we are able
51:00need to commit to a greater degree
51:03of nutrition advocacy in order
51:04to increase the availability and
51:06the affordability of plant based
51:09Whole Foods for all communities,
51:11particularly those that historically
51:12have less access to healthy food.
51:14And I think we'll need to look to the
51:17field of behavioral economics to figure
51:19out how to do this most effectively.
51:23Behavioral economics basically relies on an.
51:25Tweaking a system potentially by by
51:27moving things to a different default
51:29state such that you're more likely
51:31to achieve the desired outcome by
51:34lowering the activation energy to the
51:36desired outcome and increasing the
51:38barriers to the less desirable outcomes.
51:40That's this is not about controlling people.
51:42This is not about Big Brother.
51:45This is, you know,
51:46no one.
51:47AOC is not coming to take away your
51:50hamburger that you know there's plenty of
51:53political rhetoric that loves to make this.
51:56Really a lot more outrageous than it is,
51:59but it's simply,
52:00you know,
52:00whether this is going to be subsidies
52:03for healthier food and communities that
52:05don't have access to it or or taxing
52:07unhealthy food as unpopular as that has been,
52:10is there a better way to do that?
52:13Some economists have suggested carbon taxing,
52:15not just food,
52:16but all products,
52:17arguing that the market really
52:19doesn't recognize the carbon costs
52:21and therefore really isn't
52:22operating as a true market should.
52:24And that carbon footprint costs should be.
52:26Should be factored into all market pricing.
52:29I'm not an economist so you know,
52:31I think that that we should partner
52:33with with others in different fields.
52:36And you know, for those of you who know
52:39politicians you know we should be talking
52:41to our politicians about this too,
52:43because this needs to be
52:46a priority for everybody.
52:48I think finally we do need to realize
52:50that there's going to be an ethical
52:52gradient of personal responsibility
52:54that's commensurate with our personal
52:56resources and with our circumstances.
52:58So you know,
52:59either eating a plant based diet yourself,
53:01or advocating for change in the
53:03system may or may not be possible,
53:05depending on a number of different factors.
53:07So you know there are people with medical
53:10issues who aren't able to eat this diet.
53:13People with food allergies or GI conditions
53:15for whom it's simply not possible.
53:18And there are people with
53:20financial limitations.
53:21It's not reasonable.
53:22Like I said before,
53:24to expect somebody who does not
53:26have access to easy transportation
53:28and who lives miles away from a
53:30grocery store with fresh produce.
53:33It's it's not reasonable to
53:35expect that person to take as much
53:38action as it is to you, know,
53:40expect certainly someone like me,
53:42or like many of the people
53:44on this conference.
53:46And so, again, I would argue that.
53:48The more privilege you have,
53:51the more you're obligated to make
53:53an effort to move the needle,
53:56and to that end,
53:58I'm going to close this with.
54:01With a sort of task to everyone listening
54:04that I would like to challenge everyone.
54:07To make one small inward change
54:09and one small outward change based
54:12on this information tonight.
54:13And it can be based on whichever
54:16argument you find the most compelling,
54:18but making one small change in your
54:21personal practices to move toward a
54:23more plant based nutritional approach
54:25and one change small change outwardly.
54:28Whether that's counseling a
54:29patient more extensively,
54:30whether that's talking to your neighbor,
54:33who's a local politician,
54:34you know whether that's starting
54:36an initiative where you work.
54:38To have healthier food in your break room,
54:41something but you know,
54:43again,
54:43where we're only going to start moving
54:46the needle as a society when we all
54:49start moving our individual needles.
54:51And with that I'm just going to leave
54:54you this with this diagram showing
54:56the value of incremental change
54:59and basically the idea is that you
55:01know if we if we expect to make
55:04a two abrupt changes too quickly.
55:06All of these tasks are going to
55:08seem really daunting,
55:10but if we accept that small
55:12incremental changes overtime add up,
55:14I really do believe that overtime we
55:16will make progress toward a healthier
55:18and more just form of nutrition in our.
55:21Profession in our country.
55:22Thank you.
55:26Sarah, this was superb.
55:29This talk is strikes me as the answer
55:31to the question what happens when
55:33you get someone who is an excellent
55:35teacher and a cardiologist and a
55:37bioethicist and has expertise in
55:38nutrition and you find one person
55:40like that and get her to give you
55:43an hour and a half of her time.
55:45This is obviously a very well prepared,
55:47very compelling arguments.
55:50And there was a lot of interesting
55:52questions that I want to get to,
55:53but but I had some of my own,
55:56but I'm going to get to the others first.
55:58It strikes me that.
56:01And I wonder if you would comment on this.
56:02I will. I will make one comment.
56:04I think that.
56:05So often when we make these
56:06when arguments are made as well
56:08as yours have been presented,
56:09that what we do in medicine,
56:11what we do is human beings in general.
56:13I do think it's related to your
56:15point about cognitive dissonance
56:16is we have a fear of the data.
56:18If the data suggests that our
56:19current practice is not the
56:21right thing to do what we do.
56:22Even within medicine,
56:23I mean I know this with an ethics.
56:25When I say here's all the data
56:26that show that we should treat
56:28these this particular class of
56:29patients differently than we do.
56:31People with this diagnosis
56:32different than we do often.
56:33The solution is I don't want
56:34to hear those data.
56:36Just keep quiet about that.
56:38That we fear the date and so
56:41part of this is just facing it,
56:43just facing facing this fact.
56:45What I've not heard when I've
56:47heard people talk about this is
56:48anyone say that the issues related
56:50to the carbon footprint from beef
56:52consumption are not true or anyone
56:55suggest that these animals don't
56:57have the pathways to feel pain.
57:00So that that that the arguments are
57:02compelling and the data are compelling,
57:04but you know it gets to a comment by.
57:06I wish I remember the exact quote.
57:09Of course when we talk about the
57:11moral status of animals and well,
57:13some people say, well,
57:14animals count less than humans and
57:17therefore one makes the leap that
57:19therefore they don't count at all.
57:21And you know it was.
57:23I think it was Jeremy Bentham,
57:24right, who said the question is not,
57:26you know, kind of thing.
57:28Or can it reason?
57:29But can it suffer?
57:30And there's no question that these
57:32animals can suffer.
57:33What's interesting to me is that you
57:35have pointed out that, by the way,
57:37in addition, they can also think and reason.
57:39Many of them can,
57:40and that's been shown,
57:41of course,
57:42so many different ways in so
57:43many different species,
57:44including some of the farm animals.
57:46You rightly point out our hypocrisy
57:48when we criticize those who eat dogs
57:51as we line up for our pork chops.
57:53We just have to, you know.
57:54Again,
57:55we might want to face it,
57:56but we have to face that there's a
57:58strong analogy here and that that our
58:00approach this may indeed be be hypocritical,
58:02but but I want to get to
58:04some of these questions.
58:05Sarah,
58:05because there there's some of them
58:07are really very insightful and they
58:09range that they have a wide range.
58:11So I want to get to 1.
58:14That was one of the later
58:16questions which I thought was
58:18was very good and very practical,
58:19so this is terrific and
58:21I'm closer than before.
58:22I assume I'm closer than before
58:24going to a plant based diet.
58:26My questions number one.
58:27This reminds me of the whole thing about
58:30physicians smoking and then we stop smoking.
58:32It became better role models and then
58:34we got the hospital to do the same
58:37smoking not allowed in the hospital.
58:39How can we move the hospital system
58:41to presenting the whole food plant
58:43based diet in cafeterias?
58:44And for patient meals,
58:46that was one question is,
58:47can we and should we?
58:48How do we move the hospital?
58:50I mean not the hospitals all over the world.
58:53How about our hospital to start with?
58:55And there's a second question
58:56of laziness which was.
58:58Has anyone looked at Speaking
58:59of health at the salt content
59:01of whole food plant based diet?
59:03So how do we change the hospital system?
59:05And can you talk briefly to
59:06the question of salt content?
59:10So thank you. First of all,
59:12thank you so much for your very
59:14kind words and also thank you
59:16for this fabulous question,
59:18because it's a really important
59:19one and you know one of the other
59:22epiphanies I had about this,
59:24maybe even before the epiphany I had
59:26at this nutrition conference was
59:28when I was rounding on the inpatient
59:31cardiology service and I realized that,
59:33you know, these these patients after
59:35having heart attacks the next morning.
59:37There's there's a sausage and.
59:39Bacon or on their tray, Anan.
59:41It's just you know,
59:42it's infuriating because it's like,
59:44well, why don't we just give them
59:46a cigarette and tell him to go take
59:49a smoke break outside and and you
59:51can say Oh well, it's not the same.
59:53I think it's actually quite similar,
59:55and I do think you're the smoking is
59:58also a really. It's a really good analogy.
01:00:01But you know,
01:00:01Doctor Smoke until we until we didn't,
01:00:03and you know you can go to a lot of
01:00:06cardiology dinners and it's not whole
01:00:08food plant based for the most part
01:00:10that you're seeing on the plates.
01:00:12And I think we need.
01:00:13We need to change,
01:00:14you know ourselves and I'm not
01:00:16saying we need to be perfect,
01:00:18but we need to at least start
01:00:20working on doing better if we
01:00:23expect other people to do that.
01:00:25There have been programs that have
01:00:27implemented whole food plant based menus.
01:00:30I actually think one person I think
01:00:33doctor Michelle Mcmaken is on this
01:00:35webinar tonight and she's at NYU.
01:00:37You and she has done that.
01:00:40She's a role model it.
01:00:42In that way Dr Rob Ostfeld
01:00:44Montefiore has done that.
01:00:46He's another role model of mine and.
01:00:50He's he's actually counseled me on some
01:00:53tips and some of my colleagues as well.
01:00:57And I'm on a group actually on a
01:01:00committee that's working on bringing
01:01:02a whole food plant based menu option,
01:01:05two to the inpatient nutrition
01:01:07services at Yale, and Justin Charles,
01:01:10who's a resident,
01:01:11has been absolutely critical in this
01:01:14effort in terms of mobilizing us.
01:01:16So we absolutely have an obligation to do it.
01:01:20It's.
01:01:20It's unacceptable, actually that I and again,
01:01:22I'm not saying that we need to
01:01:24force people to eat plants.
01:01:26We're not.
01:01:26We're not talking about forcing people,
01:01:28but we need to make the
01:01:29default option healthy.
01:01:30And then patients can opt out of it.
01:01:32So the default diet after you
01:01:33get admitted with a heart attack.
01:01:35At least let's start with that,
01:01:37not even talking about other things.
01:01:38But the default diet after you get
01:01:40admitted hard with a heart attack
01:01:42should be a whole food plant based diet.
01:01:44Now we shouldn't be springing that
01:01:45on patients. It's not fair for you.
01:01:47Know the food service worker coming
01:01:48in with the tray to be the first
01:01:51one who's breaking into the patient.
01:01:52And the patients like what is this like?
01:01:55I don't want this.
01:01:56No,
01:01:56that needs to be the medical team
01:01:58that meaning you
01:01:59know, the attending the resident,
01:02:00the nurse everyone has has has a duty
01:02:03here and again I think largely and you
01:02:05and I have talked about this a lot.
01:02:07I think there's so much time pressure
01:02:09in the way that modern medicine is
01:02:11practiced that we just feel that
01:02:13we can't counsel adequately to a
01:02:14certain extent that's very true.
01:02:16But on the other hand,
01:02:17it doesn't take that long to at
01:02:19least start the conversation.
01:02:21We don't have to finish it,
01:02:22we have to plant the seed.
01:02:24And it does not take that long
01:02:26to plant the seed,
01:02:28and so having a short conversation,
01:02:29changing the default such that and again
01:02:31start start with like the low hanging fruit.
01:02:34Start with the Post heart attack.
01:02:36There's no reason why you know there that
01:02:38should be the default and their needs,
01:02:40and it needs to trigger conversation
01:02:42an that should be part of the
01:02:44cardiovascular care that's given
01:02:45at Yale New Haven Hospital,
01:02:47because that that's how we know.
01:02:49That's how we promote heart health.
01:02:51And it's not
01:02:52just admitting, or Sir, or just admitting.
01:02:54Did me saying things to people that we
01:02:57don't think they necessarily want to hear.
01:02:59I mean, I mean, I can recall years
01:03:00ago when I was telling a new mother
01:03:03that that breast feeding was actually
01:03:04healthier for her premature baby,
01:03:06her milk was better for premature baby
01:03:08than the formulas that that you know,
01:03:10one of the more traditional nurse is
01:03:12telling me that this is really bad.
01:03:14'cause you're going to make her feel guilty
01:03:16if she then doesn't doesn't provide milk.
01:03:18And this is before we had
01:03:20donor milk available etc.
01:03:21But even still the notion is so there.
01:03:23Therefore, should I not tell her?
01:03:25I mean, the notion is,
01:03:27you know this may be something that
01:03:28some people don't want to hear,
01:03:30but fact is it's valuable information
01:03:31and so that that we we should tell him,
01:03:33even if they don't want to hear,
01:03:35just like if we see somebody
01:03:36who's overweight,
01:03:37even if we recognize that it's unlikely
01:03:38they're going to be able to lose that weight,
01:03:40it's unlikely that change the lifestyle that
01:03:42doesn't absolve us of the responsibility,
01:03:44I think,
01:03:44to make it clear that by the way,
01:03:46this would include your health
01:03:47in a positive direction if you
01:03:49were able to make this change,
01:03:50or that change,
01:03:51and I think I think that there's
01:03:52an analogy there with that too,
01:03:54that that we have kind of responsibility
01:03:55to tell people things.
01:03:57Sometimes they don't want
01:03:58to hear, and I think that's absolutely true,
01:04:01and I will also add that I'm very mindful
01:04:03of that and I try to be very explicit
01:04:06when I'm counseling to also say look,
01:04:09you know this is this is not just I'm,
01:04:12you know, with smoking as well.
01:04:14This isn't a moral failing,
01:04:16you know this this is not
01:04:18this is granted societally.
01:04:19I think that that we are morally failing,
01:04:22but this is not on one individual
01:04:24person who's doing it wrong.
01:04:26We live in.
01:04:27In a system that really promotes
01:04:28unhealthy eating and unjust eating,
01:04:30as I've argued,
01:04:31and so I tried to make it very clear
01:04:33that that I'm on the same team as
01:04:36the patient and that you know this
01:04:38is an uphill battle in many ways,
01:04:40and that we live in a system that does
01:04:42not promote making the right choices,
01:04:44and that we need to make the best
01:04:46choices we can within that system.
01:04:48And we do that by by small steps.
01:04:50So I'm very sensitive to the guilt issue
01:04:53and I try to make it very clear when I'm
01:04:55counseling that again we're the same team.
01:04:58This is not me, lecturing you.
01:05:00It is hard and you know,
01:05:02so I think that's important just
01:05:04quickly to answer the second question
01:05:05about salt content for a plant based diet,
01:05:08whole food plant based diet
01:05:10has very low sodium content,
01:05:11so processed plant based
01:05:12foods can be high in sodium,
01:05:14so a lot of times the question I get is like,
01:05:18well, what about those?
01:05:19Like you know,
01:05:20meatless burgers like an impossible whopper?
01:05:22Or that that really would not fall under the
01:05:25rubric of true whole food plant based diet.
01:05:27However,
01:05:28you know it's still an impossible whoppers.
01:05:30Probably still better than
01:05:31than a real beef whopper.
01:05:33From a nutritional standpoint,
01:05:34Albiet somewhat marginally.
01:05:36But it's certainly a lot better
01:05:37from an animal welfare standpoint.
01:05:39From a carbon footprint standpoint,
01:05:41it is going to be high in sodium,
01:05:44but you know again in terms of not
01:05:47making perfect the enemy of good.
01:05:49For some people moving toward a
01:05:50plant based diet is going to mean
01:05:53searching for alternatives as they
01:05:54make that transition because they're
01:05:56not just going to start eating quinoa
01:05:59bowls and avocado on sprouted toast.
01:06:01As delicious as that is.
01:06:03You know,
01:06:03and and so I think we need to
01:06:05be creative and use all the
01:06:07available tools we have.
01:06:09Sarah
01:06:09best beautiful. Now I'm going to go.
01:06:11We got a lot of people coming,
01:06:13chiming in with questions here on the train.
01:06:15Get to some through and some of them.
01:06:17Some of these you could give a whole
01:06:19hour lecture on if you're not careful,
01:06:21but but there's some of these are
01:06:23really interesting and very basic,
01:06:25practical and some are more philosophical.
01:06:26But let me get a little bit deeper here to
01:06:28witness both philosophical and practical.
01:06:30Very sympathetic to your arguments,
01:06:32against an animal based diet,
01:06:33particularly environmental
01:06:34and animal based arguments.
01:06:35One challenge to animal rights
01:06:36based arguments is differentiating
01:06:38between the moral weight of
01:06:39animals and humans with similar.
01:06:40Or lesser capacity to those animals, right?
01:06:44A singer others assigned moral
01:06:46weight to animals based on their
01:06:48capacity to experience pain,
01:06:50suffering, pleasure,
01:06:50happiness,
01:06:51another morally relevant capacities.
01:06:52How do you assign moral weight to
01:06:56account or pig?
01:06:58To hold power pig based on their
01:07:00various cognitive and social capacities
01:07:02without denying equal or hopefully
01:07:05greater to this speakers mind.
01:07:07Hopefully greater moral weight to humans
01:07:09who permanently lack those capacities.
01:07:13Yeah, that's that's a great question.
01:07:16So you know, I, I think that there's
01:07:19there's something to be said.
01:07:21I think a lot of people would argue.
01:07:24Certainly the disability rights community,
01:07:26and but but I,
01:07:27I think most people tacitly agree with this,
01:07:30even if they don't explicitly argue it,
01:07:33that that humans by very nature of being
01:07:36humans, by by nature of being people,
01:07:39have intrinsic value, or they have,
01:07:41you know, they're they're of infinite worth.
01:07:43They are ends in themselves.
01:07:45You know, using the content
01:07:47categorical imperative?
01:07:48Or any number of other frameworks
01:07:49that you want to use to argue that
01:07:52and being disabled doesn't take
01:07:53that away like you're born human,
01:07:55and that that that is part
01:07:56of the human condition,
01:07:58much like being imperfect is
01:07:59part of the human condition,
01:08:00so so is that intrinsic value.
01:08:02You're an end in yourself,
01:08:03you're human and you have satisfied that,
01:08:05and I think you know what I'm
01:08:07arguing about is not not.
01:08:09I'm not trying to take away
01:08:10moral weight from anybody.
01:08:11I'm trying to add moral weight too.
01:08:13I'm trying to widen the net,
01:08:15not narrow it,
01:08:16so I'm also not suggesting,
01:08:17as
01:08:18I understand it,
01:08:18'cause this to get to get to that question.
01:08:21Is you're not suggesting, for example,
01:08:24a pig who has, you know,
01:08:26significant cognitive abilities,
01:08:27and there are severely disabled
01:08:29humans who have lesser cognitive
01:08:31abilities than that pig.
01:08:32You're you're suggesting that simply
01:08:34by virtue of species identification,
01:08:36the human nevertheless retains
01:08:38a higher moral status by your
01:08:40calculus than the pig would?
01:08:43Yes I would, but but that's not to say I,
01:08:47I think that's almost.
01:08:49I understand that the theoretical concern,
01:08:51but I I don't exactly see how
01:08:54that how that bears out in this.
01:08:56I could see how that could
01:08:59be expanded in other ways,
01:09:00but I really don't think treating
01:09:03this as sort of a 0 sum game
01:09:06where giving more moral weight to
01:09:08some is going to therefore take
01:09:10moral weight away from others.
01:09:12I think that. That we have to.
01:09:15We have to agree that that humans
01:09:17have a moral weight that is
01:09:20distinct because of our species.
01:09:22Our ability to reason our abilities
01:09:24that do really exceed other species,
01:09:27however, that we that doesn't mean
01:09:29that we can't grant some degree of
01:09:32moral weight or dignity or autonomy,
01:09:34I think, is the wrong word,
01:09:36but it's it's sort of almost along
01:09:39that spectrum to other animals,
01:09:41and I think you can almost apply like.
01:09:44A sliding scale, just like you can.
01:09:49A plot like I talked about a
01:09:51sliding scale or an ethical gradient
01:09:53of moral responsibility.
01:09:55I think there's almost a gradient
01:09:57of weight accorded to animals
01:09:58based on their ability to suffer.
01:10:01And based on their intelligence
01:10:02or ability to form relationships,
01:10:04and I think that that can be argued,
01:10:06and I think that reasonable people
01:10:08could could disagree on that point.
01:10:10But the only point that I that I
01:10:12would strongly stand by is the
01:10:14point that it's that moral weight
01:10:16isn't a 0 sum game that you know,
01:10:18I'm not arguing that by extending moral
01:10:21weight to other animals that in any
01:10:23way that should take it away from any humans.
01:10:25And I don't.
01:10:26I don't think it needs to.
01:10:28I don't think it has two and.
01:10:31I actually think that that it
01:10:34will that treating animals with
01:10:36compassion will make us as humans more
01:10:39compassionate toward each other as well.
01:10:42Compassion begets compassion,
01:10:43gotcha. OK, next question Doctor Hall,
01:10:46one of the most important questions
01:10:47on this subject that you think
01:10:49haven't been satisfactory answered.
01:10:51Asked another way.
01:10:52Are there any studies that you'd
01:10:54like to see done that you don't
01:10:56think have yet been conducted?
01:10:57So you've presented us with a lot of great
01:11:00information to back up your arguments,
01:11:02but is there are some important
01:11:04studies that are missing that you
01:11:06think really needs to be done?
01:11:10Well, that's the way it is.
01:11:11Is the question about studies
01:11:13about health or studies about?
01:11:14Well, I think that you
01:11:15you you made the argument based
01:11:17on health based on kindness to
01:11:18animals based on environmental
01:11:20impact based even on social justice.
01:11:22So I would say I would.
01:11:23I would open up and say in any of those
01:11:26areas and it puts you on the spot.
01:11:28'cause I think you so there's
01:11:30good data in all those already.
01:11:31But what's the study that
01:11:33that's taken to be done?
01:11:35So I mean it's I have some degree
01:11:38of bias here because I find the data
01:11:41compelling in all of those domains,
01:11:44but I think right now what I'd really
01:11:46like to see is more data on on how
01:11:49we can make systemic change with
01:11:52buy in from different stakeholders.
01:11:54So you know, I'd like to see actually
01:11:57more more studies on efforts to bring
01:12:00healthy whole food plant based nutrition to
01:12:03communities that don't have access to it.
01:12:06I'd like to see it studied how
01:12:07we can do that effectively.
01:12:09You know, from an education standpoint
01:12:11and from an access standpoint,
01:12:12I'd like to see sort of more
01:12:14practical on the ground studies of
01:12:16how we can actually implement this,
01:12:18because I think we have enough
01:12:20data to know that we need to act.
01:12:22I think how exactly we act,
01:12:24I've presented some broad
01:12:25strokes suggestions,
01:12:26but I'd love to see more data.
01:12:28You know,
01:12:28in terms of how we can act in
01:12:30a maximally effective way,
01:12:32I think that's brilliant.
01:12:33I mean, I think that,
01:12:35for example, if someone said.
01:12:36We could spend money on figuring
01:12:38out whether smoking is bad for you,
01:12:39or we could spend that same money
01:12:41on figuring how to get people.
01:12:42Make it easier for people to stop smoking,
01:12:44or more likely to stop smoking.
01:12:46I say, well,
01:12:46save the nickel in the first one.
01:12:48Let's talk about what we can actually
01:12:49do to help people change behavior.
01:12:51So here's a question for you, my friend.
01:12:54Arguments or even strategies
01:12:56among those you have outlined,
01:12:57do you think will resonate most strongly
01:12:59with the public and have the greatest
01:13:02traction in getting us to change?
01:13:03Our feeding behaviors?
01:13:04Will government restrictions and regulations
01:13:06be necessary all that scary business?
01:13:08No giant sodas in NYC and such.
01:13:10Do you think the government's
01:13:12going to get involved in place
01:13:14restrictions on us to get this done?
01:13:17Do I think the government is
01:13:19going to need to get involved?
01:13:21Absolutely. Do I think that
01:13:23we need to place restrictions?
01:13:24No, I am not about restrictions,
01:13:26but I am about leveling the playing
01:13:29field because we don't have a leveling
01:13:31level playing field right now.
01:13:33So again, and I think that's part of the
01:13:36problem of a lot of the political rhetoric.
01:13:38Now is this idea that when we're
01:13:40actually just trying to change
01:13:42make behavioral economics changes
01:13:43and change defaults that somehow
01:13:45gets marketed as restrictions?
01:13:47And when in fact that's not the case,
01:13:50so no one saying you can't, you know?
01:13:52Well, let's leave the soda thing out of it,
01:13:55because that that ended up being a debackle,
01:13:58but I'm not suggesting banning,
01:14:00so I'm suggesting.
01:14:02Pricing things that are actually
01:14:04more reflective of the health
01:14:06costs of the environmental costs
01:14:08and just of the production costs
01:14:10because the you know the meat there.
01:14:13There are a lot of subsidies
01:14:15that are currently given to some
01:14:17industries and not to others.
01:14:19And you know.
01:14:20And in terms of the way food
01:14:23is taxed or not taxed,
01:14:24what are ways that we can change the
01:14:27pricing schemes of food and then also
01:14:30the distribution of food such that.
01:14:32It can be allocated in a more just way.
01:14:35That's where I'm I'm not.
01:14:37I'm not saying restriction,
01:14:38I'm not saying you can't sell
01:14:40this stuff here,
01:14:41but I'm saying how can we ensure
01:14:43that in these food deserts
01:14:44that grocery stores are open?
01:14:46Are there are there in monetary
01:14:48incentives that you can give franchisers
01:14:50to open up a grocery store in an
01:14:53underserved area and sell this food?
01:14:56You subsidize it that way.
01:14:57What are ways that we can make
01:14:59this food cheaper in other areas?
01:15:01How can we change the default
01:15:03choices so I don't?
01:15:04I don't want restrictions,
01:15:06but I do think that we need to
01:15:08change the way make it the path
01:15:10of least resistance to eat the
01:15:12healthiest food rather than currently.
01:15:14As it stands,
01:15:15it's the path typically of most resistance,
01:15:17and I think that's how it needs to change.
01:15:20I don't think again,
01:15:22to paraphrase what we heard on
01:15:24Fox News with the Green New Deal.
01:15:26Alexandria Ocasio Cortez is not
01:15:28coming to take away your hamburgers
01:15:30like if you want a hamburger
01:15:32you can have a hamburger.
01:15:33However,
01:15:33understand that you know maybe under
01:15:35a more just scheme the price of the
01:15:37hamburger will be a little higher
01:15:39because maybe the beast industry
01:15:41isn't getting Subs subsidies.
01:15:42Maybe they're not allowed to
01:15:44practice these inhumane practices
01:15:45in their factory farms and in on
01:15:47the factory line where workers
01:15:49are being mistreated in crowded.
01:15:50You know we have to have much
01:15:52higher standards there that in and
01:15:54of itself having higher standards
01:15:56for factory farms and factories.
01:15:58Farm factory workers.
01:15:59That's going to raise prices because
01:16:01the price is currently that that
01:16:03are are charged are artificially
01:16:04low because of really cruel
01:16:06and inhumane practices.
01:16:07Tord Animals and Tord people,
01:16:09and so already if you just
01:16:11change that and nothing else,
01:16:12prices are probably going to go up
01:16:14and then combine that with subsidies
01:16:16and financial incentives to provide
01:16:18healthier food in food deserts already,
01:16:20that that that in and of
01:16:22itself makes a huge change.
01:16:24And and that just seems to
01:16:26me like it's common sense,
01:16:28and that that really shouldn't be.
01:16:30A controversial point, but again,
01:16:31realizing that I have a bias
01:16:33if not a conflict of interest,
01:16:35it's my confluence of interests that,
01:16:37you know, I I find all of
01:16:39these reasons very compelling,
01:16:40and I think you know it's it's well past
01:16:43time to make these changes alright?
01:16:45Well, here's
01:16:45a suggestion from someone that maybe
01:16:47will get us to change our behavior.
01:16:50Do you think images of animal slaughter,
01:16:53similar to cancer pictures on
01:16:55cigarette cartoons would be effective
01:16:57in altering consumer habits?
01:17:00I do and I will say that as someone
01:17:03for whom that's been effective.
01:17:07You know, I've I've had a sort of slow
01:17:09progress tored a more plant based diet.
01:17:12As I've gotten older and you know we were
01:17:14talking about this a little bit before,
01:17:16but you know, I I when I was in
01:17:19middle school I had that that dog pig
01:17:21epiphany and I was like wait a minute
01:17:24like this is this is not OK I was,
01:17:26you know totally in love with my with
01:17:29my Westie and I just one day is like I
01:17:31can't eat other mammals and so I just
01:17:34stopped eating mammals and because I
01:17:36that was where the connection was made.
01:17:38And I actually I had thought about
01:17:41not eating poultry for a long time,
01:17:43but I sort of didn't stop really,
01:17:46mostly not to inconvenience other
01:17:48people and not to be, you know,
01:17:50the quote difficult.
01:17:51And I actually saw some some pictures
01:17:54of poultry and and it was just one
01:17:57picture in particular an it just.
01:17:59It was heartbreaking.
01:18:00I was like that's it, I'm out.
01:18:02And then I became PESCO vegetarian and it
01:18:05was only recently that I've moved toward.
01:18:08Predominantly vegan or vegan at
01:18:10home and an otherwise vegetarian
01:18:11and experience so so that to get
01:18:13to the questions directly.
01:18:14Though because those pictures you
01:18:16know in in the consumer spaces are
01:18:18very very start so you think when
01:18:20someone goes to buy a couple of pounds
01:18:23of ground beef that on the back of
01:18:25the package or the front of the
01:18:27package there should be a picture of
01:18:29a cow in the slaughterhouse. Sorry I
01:18:31didn't I misunderstood the question
01:18:32I thought you meant just more in
01:18:35general are those pictures compelling?
01:18:36Like in the pictures
01:18:37are certainly compelling, but they're
01:18:39talking about the cancer pictures.
01:18:40On cigarette carton, so I think
01:18:43the analogy would be slaughter
01:18:45pictures or be King pictures
01:18:47on meat packaging.
01:18:48I mean you know that that stuff do.
01:18:51I think that that would be affective.
01:18:54Absolutely do I think that that
01:18:57would be incredibly polarizing
01:18:58Ann and might ultimately.
01:19:02Hurt the movement more than help it.
01:19:05I don't know. I don't know.
01:19:06I mean, I think that's a great idea.
01:19:10But I I think I, you know, I almost
01:19:14wonder in our hyper polarized environment.
01:19:16What kind of backlash
01:19:18that might create and I?
01:19:20I can't help but think I'd I'd rather I'd
01:19:24rather use more carrots and fewer sticks.
01:19:27And in that sense, but you know honestly,
01:19:30I need to think about that.
01:19:31I don't know. I think that.
01:19:34I think it would be effective, but is that?
01:19:39I just don't know.
01:19:40I'd love to see data on that.
01:19:43Now you got the study.
01:19:44Now you have
01:19:45this study. OK,
01:19:46let's go to another question.
01:19:48Do you have any thoughts on
01:19:50regenerative agriculture?
01:19:52Oh mean meaning. Cell based
01:19:56meat is that you know, I'm not
01:19:57sure if that's what they mean,
01:19:58but I'm gonna I'm going to
01:20:00assume that's what's meant. Here.
01:20:02Because I think this mean that term also,
01:20:05you know to some brings to mind
01:20:08you know top cell regeneration.
01:20:11Water cycling and such,
01:20:12but but I think that the the the
01:20:15the cell based meat, the plant,
01:20:17you know that these laboratory based
01:20:19meat etc that that Bill Gates has
01:20:22recently been talking to us about even
01:20:24the laboratory based yogurts right?
01:20:27I think that's that's the area
01:20:28perhaps that the question and I don't
01:20:31mean to try and reach someone else,
01:20:33am I think that's
01:20:34perhaps what they're referring to?
01:20:35OK, I mean, I, I think that sort of
01:20:38similar to the plant based meat there.
01:20:40There's some, certainly it
01:20:41helps with some of the issues.
01:20:43So in terms of animal welfare and excuse me,
01:20:46climate change, I think it
01:20:47definitely makes a huge difference.
01:20:49And if that's going to be a
01:20:51necessary stepping stone,
01:20:52and I do think that we're going
01:20:53to be multi pronged approach
01:20:55because some people are just not
01:20:57going to be willing to give it up.
01:20:59I think that's a great idea, but again,
01:21:02going back to a health standpoint,
01:21:04putting on my cardiologist hat,
01:21:05taking off the animal lover hat,
01:21:07you know that's really going to be.
01:21:09If it truly is lab based,
01:21:11you know regenerated cell based meat.
01:21:13Presumably it will be nutritionally
01:21:15equivalent to eating meat from a cow,
01:21:17and so you know if you if you
01:21:19don't care about your health
01:21:21and you're like you know a doc.
01:21:23I hear you, but I'm healthy, I'm good.
01:21:26I mean, I want to keep eating meat,
01:21:28but I'm very concerned about
01:21:30animals on the planet.
01:21:31You know,
01:21:32for someone for whom those are
01:21:33more compelling priorities,
01:21:34I think cell based or lab based meat
01:21:36is going to be helpful alternative.
01:21:39And again,
01:21:39I I think realizing that we're
01:21:42going to have to sort of.
01:21:44Attack this on multiple fronts.
01:21:45I think that's a fantastic idea.
01:21:47Something I'm going to, you know.
01:21:49I have no intention of eating
01:21:51plant based meat,
01:21:52but that doesn't mean that
01:21:54other people people shouldn't.
01:21:55It's just that that's not
01:21:57appealing to me at all gotcha.
01:21:59OK, so here's a question
01:22:00for a cardiologist as well,
01:22:02perhaps is there a way to promote plant
01:22:05based plant based diets in a way that
01:22:07is congruent with health at every size?
01:22:10Another fat liberation movements that
01:22:11seek to separate weight and health.
01:22:14I mean, I, I think that again,
01:22:16as a cardiologist, I think the the.
01:22:20An effort to to to play down body shaming
01:22:22I think is a very worthwhile effort.
01:22:24On the other hand, I think is a cardiologist.
01:22:27Perhaps you might want to tell us that
01:22:28we can't completely separate size and
01:22:30health or weight and health that these are
01:22:32not totally distinct concepts as well,
01:22:34but but the question wants to know,
01:22:36is there a way to do this to promote the
01:22:38plant based diet in a way that's congruent
01:22:40with the health at every size movement?
01:22:43Yeah, so you know, I think your comments.
01:22:46Actually, you're you summed it up perfectly.
01:22:50Which is to say that I don't think that
01:22:52you can fairly completely D couple
01:22:56weight and cardiovascular health.
01:22:58I just think that the the
01:23:00data would not support that.
01:23:02However, you know that that's there
01:23:05other things that are more directly
01:23:07correlated with cardiovascular
01:23:09disease specific risk factors,
01:23:11although many of those risk factors.
01:23:13Are also correlated with obesity,
01:23:15but I think that we really that being said,
01:23:19you know what?
01:23:20While I don't think that we should
01:23:22be disingenuous and sort of actively
01:23:25state that that we see no correlation,
01:23:28where in fact there is a correlation.
01:23:30But certainly I don't think that should
01:23:33be the focus of healthy eating programs,
01:23:36whether it's plant based or otherwise,
01:23:38where you know the the primary concern
01:23:40should not be weight so much as other
01:23:43metabolic indices that actually.
01:23:45Are better correlated.
01:23:46So what do I mean by those metabolic indices?
01:23:49Waist circumference,
01:23:50which again does correlate with weight.
01:23:52But we know that that central
01:23:54obesity or central adiposity?
01:23:56Those fat cells that deposit on our organs,
01:23:58also called visceral fat.
01:24:00That's a lot more metabolically active.
01:24:02And subcutaneous fat and so measuring
01:24:04someone's waist circumference may actually
01:24:06give you a lot more information than
01:24:09than just putting them on the scale.
01:24:11But even that is if that's going
01:24:13to be too difficult.
01:24:15You know, let's look at blood pressure.
01:24:17Let's look at hemoglobin A1C,
01:24:19which is a measure of long-term
01:24:20blood glucose control that's used
01:24:22to measure people with diabetes and
01:24:24pre diabetes and how well they're
01:24:25doing on their regiments.
01:24:27Let's look at cholesterol panels
01:24:28like there are lots of metabolic
01:24:30indices that that we can look at.
01:24:32We can look at CR P,
01:24:34which is a measure of of inflammation.
01:24:36So so I I I don't think again,
01:24:38I think this is not exclusive to
01:24:40plant based we we shouldn't be
01:24:42in the business of shaming.
01:24:43And again, it sort of goes toward the.
01:24:46Let's I want us to focus on
01:24:48carrots more than sticks.
01:24:49I want this to be as inclusive as possible.
01:24:52I think that you know we need to
01:24:54realize that there are some people
01:24:55who are going to find the health
01:24:57arguments compelling but not the others.
01:24:59Some that are going to find the animal
01:25:02arguments compelling but not the others.
01:25:04The climate arguments compelling we
01:25:05I wanted inclusive movement that's
01:25:07not about 0 sum.
01:25:08You know, if you're not with us,
01:25:10you're against note like that there.
01:25:11There's something in plant based
01:25:13nutrition for for most if not everyone.
01:25:15And so I I.
01:25:16I don't think that you know a myopic
01:25:18focus on weight is is helpful
01:25:20or necessary without explicitly
01:25:22decoupling the link between
01:25:24weight and cardiovascular disease,
01:25:26because I do think that's disingenuous.
01:25:30You know, so there's a whole bunch
01:25:32more questions, and our time is up.
01:25:34There was tremendous influence.
01:25:35Obviously tremendous interest in the talking.
01:25:37The talk stimulated a lot of great
01:25:39questions and conversations which will
01:25:41hopefully carry forward to beyond tonight.
01:25:43Doctor Who I want to thank you
01:25:45for a tremendous presentation.
01:25:46I want to apologize to those who
01:25:49ask questions that I didn't get to,
01:25:51but I've promised you all
01:25:52the hard stop at 6:30,
01:25:54which is about to happen any second now.
01:25:56It's 629, so I am going to stop it here.
01:26:00I'm going to thank you and
01:26:01thank you all for attending.
01:26:03We look forward to seeing you at our
01:26:05next program when in a couple weeks
01:26:08and you can check our schedule on
01:26:10the on the website and Doctor Hall.
01:26:12Wonderful talk.
01:26:13Thank you so much.
01:26:14Thank you and thank you everyone for coming.
01:26:17Good I thought.