Hey everyone, welcome to a sneak peek. Ask me, anything or am a episode of the drive podcast? I'm your host Peter attea. At the end of this short episode. I'll explain how you can access the AMA episodes in full along with a ton of other membership benefits. We've created or you can learn more now by going to Peter Atia, m.com.
R / subscribe. So without further delay, here's today's sneak peek of the ask me. Anything episode. Welcome to ask me anything episode number 36. I'm once again, joined by Nick Stenson. In today's episode, we talk about all things, fruits and vegetables, we compiled. Some of you may recall, a list of questions around this subject that came through the website, through social media and directly through the users.
And we've tried to
This podcast around the themes of those questions because we literally received thousands of questions conversation basically goes as follows. We look at the idea of fruits and vegetables being uniform which, of course they're not. So we talked about how they're similar, and how
they're different in terms of many features of their nutritional value. We think about specifically, the fiber, sugar, and other nutrient content of fruits and vegetables
is ways to assess their relative value. We comment on the difference between eating them or
drinking them and how processing fruits and vegetables can
Change their properties talk about nafld and type 2 diabetes. And ask the question of whether or not those specific
diseases, require a different nutrition strategy when it comes to fruits and vegetables, we can get into some of the science around the good and the bad of phytochemicals. Which we get asked a lot about talk about organic versus non-organic handling of food and if different preparation strategies can affect the nutrient value fruits and vegetables. We round out the discussion by talking about supplementing fruits and vegetables through things like multivitamins are green powder so if you're not a subscriber
You'll only be able to listen to a sneak peek version of this episode, but you can learn more about our subscription via the website. One last thing to note is that, based on the timing of, when we recorded this, we weren't able to do it via video. So this will be an audio only episode. Although the show notes will be very helpful because that includes a number of charts and
Graphics that we use in the episode.
So, without further delay, I hope you enjoy. Am a number 36. Welcome to another Ama.
Hey, how you doing?
I'm doing well, we just spent the last 15 minutes talking about why season 4 of drive to survive was not good. So I wish we could continue on that discussion, but I don't think anybody wants to hear us talk about Formula One anymore. Yeah, it will be interesting to see. I mean, on the positive front, we picked a topic for today that your second most excited about in terms of right after Formula 1, which is nutrition and in particular, fruits and vegetables. So I'm sure the excitement we had in our little intro on Formula One.
Will be carried over to this one. What do you think? I think it's hilarious that most people listening to this, don't appreciate the sarcasm in your comment, that might be true. This one's not via video, so they can't see you smirking and smiling over there. So, they might think we're being dead serious. This is polar opposite discussion, all things Formula, One, all things, fruits, and vegetables. I think just to completely show my hands to the audience. This is not a topic. I'm particularly interested in diving into, but this
This is as close to taking one for the team as I've ever done in my life. The only reason we're having this discussion is because of you, you meaning, not you, Nick, you the listeners, the subscribers have asked so many questions on this topic, that I simply can't avoid this any longer if we're going to be true to our principles of trying to answer questions, people have, we have to do this. I spent a little bit of time in therapy, trying to understand why I don't want to talk.
About this. And that's only slightly an exaggeration. I think here's what it comes down to. I think everybody kind of has this narrative that fruits and vegetables are like, quote, unquote, good, fruits, and vegetables are good. Everybody should either fruits and vegetables, have your five to six servings a day. It's all really good. Good, good, good, good. Okay. But the reality is, we don't really know that much. It's true on average and certainly all of the epidemiology would suggest that that is correct. People who eat more fruits and vegetables are healthier than people who don't
Aunt and as you'll see, as we get into this discussion, I think there's plenty of evidence to suggest that that's the case. But if you really get into the details of this stuff, I think there's far less that's known than is represented as true. And I actually think that's a broader concept that applies to nutrition in general, which also speaks to. Why of all the chapters I'm struggling with in, trying to wrap up in my book, The Nutrition chapter
Doctor is the one that is hands-down posing. The greatest difficulty. It's not because I don't have anything to say it's because there's less to say, definitively than I would have said ten years ago or five years ago and Beyond a couple of really obvious things too much. Food is bad too, little food is bad too. Little protein is bad. Certain micronutrients are essential certain things or
Toxic the obvious things like avoid E coli in your food, it starts to go from really clear absolute knowledge, to probable knowledge very quickly quicker than it does with sleep with exercise and even with Pharmaceuticals and yet it's the one area where I think people speak about things in more absolute terms than they do in anything else outside of, maybe their religion and their politics. Why do you think that is? I mean, I know you've spent a
The time, thinking about this and looking at it. And my immediate thought goes to the podcast, we did with David Allison and David talked about how if you worked on a pancreas and you're at a dinner party, it's hard to talk about that because unless someone else works on the pancreas they're not going to know the details but with nutrition. It's everyone eats every day. It's in their face every day. You know what works for you first? Question would be why do you think that is? The second question is, is it because people are trying to speak in absolutes
Because what works for them? Might genuinely work for them, but it's not guaranteed to be widespread across a variety of people. I think what you said, if David came up with that example, I don't remember that about the pancreas, that's really funny, but I think there's an absolute truth to that rich. Is we all have expertise in nutrition. Albeit, not necessarily scientific not necessarily broadly applicable, not necessarily nuanced, but there is no one on this planet, who doesn't have expertise.
Of some sort with this thing because we all do it every single day. Not everybody exercises every day. Most of us aren't conscious when we sleep but we're conscious and we make deliberate choices when we eat every single day. And so, yeah, I think we generally have a sense of this works for me. This doesn't work for me, I think there's also a very significant cultural and social component to this thing as well, so I think that's where the tribalism comes from around nutrition. I think, on the flip side, it's
It's very difficult to acquire reliable knowledge in this space. And I think there are some really good scientists working on the mechanistic side of nutrition. There's people who are really under very tightly controlled conditions elucidating, some of the most interesting knowledge, with respect to energy balance, with respect to appetite with respect to fuel, partitioning food, reward, all of these things. I think these things are very interesting.
The problem is, they're nearly impossible to do this type of work. In large, sample sizes, over long durations and you need large sample, sizes, and long durations to infer hard outcomes that we care about which are prevalence of disease, or incidence of disease, and ultimately mortality. And so therefore to get insights on those topics, you have to rely almost without exception on epidemiology.
That's not entirely true. There are some reasonably well done, large clinical trials, but they require thousands of people and many many years and that means your interventions had better. Be very, very simple if you're going to achieve compliance over that period of time. So all of this is to say nutrition is very hard. And when we rely on epidemiology, we're struggling to necessarily get it right in areas.
Is where the hazard ratios end up being quite small. I won't get into all that now, because we talked about that so much, but when you get Hazard ratios, like, 1.19, it's very difficult to know that you've captured and removed. All of the biases that fed into that the work that the people you were talking about what they're doing. Do you think in the short term will be able to have more concrete answers? Or is this one thing where you think just given all the limitations. It might be a
little
Long time before we have a lot of concrete really solid Insight on this. There's certain people like to have on the podcast and at least at the time of this recording, I haven't had them on yet. Although I think we will. I mean, Kevin Hall, I think, is really doing some super interesting work and I know Kevin. Well, right, I've known Kevin for over 10 years and I've worked very closely with him in a previous project and I think Kevin is I think one of the most thoughtful people on the subject of energy balance and I think that's the type of work that can be
be studied over shorter periods of time. I mean those are areas where you can get answers to questions in months you don't need years to get answers, you can get them in months now. Maybe you'll get different answers in two years, but but you're getting pretty interesting answers in months. And you don't need thousands of people. You can actually do these in tens of people provided you're using very precise instrumentation people like Kevin, Rudy libel Erik Robinson. I have somewhat of a bias because I've worked with them and I know them and I think they're
Good thinkers. They're able to answer those types of questions, but they can't answer the questions that we're about to talk about today. They can't answer the questions that are still vexing. Me like are omega-6 polyunsaturated fats, inherently healthy or harmful. This is a very vexing question and I'm sitting here trying to write about it in a book and I don't know what to say because I've seen pretty compelling evidence for example, looking at the unpublished
Ali unpublished data from the Minnesota, coronary experiment that completed in 1973. Didn't get published in its first rendition, till 1989 and then wasn't re-examine and republished until I don't know. Something like 2013. If you look at those data, you could make a very compelling case that omega-6 polyunsaturated fats, as substituted for saturated fats, could actually be viewed as harmful. But then you look at a whole bunch of other data. And you think no any harm associated with those fats is purely do.
To the confounders of what they track with the seed oils that show up in low quality foods and junk Foods, it's not the seed oil. That's the problem. It's the junk food, that's the problem. So, that's just another example of I think questions that have profound importance. I'm not really clear at this point. If I have a sense of what the answers are, I mean, we could skip answering these questions and just do a, what grinds, my gears episode with Peter Atia for the next hour?
If that would be more entertaining for people on that train of thought, just to give people a background. What we did is we receive a lot of questions on nutrition fruits and vegetables. So we compile them and then a few months ago it feels like you went to Twitter and Instagram and also said, hey, we're thinking about doing a podcast on this. What questions do you have? And there's just hundreds, and hundreds and hundreds of questions that came through, which kind of made us realize. Okay, there's interest here and we should probably try and work through these. So
We're going to do is we're going to go through these questions, but do you want to set the tone a little bit? Which is one, we're not going to give clear-cut guidelines on what people should and shouldn't eat. It is variable depending on your metabolic Health diet, what you're already eating but the hope is the information. We give you here, you'll be able to apply it to your life to help you understand this subject veteran ultimately have better nutrition.
Or that means for you. Yeah, I think there's another point that I would add to that which is and this is true of nutrition in general. Don't confuse the optimal diet for you in a state of health versus the optimal diet for you. In a state of sickness that's trying to restore your health. They aren't necessarily the same thing. So I'll use just one example because it's germane to our topic when we work with patients who are metabolically healthy.
I've never once restricted, the amount of fruit they consume when I work with a patient who has Type 2 diabetes and non-alcoholic fatty liver disease, I will actually restrict how much fruit they consume. I'm not going to say, they shouldn't have any fruit, but if that's a person who's eating for Bananas a Day and watermelons and apples and pears, and peaches, I am going to say, actually, we're gonna have a better chance, improving your metabolic.
Health. If we at least temporarily reduce the volume of that significantly reduce the burden of fructose on your liver because fructose and ethanol are at least to my reading of the literature pretty uniquely poised to make a sick liver sicker. So again, does that mean that that person is going to always be restricting fruit? No, not necessarily does that mean, it's the only way to do it? No, you could probably just completely
restrict other calories and not restrict fruit as much, and you might achieve the same benefits but empirically, it seems easier. In those people to reduce friction dose intake and to do. So through fruits, there's multiple different ways to think about this, but I think it is important for people to not extrapolate from the hill that they're sitting on to the hill that anyone else is sitting on. How I eat today to preserve. My health is probably different from, not probably it's unquestionably.
From how I was eating 15 years ago when I was in the process of trying to improve my health from a place that was actually below where it is today. Keep all of that in mind. Yeah, I think that's really good and just for everyone listening. Do you mind just giving that quick definition of metabolic Health again, just so everyone is on the same page of what that is and what you mean by that? Yeah, I mean, I think there's a lot of different ways you can Define it. It's sort of like BMI can be used to define overweight and obesity and
That's the way we do it, it's not really great. I think body composition would be a better way to do it. Similarly, I think the quickest and easiest and dirtiest way to define metabolic health is probably to use the criteria for metabolic syndrome. So metabolic syndrome is basically defined in a somewhat binary fashion which is you have three or more of the five criteria or you don't those five criteria are, truncal obesity, high blood pressure, high fasting glucose.
Hi fasting, triglycerides and low HDL cholesterol and we'll list in the show notes exactly what the criteria are. They differ slightly between men and women. We don't look at that in our patients truthfully because we're not trying to make assessments at a population-based level. So we're looking at many more factors beyond those things looking at Oral glucose tolerance. Test looking at uric acid levels homocysteine levels, looking at the entire lipid
Profile and then looking at functional testing. So looking at how the mitochondria perform in a Zone to test, so how much lactate is a person producing it rest? And then how much lactate do they produce under increasing amounts of workload? And all of those things than factor into our assessment of metabolic Health, that sounds good and it kind of fits well into the first question that we were going to tackle here, which is someone reached out and said, fruit seem to exist on a spectrum. Many are high in sugar and our calorically dense.
Ends. Could you help break down the glycemic content of common fruits and how this matters in determining best choices for different diets? Tables. I know this could vary person to person in terms of determining the quote-unquote best choice but I think just even breaking down how to think about the sugar content, the various nutrients in fruits. How'd you do that with the patient?
Thank you for listening to today's sneak peek. Am a episode of the drive?
If you're interested in hearing the complete version of this, am a you'll want to become a member. We created the membership program to bring you more in-depth, exclusive content without relying on paid ads. Membership benefits are many and Beyond the complete episodes of the AMA. Each month, they include the following ridiculously comprehensive podcast show notes. That detail every topic paper person, and thing we discuss on each episode of the drive, access to our private podcast. Feed the qualities, which are
For short podcast, typically less than five minutes released every Tuesday through Friday, which highlight the best questions topics and tactics discussed on previous episodes of the drive. This, particularly important. For those of you who haven't heard all of the back episodes, becomes a great way to go back and filter and decide which ones you want to listen to in detail really steep. Discount codes for products I use and believe in, but for which I don't get paid to endorse and benefits that we continue to add over time if you want to learn more about
Or in access. These member only benefits head over to Peter Atia em. D.com forward, slash subscribe. Lastly, if you're already a member, but you're hearing this, it means you haven't downloaded Our member only podcast feed where you can get the full access to the AMA and you don't have to listen to this. You can download that at Peter. Atia em, d.com. /Members. You can find me on Twitter, Instagram and Facebook all with the ID Peter, Atia, MD, you can also leave us a review on apple pie
Cast or whatever podcast player you listen on this podcast is for General informational purposes only and does not constitute the practice of medicine nursing or other professional health care services including the giving of a medical advice. No, doctor-patient relationship is formed, the use of this information and the materials link to this podcast is at the user's own risk. The content on this podcast is not intended to be a substitute for professional medical advice, diagnosis or treatment.
Others should not disregard or delay in obtaining, medical advice from any medical condition they have, and they should seek the assistance of their Healthcare Professionals. For any such conditions. Finally, I take conflicts of interest, very seriously for all of my disclosures and the companies I invest in or advise, please visit Peter. Atia MD.com forward slash about where I keep an up-to-date and active list of such companies.
