Vegan vs. Omnivore: The Debate (Breakdown of Kahn & Kresser)

Vegan vs. Omnivore: The Debate (Breakdown of Kahn & Kresser)

July 26, 2019 100 By William Morgan


This is a chronological breakdown of the Joe
Rogan Experience #1175 – with Dr. Joel Kahn
and Chris Kresser, debating on whether a whole
foods based vegan diet or a whole foods based
omnivore diet is better.  I’ll lay out
their arguments and add a little commentary
where relevant. At the end I’ll briefly
talk about what I think each side could have
done better. First here’s a list of the
topics we’ll look at:
The discussion starts with introductions.
Dr. Joel Kahn MD is a holistic cardiologist
and 42 year vegan.Chris Kresser has a Masters
in Science and is the co-director of the California
Center for Functional Medicine. He was once
a vegan, but switched to a whole foods omnivore
diet.
Around the 6 minute mark, they jump into discussing
the problems with using epidemiology to make
conclusions about nutrition.
“Epidemiology, observational studies, are
studies that look at a certain group of people…
say we take a group and we look and see how
much saturated fat are they eating – we separate
them into, y’know, low consumption, medium
consumption, high consumption… we might
then look 20 years later and see how many
people had heart attacks and died…”
The criticisms mentioned were that
・Epidemiology assumes that there is one
diet for everyone. ・It reduces everything
down to components without looking at the
whole picture. For example if a study is looking
at the effects of high fat diets, it wouldn’t
differentiate between a high fat dominoes
pizza and snickers bar diet and a carefully
formed whole foods diet that is packed with
coconut oil and avocados.
Dr. Kahn does say that epidemiology studies
are at least useful for testing hypotheses.
 “You can test a hypothesis … what happens
if … our data, may be crappy, but it’s still
data and it allows you to go further with
100,000 people, 50,000 people, 500,000 people”
Kresser then goes on to explain three more
problems with epidemiology:
“I think there’s huge problems with epidemiology.”
・The data are only as good as the tool used
to collect them. The tool very commonly used
for epidemiology studies is a questionnaire,
which is not reliable simply because people
are not good at precisely remembering what
they ate. An example of this problem is the
recent study on low carb diets which relied
on a questionnaire like this one asking participants
things like “How many of these foods did
you eat per month over the past year?” My
hat is off to you if you can remember your
precise monthly consumption of bananas, broccoli
and chicken for all of last year.
The second point is the healthy user bias
which says that people who are likely to do
a vegetarian diet, which is thought to be
healthy, are also likely to do several other
things that are thought to be healthy like
not smoke or get plenty of exercise.
“Well, red meat has been perceived as unhealthy
for a long time. In those observational studies,
the people who eat more red meat are also
smoking more, they’re eating less fewer fruits
and vegetables… they have higher body mass
index, they’re less physically active. So
how do you know that it’s the red meat…
that’s causing the problem and not those other
things? You don’t.”
The third point is that the relative risks
in nutrition derived from epidemiology research
are so low that they are indistinguishable
from chance.
“So, in fields outside of nutrition and
epidemiology, nobody would consider an increase
in risk less than %100 – a doubling, to be
really worth paying attention to. The observational
studies that Joel was referring to that confirmed
that cigarette smoking led to lung cancer…
that showed between a 1000 and 3000 percent
increase in lung cancer in smokers. Okay?
The IARC, the WHO report that suggested that
processed red meat is a carcinogen – that
was 18 percent increase”
“Lot of respect and agreement, but if we throw
epidemiology out-“
“I’m not suggesting that by the way.”
“I know I know, if we throw epidemiology away,
we’ve thrown away about 80% of nutrition knowledge,
because that is the most common kind of study.
And that still leaves us with basic science,
it leaves us with randomized clinical trials
which are very hard in nutrition, and they’re
very expensive. And it finally leaves us with
studying old healthy people – centenarian
studies.”
Around the 34 minute mark, the conversation
shifts to meat. Kresser mentions that the
proposed mechanisms thought to be behind processed
meat causing cancer are N-nitroso compounds,
heme iron, TMAO and Neu5GC and heterocyclic
amines formed from cooking. He then points
out that context is very important: For example,
eating a hot dog is very different from eating
a hotdog with Kale.
vegetables reduce levels of N-nitroso compounds
and heme iron, and cruciferous vegetables
reduce heterocyclic amines. Neu5Gc wasn’t
addressed but TMAO is discussed later in the
debate.
Kahn agrees that if people eat meat it should
be with vegetables.
“Next time you eat meat, get a salad, next
time you eat meat, order broccoli. Next time
you have bacon, get a, y’know, sliced tomatoes.
You will actually improve your health.”
“they took healthy volunteers, they took them
down to the hospital cafeteria and they fed
them a hospital burger, and they were measuring
on their arm how their arteries functioned.
Artery function goes down in 3 hours when
you eat a hospital burger. They took the same
group a week later, they had them eat the
same burger with a big salad. They didn’t
see that finding.”
After this, from about the 40 minute mark
and for the next hour and twenty minutes,
they had a meandering discussion on whether
saturated fat causes heart disease. Dr. Kahn
illustrates his position on saturated fat
with five points, starting with some history:
“…Ancel Keys suggested dietary fat might
be a factor – it was a hypothesis, it was
early stage epidemiology, doesn’t prove anything.
He went out and did studies, other people
did studies and the idea transitioned, the
focus went on saturated fat in food which
is basically chicken, red meat, pizza and
subsequently enough data accumulated that
guidelines started to suggest – we have this
huge problem with heart disease, we should
limit saturated fat in the diet. And that
has now promulgated into 21 international
statements, whether it’s the World Health
Organization, American Heart Association,
American College of Cardiology – Institute
of medicine says eat as little saturated fat
as possible – they couldn’t be more clear,
and these are high brow.”
“Okay but why did they come to the conclusion
that saturated fat-“
Then he explains that this is because
・Basic science shows that when you eat foods
rich in saturated fat – which is called: “meat,
cheese, eggs and such”, receptors on your
liver for cholesterol goes down. This prevents
the cholesterol from getting into the liver
so the cholesterol floats around in the blood
stream.
“That’s the basic biochemistry. Then they
had epidemiology studies, flawed, perfect,
it doesn’t matter, there were so many of
them.” “Then they did controlled trials – Clarke
1997, 395 – it’s called metabolic studies
– change the diet, see what happens. You add
saturated fat, cholesterol skyrockets – on
average, not in a single person. Then there
were many epidemiology studies that seemed
to support this point.
・Then there was a 1997 paper on 395 metabolic
ward experiments that showed that saturated
fat increases cholesterol on average – not
in a single person. …It’s our microbiome…
it’s our genetics – it would rise.”
“And then finally, finally, they looked at
populations that live over 100 – these are
called the pillars of longevity – they don’t
eat foods rich in saturated fat. They eat
a lot of olive oil in Italy and Greece – they
eat almost no dietary fat in Okinawa Japan
and they have the greatest longevity in the
world in 1970 – they eat almost no dietary
fat, about 6 – 7%”
In response, Kresser says “First of all,
everything we eat has all the fats in it…
Does it make sense that you could eat mackeral
and you know the polyunsaturated fats in it
are good for you but the saturated fat in
it is bad for you?“ “… and in fact, two
tablespoons of olive oil has more saturated
fat than a 7 oz pork chop.” Actually this
isn’t quite right as a 7oz pork chop will
give you 7g of saturated fat vs. 4g from two
tablespoons of olive oil, but if Kresser had
compared by calories, Olive Oil would give
you more a little bit more saturated fat.
Also, let me comment on this idea that they
eat almost no dietary fat in Okinawa Japan.
In Okinawan restaurants in Tokyo and Okinawa,
most of the dishes you see are …pork. Pork
belly, pork ribs, pig innard soup, pig ears,
pig feet and so on. And if you go to the Okinawa
prefectural website and click on “food culture,”
it says that “Ryukyu cuisine begins with
pork and ends with pork.” Historically,
the pig population of Okinawa was very high,
reaching 110,000 pigs – that is 1 pig for
every 6 people before World War 2. Tragically,
the devastation of the war cut the Okinawan
population almost in half and destroyed most
of their food supply. The pork population
was cut down almost 90% to just 14,000. You
may have heard that the Okinawan has nearly
70% of calories coming from purple sweet potato
and just 3% from saturated fat. But the survey
that found this was conducted in 1949, when
people were still struggling to avoid starvation
in the aftermath of the war. However, just
14 years after the war, the Okinawan pig population
surpassed its previous high reaching 142,000
in 1960.
Moving on, around the 45 minute mark, Kresser
references this paper by Zoe Harcombe that
reviews meta-analyses of randomized controlled
trials before 1983, and says “No randomised
controlled trial had tested government dietary
fat recommendations before their introduction,”
it concludes that reducing blood cholesterol
“did not result in significant differences
in CHD or all-cause mortality.” Randomized
controlled trials and their meta-analyses
are widely regarded as a very strong piece
of evidence, especially in comparison to epidemiology
studies. Meaning dietary recommendations to
limit saturated fat were introduced without
proper evidence for them.
So how did they stay on this topic for the
next hour? Well there were a couple reasons:
Kresser early on pointed out that we should
be focused not on whether saturated fat increases
cholesterol, but on whether saturated fat
actually directly increases heart disease
or all cause mortality. “The other problem
is they were using cholesterol as a proxy
marker – they weren’t looking at did people
eat saturated fat and die more, they looked
at did saturated fat increase cholesterol?”
However, Kresser at times was questioning
whether saturated fat increases cholesterol
on average. This muddled his argument about
looking at end points, and the data seems
to be on Kahn’s side here- “You add saturated
fat, cholesterol skyrockets on average, not
in a single person.” as Chris Masterjohn points
out in his own analysis of this debate:
“Kresser was mistaken to say that saturated
fat on average does not raise cholesterol
levels. What you see on the screen is data
from the LA veterans administration hospital
study. This is reflecting the main difference,
which is the difference between saturated
fat on the top and polyunsaturated fat on
the bottom and over the course of 1, 2, 3,
4, 5, 6, 7 years, right up until the study
was terminated, although the cholesterol levels
changed over time, this big gap between the
two diets remained.”
Also, throughout this section, Kresser brings
up several meta analyses of randomized controlled
trials in favor of low carb diets, which are
expected to be higher in saturated fat, “there
have been several metaanalyses now that have
looked at low carb diets and all of these
meta analyses have found that low carb diets
are superior for glycemic control, for reducing
insulin, for reducing triglycerides without
increasing cardiovascular risk markers – so
now we’re talking about randomized controlled
trials which is the best form of evidence
that we have and we’re not seeing any harm
from increased consumption of saturated fat.”
In response to this it would have been a good
idea for Kahn to just point out that it would
be too time consuming for them to sit down
and analyze these studies and move on. But,
when asked to address or explain what is wrong
with these studies Kresser has brought up,
Kahn dodged the question several times over
a period of about 50 minutes and Joe Rogan
had to keep bringing the question back up.
“Why are you dismissing this new evidence?”
“What is your response though to all these
studies that he was citing?”
“These new studies that he’s showing, and
we can go over them again, but you didn’t
address why- you did?”
“get kids healthy-”
“Please, please, what is wrong with what he
said?”
“What’s your take on what he said though?”
“Well I don’t care honestly what he said,
I’ve got to go with the best science in the
world because I deal with patients who have
serious disease…”
“I think we should move on, but-”
“No we definitely shouldn’t because we’re
not- we’re not really clearing this up. What
is he saying that’s wrong?”
“Okay, the biochemistry that saturated fat
in your diet will lower the number of LDL
receptors on your liver and your blood cholesterol
goes up. Then you get to epidemiology-“
“Okay but do you understand that he’s, he’s
saying something totally different. You’re
citing epidemiology studies-”
“Well I started with Biochemistry, then I
went to epidemiology-”
“I want to know what’s wrong with what he
said…”
“Because he’s not being broad with the science.”
“Okay but what’s these studies that he’s talking
about.”
“They’re pixel mentalities. Picking one…”
“I’m trying to boil this down – so what is
your take on that? Without any references
to the past and people who lived in Mongolia
that lived longer…”
“These are three disruptive randomized trials
from 2010 on that questioned the relationship-”
“No, those are different trials, Joel. I’m
not referring to Krause’s research or Chaudhry’s.”
“What is wrong with what he’s saying?
“It takes a heretical conspiracy attitude
to say everybody’s got it wrong for 60 years.
21 international societies have it wrong – they
could…”
“So he’s saying that the current science is
showing that there is no negative consequence
of saturated fat.”
“That’s BS. That’s BS.”
“So what is wrong with these studies that
he’s citing?”
“I don’t know, I have not read every article
in the world, nor has Chris. There are three
famous studies that I’ve read. Seri Torino
Chaudhry and DeSuza, those have been dissected,
those are generally-”
“Those were not the ones that I cited anyways.”
Joe Rogan’s constant challenging of Kahn
to address this question may be why some commenters
felt Rogan was biased in the debate. But,
the same thing happened when Kresser made
a mistake. He was wrong about the dietary
guidelines having changed their position on
total fat intake in 2010, and Rogan challenged
Kresser multiple times to get this point addressed.
“Is that a mistake, Chris?”
“It’s right here…”
“Can we find it because these seems like a
major point of dispute.”
“Lemme, can I stop you because I really think
we should clarify that.”
“So what was it that you remembered from 2010
and did you remember it erroneously?”
“Umm. Let’s see here.”
“Did you find out if you made an error on
this 2010 requirement from the USDA?”
“So, I don’t have the full guidelines in front
of me and I’m not sure what the language says
so I could have made an error, it’s possible.”
Finally moving on, at the 1 hour 58 minute
mark they discuss the point that saturated
fat combined with sugar is particularly bad.
In the context of a super low carb high fat
ketogenic diet, dietary fat will actually
decrease blood levels of saturated fatty acids.
On the other hand, refined carbohydrates will
increase them “You eat a lot of sugar, you
activate another aging pathway called p-KRas.”
Kahn also argues that meat inherently accelerates
the aging process due to its effects on MTOR
and IGF-1, and he cites this paper by Morgan
Levine that shows that high animal protein
intake increases cancer, overall mortality
and IGF-1 in people. Interestingly, the paper
mentions that specifically, low protein may
be beneficial if you’re between the ages
of 45 and 65, but if you’re over 65, low
protein can be detrimental.
In any case, Dr. Kahn says that the methionine
in animal protein is what stimulates aging
via the mTOR pathway, but as Chris Masterjohn
points out in his breakdown video
“Methionine is an amino acid and you can divide
it into two components. One is there’s a basic
skeleton of that amino acid and on top of
that, there’s what we call a methyl group.
That methyl group is what supports an entire
system in the body called methylation that
is important to all kinds of mental and physical
health.”
for methionine to stimulate mTOR it needs
to donate a methyl group. So if you have too
much methionine, you’d have too many methyl
groups and you could accelerate aging. But,
we have an amino acid called glycine that
acts as a buffer for too many methyl groups.
So if you’re getting methionine from muscle
meat, it’s not an issue if you’re eating
other glycine rich parts of the animal like
connective tissue and skin, or drinking bone
broth.
The other worry about meat is homocysteine,
homocysteine is well known for its apparent
contribution to heart disease.
So, once methionine donates that methyl group,
it becomes homocysteine. But, In order to
get rid of the homocysteine, you need all
the B vitamins. And… animal foods are quite
high in B vitamins.
Shifting topics, around the 2 hour 29 minute
mark, Dr. Kahn brings up TMAO: “TMAO. If you
eat red meat which is rich in L-Carnitine,
another amino acid, if you eat eggs that’s
rich in choline, those directly led your liver
to create TMAO. What does TMAO do? It stuns
your HDL so it doesn’t reverse cholesterol
transport, it causes LDL to enter the cell
wall to create foam cells, macrophages, plaque
and you get a heart attack.”
“Actually Joel, what in the diet increases
TMAO orders of magnitude more-
“-fish! Because fish has it right in there
fish flesh along with that mercury and their
PCB’s and…”
“-What would most doctors and researchers
say about fish consumption and cardiovascular
disease and mortality. There are few things
that are associated with a greater decrease
in cardiovascular disease risk than fish consumption.
And… TMAO, if you look at a graph – the
increase in TMAO from eggs, beef, cheese,
milk, clams and then look at cod and halibut.
Cod and halibut are increasing TMAO, as I
said, orders of magnitude more than beef or
eggs. You can’t even see eggs and beef there
and fish consumption, I think almost every
public health authority would recommend-would
agree with this is reducing the risk of heart
disease and mortality so the other thing about
TMAO to know is that certain types of gut
bacteria metabolize choline and carnitine
into TMAO whereas others don’t. A lot of scientists
have speculated that high TMAO levels are
essentially a result of a disrupted gut microbiome.
There’s studies showing that rifaxamin which
is an antibiotic that treats bacterial overgrowth
in the small intestine reduces serum TMAO
levels. Which suggests that it’s mediated
by the gut microbiome.”
The conversation on TMAO eventually fizzled
out and later on Kahn and Kresser agreed that
you should up your veggies in any case. Kresser
said your plate should be ⅔ to ¾ plants.
Around the 3 hour 4 minute mark, Joe Rogan
asked Kresser what the benefit is of “putting
that one quarter of your plate – putting animal
protein.” “There are lots of benefits, animal
protein is more nutrient dense in essential
nutrients – animal foods are higher in B12,
bioavailable Zinc, Iron, Calcium, Choline,
Taurine, Creatine and not just higher in terms
of the actual amounts, but higher in the amount
that you absorb and that’s a very key point.”
 Joe Rogan then asks what would be negative
about removing the animal products from that
one quarter of your plate. Kresser begins
by explaining you would end up lacking B12,
and he says that more important than looking
at what is theoretically possible, that is,
instead of seeing whether it’s possible
fill in this B12 lack with supplements, what’s
important is checking the actual incidence
of deficiencies.
“for example, the average omnivore – the rate
of B12 depletion is 11% and then for vegetarians,
it’s 77% and for vegans it’s 92% of depletion
which is the first stage – there’s four stages
of B12 deficiency and that’s the first stage.”
As was discussed earlier in the video, you
want to keep homocysteine down and you need
B vitamins like B12 to do that. This study
also found that 16% of the omnivores, 38%
of the vegetarians and 67% of the vegans had
high homocysteine levels.
“A lot of people turn to a no animal product
diet to improve their cardiovascular health
and yet you’re seeing much higher rates of
homocysteine like the average in vegans is
16, which is clearly associated with increased
risk of not only cardiovascular disease but
also dementia and alzheimer’s.”
This a point where Kahn seemed to agree with
Kresser. “Chris I couldn’t agree more,
I’ve written many articles- ‘don’t be
a dumb vegan’… and I don’t mean to offend
but y’know… We are prone to have a few holes
in the wall that an intelligent person knows
how to plug.
It’s Vitamin D, it’s DHA, B12, Iodine, Taurine,
Vanadium, Chromium, I just got those, that’s
what I do every other day. I’m totally complete.”
“But let’s look at things like Calcium, Iron,
Zinc, Choline, Creatine, Retinol which is
preformed Vitamin A, let’s look at EPA and
DHA. All of these are shown to be lower in
vegetarians and vegans than they are in omnivores.”
Next, Kresser talks about whether or not it’s
a good idea to rely on supplements.
“Yes, you can supplement, but it just- do
the supplements have the same effect? Like
look at calcium. Dietary calcium has inversely
related to heart disease and kidney stones.
But when you look at studies on calcium supplements,
the opposite is true. Calcium supplements
are associated with an increase in heart disease
and an increase in kidney stones. But the
theory is that supplemental calcium is not
the same as dietary calcium – you get a large
bolus of calcium that goes into your blood
all at once and then it can get into the soft
tissues – which, Joel will tell you, is not
good for your heart health. My point is that
supplements don’t always affect the body in
the same way…. I just think it’s better
to get nutrients from food if you can because
that’s the way we’ve been getting them for
millions of years, y’know.
“Just to show how nutrient dense organ meats
and shellfish are: You could eat 1 clam, 1
oyster, and four grams of liver a day and
you would completely meet your needs for B12,
Zinc, Copper, Choline and many other nutrients
with no other consumption of animal foods.”
Moving onto the 3 hour 19 minute mark, they
briefly talk about the carnivore diet. “I
am baffled by this carnivore diet.”
Dr. Kahn and Joe Rogan talk about how Vitamin
C may not be an issue because glucose competes
with vitamin C for uptake, so the little Vitamin
C these carnivore people get from organ meats
and muscle meat could be sufficient because
they use it very efficiently. Kresser has
a theory that the people benefitting from
this are experiencing something like a gut
rest. “Meat is absorbed very high up in the
digestive tract- when you only eat meat, it’s
a low residue diet. And there’s nothing left
over to irritate or inflame the gut, my theory
is a lot of people who are benefitting from
this have a really disrupted gut microbiome
and the carnivore diet is essentially like
a gut rest or a fast, and so I don’t doubt
that people are benefitting from it – the
question is what is the long term implication.”
Other than that a big concern was how well
people will fare without phytonutrients and
fiber.
“Should we wrap this up? One thing that we
came to a really solid conclusion is the standard
american diet sucks.”
All in all both sides had interesting points
to contribute to the debate and the video
is worth watching or listening to, though
I’d recommend to start watching from about
the two hour mark as I felt the second half
was more productive
and interesting.