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to learn more and start feeling and performing

2:14

your best. Hey

2:16

everybody, Chris Kresser here. Welcome to another episode

2:19

of Revolution Health Radio. Many

2:21

of you have probably heard of the Eat

2:23

Lancet Planetary Health Diet.

2:26

This made a big splash when this paper was published.

2:28

The idea was that researchers

2:30

tried to come up with a diet

2:33

that is good for individual

2:35

humans and good for the planet and will

2:38

be sustainable over time. But

2:40

it turns out that this diet approach

2:43

that they proposed, which was heavily plant-based,

2:45

lots of grains and legumes and very few animal

2:47

products, fell short of

2:50

some critical micronutrients that most people

2:52

don't get enough of already and

2:54

could potentially deepen and exacerbate

2:57

those micronutrient deficiencies. So

2:59

I invited Ty Beal on

3:02

the show to discuss this. Ty is a global

3:04

nutrition scientist. He's a research advisor

3:06

on the knowledge leadership team at Global Alliance

3:08

for Improved Nutrition, or GAIN, where

3:11

he generates evidence to guide programs and

3:13

mobilize knowledge related to global nutrition

3:15

and food systems. He has a PhD from

3:17

UC Davis, where he was National Science

3:20

Foundation graduate research fellow. He

3:23

and his colleagues published a critique

3:25

of the Eat Lancet Planetary

3:27

Health Diet and highlighted

3:31

what the micronutrient deficiencies

3:33

would be if you were to follow that

3:36

diet and why that is a problem

3:38

in a world where those nutrient deficiencies

3:41

are already prevalent

3:43

not only in the developing world, but even in rich

3:45

industrialized countries like the US and

3:47

Canada. So in this

3:50

show, I dig into the paper that

3:53

Ty just published. We talk about what

3:55

the planetary health diet is, which micronutrients

3:58

are lacking. what can

4:00

be done, if anything, to shore that up, what

4:03

ties recommendations would be for a truly

4:06

nutrient-dense and nutritionally

4:09

sustainable diet for

4:11

most of us. And we

4:14

talked a little bit about some of the responses

4:17

that he's had from his paper from the authors

4:20

of the Eat Lancet planetary health diet like

4:22

Walter Willett and also David Katz.

4:25

So this was a fascinating

4:27

discussion. As you know, if you've been listening

4:29

to this show for any length of time, I'm

4:32

really passionate about nutrient

4:34

deficiency and nutrient density and how

4:37

we can improve our micronutrient

4:40

status and why that is the rising

4:42

tide that lifts all boats and can

4:44

help us to achieve almost all of our health goals,

4:47

at least to some extent. So this

4:49

was a really important

4:51

interview for me and really important

4:54

topic. So I hope you enjoy it as much

4:56

as I did. Let's dive in.

4:58

Ty Beal, welcome back on the show. Pleasure to

5:00

have you. Thanks for having me, Chris. So

5:03

I think a lot of people have heard of the

5:06

Eat Lancet

5:07

planetary health diet from

5:10

this show, listeners of this show, or people who

5:12

followed my work or yours. But for those that are

5:14

completely unfamiliar with this concept, why don't

5:17

you just start by defining what that is?

5:19

Sure. So a planetary health diet in the

5:21

context of the Eat Lancet report was

5:24

really trying to design a diet that

5:26

can meet the needs of a human, the global human

5:28

population now and in the future,

5:31

as well as stay within

5:33

planetary boundaries. So a way to think of that

5:36

as like a healthy and sustainable diet.

5:38

Healthy for us, healthy for the planet. That's

5:40

the promise, right?

5:42

Exactly.

5:43

And

5:44

what would you say about

5:47

how this diet has been received overall,

5:49

like in the mainstream media and just

5:52

from what you've seen on Twitter and social media

5:55

and the kind of general reception of

5:57

the Eat Lancet?

5:59

Yeah, I think there's there's sort of two camps.

6:02

I think that's highly praised by by

6:04

a lot of media has sort of the solution

6:07

that we need to be working towards, you

6:09

know, especially by environmentalists,

6:12

I would say. And there's also been

6:14

a fair amount of pushback, certainly on social

6:16

media as well. A little

6:18

bit less so on mainstream media but social media

6:21

has been full of people

6:22

pushing back on the sort of

6:25

limits on animal source foods, questioning

6:28

the nutrient adequacy of the diet. And

6:30

so we really see some polarized

6:32

responses to the report.

6:35

So I recently had a rich

6:38

in and Lynn pleasure on to talk about more

6:41

the ecological, environmental and

6:43

sustainability aspects of an animal

6:46

based diet and why animals might actually

6:48

be necessary in our

6:50

food system and ecosystem. So I'm going to not

6:53

focus on that in this conversation, especially

6:56

because you have published a paper that is specifically

6:59

about

7:00

some concerns that you have about

7:02

the micronutrients lacking

7:05

in the planetary health diet. And this

7:07

is an interest that you and I both share just

7:10

overall nutrient status

7:12

and nutrient density and the importance of that for

7:14

our health and well being. And I think we've done a lot of phenomenal

7:17

work on this subject before and for listeners

7:19

who haven't heard our recent my recent my

7:21

previous interviews with Ty should definitely

7:24

check those out because we talk about

7:26

another paper that I think

7:28

was from 20 March of about

7:30

a year ago right

7:32

there earlier this year, the frontiers and nutrition

7:34

paper. Yeah,

7:36

exactly. That was last year at same time,

7:38

last year where you and

7:40

your colleagues published the

7:43

nutrient density ratings of

7:45

foods, and I believe it was the first

7:48

paper to take bioavailability fully

7:50

into account. And from

7:52

that we just we learned how important

7:54

animal foods can be in

7:56

the diet from a nutrient density perspective

7:59

so

7:59

Tell us a little bit about the

8:02

Eat Lancet planetary

8:04

health diet from a micronutrient perspective

8:06

and what some of the concerns that you have are.

8:10

Sure. So I'll just start by saying I

8:12

was actually asked by an editor of

8:14

a journal about the adequacy

8:17

because they had some concerns and I think some

8:19

people had reached out to them. So there,

8:22

it was not just, it was not just me

8:24

who was sort of questioning the adequacy, I think there

8:26

was, there was, there were some others, but

8:28

really I think for me, I have

8:31

done enough work on modeling global

8:33

diets, nutrient density, nutrient adequacy,

8:36

as well as actual deficiencies

8:38

in people when you look at their levels of

8:41

these, you know, biomarkers in the body.

8:43

So I had concern because I knew the lower

8:46

you get with animal source foods, the

8:48

more challenging it can be to meet your needs,

8:51

especially for nutrients like iron and zinc, which

8:55

are, they exist in plant source foods,

8:57

but they're quite a bit less bioavailable.

9:00

And there are some questions, you know, in the Eat

9:02

Lancet diet, which, you know, we don't

9:04

have to get into sort of the,

9:06

the debate about how protective that is of non-communicable

9:08

disease, but you know, it's a minimally processed plant-based

9:11

diet, I don't have a lot of concerns there. It's really

9:13

more on the adequacy side where it's

9:15

very high in whole grains and legumes,

9:18

which, you know, minimally processed can

9:21

be, can be part of healthy diets, but it's,

9:23

it was concerning because they're very high in phytate.

9:25

And I don't think maybe

9:28

many people don't realize this, but it was, it's sort

9:30

of off the charts of phytate in terms of how

9:32

we look at recommended intakes

9:34

for zinc, for example,

9:36

where you have these categories of, you

9:39

know, an unrefined diet, which would, which would be about 1200

9:41

milligrams of phytate. There's a

9:44

lower bioavailability of zinc. This

9:46

affects iron as well. But

9:49

the, what we saw is that, wow, the

9:51

phytate on this diet is actually closer to 2000 and

9:54

even close to 2,500 milligrams. So

9:57

it's impact on bioavailability.

9:59

really isn't well understood.

10:02

So can I just interrupt there just for

10:04

the listeners who are not aware of what phytate

10:06

is also known as phytic acid, can

10:09

you tell folks a little bit about why

10:11

that's a concern from a micronutrient

10:14

perspective?

10:16

Yeah, so phytate binds

10:18

to minerals like iron, zinc, calcium,

10:21

and it really inhibits their absorption. So

10:25

the higher the phytate in the diet, the

10:27

lower the bioavailability of those minerals.

10:29

And so that's why, you know, in particular, I was concerned

10:32

about recognizing that when

10:34

you have a lot of phytate in the diet, you actually have to consume

10:36

a lot more iron and zinc. And many people

10:39

don't realize that, right? It's just, oh, you

10:41

just have a set amount of iron that you need and a set amount

10:43

of zinc, but it actually depends on what your total diet

10:45

is and the bioavailability, you

10:47

know, and the other factor, which I didn't mention

10:49

is that heme iron

10:51

is really much more bioavailable

10:53

and heme iron is only found in animal

10:55

source foods. And

10:57

so you have this sort of difference

10:59

in the bioavailability from a type

11:02

of iron as well as the

11:03

amount of phytate and other anti nutrients

11:06

that can prevent that absorption or hinder the absorption.

11:09

Yeah, so this is something that, you know, I've

11:12

wrote about my first book, Paleo cure way

11:14

back in 2013, 10 years ago now, and I believe there's always

11:18

been that

11:20

whole grains and legumes, when especially

11:22

when they're properly prepared as some of the traditional

11:24

methods of preparing grains and legumes,

11:28

which most cultures did

11:30

prior to the industrial revolution and

11:32

still many cultures do like soaking

11:34

them, particularly soaking them with

11:37

some acidic substance like

11:40

yogurt or kefir or lemon juice or something

11:42

like that can break down

11:44

some of the phytic acid. And there's been some interesting

11:46

research on this and makes the nutrients

11:49

more bioavailable. But I think it's pretty safe to say

11:51

that in many situations,

11:53

grains and legumes are being consumed without

11:56

those traditional methods of preparation

11:58

in our culture today.

11:59

places in the modern industrial world.

12:02

And so if you're building your

12:05

entire food pyramid, if you will, your entire

12:07

diet around these foods,

12:09

which can be okay in moderation,

12:12

but if they're replacing

12:14

other more nutrient dense food, that's

12:16

where the problem and the concern comes

12:19

is that, would you agree with that?

12:21

Yeah, I think it's a question of balance. And

12:24

like you said, most people are not preparing their,

12:27

their grains and legumes, and we know that because

12:29

we're using food composition data from foods

12:32

in the form that they're typically, typically consumed,

12:35

right? So in their typically consumed

12:37

form, they have a certain amount of phytate. Now we know,

12:39

of course, like you said, you can ferment,

12:41

you can germinate, you can

12:43

soak grains, legumes, seeds, etc.

12:46

To reduce phytate, but that's not being done in

12:49

the majority of these foods around the world.

12:52

Yeah. I mean, I, I've tried to get patients

12:54

to do this for many years and I would say just

12:57

a small handful actually would do

12:59

it. And it's, it's a lot

13:01

of work. And that might

13:03

actually fit in with a more traditional lifestyle

13:07

where there's shared resources and people

13:09

are doing those kinds of things together. And it's just part

13:11

of a normal daily routine. But

13:14

it's not really part of the way that, or

13:17

built into the, to the modern way

13:19

of living for most people.

13:21

I have seen, yeah, I agree with that,

13:23

but I have seen more and more products,

13:26

at least in the US where they are

13:28

already, they come as like

13:31

a sprouted grain. For example, sprouted

13:33

quinoa. I see that commonly

13:36

sprouted oatmeal, even Costco has these products,

13:39

at least the sprouted oatmeal. So

13:41

I think there, there could be a movement towards

13:43

that. I think that's one potential way to sort

13:45

of improve the bioavailability.

13:47

And I certainly think it's worth pursuing. I've

13:50

also seen sprouted

13:51

lentils, and mung beans, things

13:53

like that. But I think you're right that most consumers

13:56

are not going to be purchasing those products at this point.

13:58

Yeah, we're talking about.

13:59

a very small minority, but I'm glad you brought that

14:02

up because they're particularly at health

14:04

food stores like Whole Foods, Natural

14:07

Grocers, etc. and even like you said in

14:09

Costco and some other more mainstream stores

14:11

you can find some sprouted varieties

14:13

and they are a much better choice from a nutrient

14:15

density perspective. So

14:18

what you mentioned zinc and iron is two of the main

14:20

nutrients of concern and because

14:23

they're minerals that are bound by by phytate.

14:25

Are there

14:25

other nutrients that you're concerned

14:28

about on the planetary health diet? Yeah

14:31

you know in this recent study we also found

14:33

shortfalls for calcium and vitamin

14:35

B12. Now they weren't as large

14:38

as for iron and zinc but I do think there's a concern

14:41

there especially when

14:43

you think of populations

14:45

consuming low amounts of animal source foods.

14:48

And

14:49

why do you think it is that this was was

14:51

this quantified in the in

14:53

the paper that was published on planetary health diet?

14:56

I mean the whole premise was a

14:58

diet that's healthy for humans and

15:00

healthy for the planet. So was

15:03

it that they didn't take

15:05

you know micronutrient density into account as

15:07

one of the health factors or was it they weren't

15:10

that they weren't considering bioavailability

15:12

and the impact of phytate?

15:15

In other words is your concern just

15:18

a lack of the amount

15:20

of that nutrient on paper like the RDA

15:23

or presence of phytic acid that interfere

15:26

with the absorption of those

15:28

nutrients or both?

15:30

I think it's a combination you know I've so

15:33

the lead author is Walter Willett. I think he's

15:35

probably the world's leading expert on

15:37

nutrition or nutrition epidemiology

15:41

and so his perspective is sort

15:43

of the

15:44

recommended nutrient intakes are

15:47

not really appropriate you know you should

15:50

either use you know nutrient density you

15:53

know per per calorie because people

15:55

need different energy requirements or they're

15:58

not necessarily applicable.

15:59

because he's looking at sort of

16:02

health outcomes of these, you know, intakes

16:05

of different levels. So I sort

16:07

of disagree. But I think his point

16:09

is just,

16:10

you know, there's a there's a disagreement about how much

16:12

of these nutrients do we need. And I think a big one

16:14

for that he would, I mean,

16:16

he and David Ludwig published

16:19

a review in the New England Journal of Medicine on

16:21

dairy calcium. And

16:24

you know, that that suggests that people

16:26

don't need as much calcium as are sort

16:28

of suggested in the recommended nutrient intakes.

16:30

Now, I'm sort of agnostic to that, whatever,

16:33

but I've worked with my con nutrients

16:35

enough to know that the data,

16:37

it all kind of suggests the same thing. The

16:40

food supply data says there's there's

16:42

not enough, there's not high enough nutrient density in

16:44

the food supply, the

16:45

dietary intake data, when we survey people,

16:47

what did you eat in the last 24 hours, there's

16:50

not enough micronutrients in their diet. And

16:52

the biomarkers when you actually measure in people's

16:54

bodies, there are widespread micronutrient

16:56

deficiencies. So for me, I think there's

16:58

actually, there's a it's a pretty

17:01

significant burden worldwide. And

17:03

I think the question then can sort

17:05

of become, well, what is the health?

17:07

What is the real health burden from this? What's the morbidity

17:09

and the mortality? And that's, I think, a reasonable

17:11

debate. But for me, it's,

17:13

it's, it's an important issue to focus

17:16

on. I think, when you look

17:18

at the original adequacy assessment,

17:20

for the eat Lancet planetary health diet, it

17:23

used the other the other issues that it used different

17:26

recommended nutrient intakes that were

17:28

dated. So they weren't the latest evidence.

17:31

And we also had an update

17:34

in 2020, where there was sort of

17:36

a paper out by Lindsay Allen and

17:38

others that said,

17:40

let's try to let's try to agree on a

17:42

harmonized set of recommended nutrient intakes.

17:44

Because if you look, if you look into nutrient intakes,

17:47

many countries or regions of the world

17:49

have different

17:50

recommendations. So you have the

17:52

you have the you know, FSA in Europe,

17:54

the European Food Safety Authority, you have the Institute

17:56

of Medicine in the US, and then you have

17:59

others. in other countries and many

18:01

of them are saying different things and

18:03

sort of different justification. So I think there, I

18:06

think I would acknowledge there is some

18:08

certainly there's some uncertainty around what

18:11

levels of these nutrients should we consume. But

18:13

I think you would probably agree with this, many of these

18:15

are not necessarily based on optimal consumption.

18:18

So even if you do meet the target

18:21

for for a nutrient, it

18:24

may actually be beneficial to consume above

18:26

that for many different reasons. Now, I

18:28

think you can see an argument on the other side where people

18:30

say, well, there's also a risk of consuming too

18:32

much. You know, people may say that about iron. And

18:34

I've heard that. So I think it's

18:37

there's some things that are open to debate. But from my

18:39

perspective, we looked

18:41

at things as objectively as we could, trying

18:44

to use the latest evidence on bioavailability,

18:46

trying to be pretty fair, you know, we assumed a 10%

18:49

bioavailability of iron on the E-lancet

18:52

dye, which I think is pretty generous considering how much

18:54

phytate is in there. But you know, there

18:56

is there are some animal source foods and there's quite

18:58

a bit of vitamin C. So we wanted

19:00

to be fair, and we still find shortfalls.

19:03

And so I think it comes down to sort of probably

19:05

the biggest factor is sort of a disagreement about how

19:08

what is the what are the recommended

19:11

intakes? And that I think there's

19:13

some disagreement

19:13

about. Yeah,

19:15

I want to linger here for a little bit because I'm

19:17

very concerned with the idea that of

19:20

downwardly revising the

19:23

recommended nutrient intakes rather

19:25

than increasing them, which I think

19:27

is what the majority of research

19:31

suggests we should be doing. There

19:34

are so many reasons for this. And I don't

19:36

think, you know, one of the problems

19:38

that I see is that there's

19:40

there's a lot of research in different areas

19:43

that points to the need

19:45

for increasing, I think in many cases,

19:47

the recommended intake of these

19:50

nutrients. But there isn't a central

19:53

sort of source like to your point of harmonized

19:55

recommendations that's pulling all of these different

19:58

lines of evidence together.

19:59

So an example

20:02

would be we know that

20:04

chronic disease affects

20:06

nutrient needs in two ways.

20:09

It increases the demand for nutrients because

20:11

chronic disease is a stressor on the body

20:15

and it decreases in many cases the

20:17

absorption of nutrients. For example we know that

20:19

people who with obesity and metabolic

20:21

issues absorb, they convert

20:23

less sunlight into vitamin D

20:25

in response to sun exposure than someone who's

20:28

lean and metabolically healthy.

20:31

And we also know that they absorb less vitamin

20:33

D from both food and supplements such that

20:36

if you look at the scientific research you can

20:38

see that the recommended dose for

20:40

maintaining adequate serum vitamin

20:42

D levels for someone who's obese with metabolic

20:45

disease is often 5 to 10,000 IU versus you

20:47

know maybe a thousand to 2,000

20:49

IU for someone who doesn't

20:53

have those conditions. We

20:55

also have you know

20:58

increase in environmental toxins that

21:00

bind to minerals and other

21:02

nutrients and interfere with their absorption.

21:04

There's a lot of papers on that.

21:06

We have an increasingly

21:09

industrial food system where food

21:11

is shipped for three or four thousand miles

21:13

before it's consumed and it's losing nutritional

21:15

value throughout

21:17

that that journey and that process.

21:20

So and then we have the presence

21:22

of of

21:23

anti nutrients like you've mentioned

21:25

with phytic acid but there are others that can interfere

21:28

with

21:28

nutrient absorption such that the

21:31

if you were to just look at diet surveys

21:34

and the amount of nutrients that people are consuming

21:36

on paper you know better

21:38

than anyone that that's not the ultimate

21:41

amount that we're actually absorbing

21:43

and using. And as

21:45

a clinician who has literally tested

21:47

every single person who's walked through my door

21:50

for 15 years for nutrient status

21:53

I can honestly say that there's been only

21:56

a small handful of people who didn't have at least

21:58

one and not multiple. nutrient

22:00

deficiencies as evidenced by their biomarkers

22:05

and their food intake, you

22:07

know, assessing their food intake with something

22:09

like chronometer or similar tool. And

22:12

these are people who are highly, you know, my patients

22:14

are not the average population.

22:17

They're people who are highly motivated.

22:19

They've typically, you know, been listening

22:21

to blogs and podcasts like mine

22:23

for a long time. You know, they're not eating

22:26

a standard American diet. They're shopping

22:28

at health food stores and eating a relatively

22:30

good diet. And it's still an issue for

22:33

those people. So I get really nervous

22:35

when I hear the idea that,

22:38

you know, we should be, we don't have to worry about

22:40

it. And maybe we need fewer nutrients than

22:43

the RDA has established, especially because

22:45

in many cases, the RDA has not

22:47

been updated for 20 or even 30

22:49

years. And

22:52

the formula for the RDA is often based

22:54

on things like average body weight. And

22:56

average body weight has gone up hugely in

22:58

the past 25 or 30 years alone. So

23:02

yeah, I'm just curious about your take on that

23:04

because this is your, your, really

23:06

your area of expertise and study. And

23:08

you see, you're aware of all these different

23:11

lines of evidence and different factors

23:13

that affect nutrient density.

23:16

Yeah, Chris, I think you're absolutely right about

23:19

all of that. I fully agree.

23:21

And I mean, I

23:23

don't have any question that the risk of inadequacy

23:26

is much higher than any risk of harm from from

23:28

excess nutrient intake. I mean, you

23:31

look at the data, our

23:33

nutrient density of our diets is is

23:35

not great. And you look, you look back to traditional

23:39

cultures or, you know, our our

23:42

ancestors, they had much higher nutrient

23:44

densities than we consume now. And

23:46

there are other concerns. And

23:49

I think that's a good change as the as more carbon comes into

23:51

the atmosphere, there's actually going to be a reduction

23:54

in the iron and zinc and other minerals

23:56

in our crops. So the

23:59

very crops that are going to

23:59

be supplying these plant rich

24:02

diets, grains, staple

24:04

foods,

24:05

there's gonna be less iron and zinc and protein

24:08

in these foods. So we have to pay

24:10

attention to this. We need to increase the nutrient

24:13

density of foods. I fully agree

24:15

about that. So I think that the

24:18

concern about, or the question

24:20

maybe of, well, what exactly do people need?

24:23

Well, what do we need to avoid the

24:25

specific effects of

24:28

some disease from a deficiency? That's

24:30

a different question than what's optimal. And you

24:32

talked about vitamin D. We looked at

24:35

prevalence of vitamin D deficiency

24:38

using a very sort of low bar

24:40

of the 25-OHD. And that's

24:43

not optimal, right? I think

24:46

there is a case where 50 or higher would

24:49

be optimal when you look at other markers,

24:51

right? And we're just looking at sort of this

24:53

very low bar and we find widespread deficiency.

24:55

So I think I am concerned

24:58

just as you are, you mentioned

25:00

your patients. Well, we looked at people

25:03

in the US, the UK, all

25:06

around the world, and we found,

25:08

this is a study that came out last fall,

25:10

we found actually very high

25:13

prevalence of deficiency all over the place. So

25:16

worldwide, two in three women

25:18

aged 15 to 49 had

25:20

at least one micronutrient deficiency. And

25:22

that wasn't even looking at all of the nutrients.

25:25

There are 25 essential micronutrients. We were looking

25:27

at three or four.

25:29

Some countries in

25:31

India and Cameroon,

25:34

Cote d'Ivoire, other others, it's

25:36

nine in 10 women.

25:37

So it's not a small issue. Even

25:39

in the US, over 20%

25:42

of women

25:43

in that age group are deficient in iron.

25:45

In the UK, it's similar. And also

25:48

in the UK, you see folate and vitamin D

25:50

deficiency around 20%. So I agree,

25:53

I think this is an underappreciated issue and

25:55

it's something that requires attention.

25:57

Yeah, and again, even though...

25:59

deficiency statistics are using

26:02

benchmarks which themselves

26:05

might be out-of-date or too low, right?

26:07

So I mean an example

26:09

that I've used recently

26:12

is with magnesium. So the

26:14

current RDA for magnesium is 320 for women and 420

26:17

for men,

26:19

but those RDAs were last published in 1997 using

26:21

average body weights of 133 pounds

26:24

for women and 166 pounds for men. But today

26:26

the average body weight is 169 pounds

26:31

for women and 196 pounds for men. And so some researchers

26:33

published a study

26:40

in 2021 where they recalculated the RDAs

26:42

for magnesium to reflect

26:45

that increased average body weight in

26:47

the US population. And they

26:49

came up with a new adjusted RDA

26:52

for women of 467 to 534 milligrams

26:54

per day. That's a huge difference.

27:00

That goes from 320 to up to 534. That's 200 milligrams

27:02

per day more that

27:07

a woman would need and the male level

27:10

was 575 to almost 660. So again another 200

27:14

point increase. Then you look at the

27:16

average... Chris, we just consume

27:19

just consume an extra thousand calories to

27:22

compensate, right? Yeah,

27:25

but the problem is, as you well know, there's

27:28

extra thousand calories of

27:30

cheese doodles and big gulps and

27:33

highly processed and refined foods don't contain

27:35

any nutrients to speak of. So

27:39

the average intake of magnesium for US

27:41

adults is currently 340 to 344 milligrams for men

27:43

and 256 to 273 milligrams for women. So women

27:49

are falling short already of

27:52

the inadequate RDA that

27:54

was published in 1997, but if

27:56

we were to use these updated RDAs

27:59

based on the actual current average

28:01

body weights today, the typical

28:04

person is falling short 200 to

28:08

300 milligrams per day less

28:10

magnesium. So, you

28:13

know, that's just one example. Like there's papers

28:15

that suggest the RDA for B12

28:17

should be 300 to 500% higher in order to reliably avoid

28:22

signs and symptoms of B12 deficiency.

28:24

There's been arguments that the RDA

28:27

for vitamin D, which is currently only 600

28:29

IU should be at least 1000 IU per day,

28:31

if not higher. Linus Pauling

28:35

Institute has argued that the RDA for vitamin

28:37

C should be increased by 200%. So,

28:40

you know, I want there's other things I want to talk

28:43

about, but I just couldn't let that go because

28:46

like this, the you and

28:48

I think just both know too much to

28:51

be able to accept the proposition that,

28:53

hey, you know, the RDA's are not

28:56

only fine, they're there, maybe they're too

28:58

high and we should just be satisfied

29:00

with people not even meeting the

29:03

RDA. I think that's a really dangerous argument.

29:06

If you've listened to the show for

29:08

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29:15

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29:18

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29:20

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29:22

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29:25

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29:28

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29:30

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29:32

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29:34

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32:22

Yeah and I think another point to highlight

32:24

is that the recommended intakes

32:26

used from the original E-Lancet adequacy

32:29

were from 1973. So they were far more dated

32:31

than what

32:33

you're referring to which of course yes

32:36

many of the the latest recommendations are

32:38

still based on evidence that is quite

32:40

dated. Yeah. Okay

32:42

I want to, there's one more point I have to make

32:44

and I promise I'll let this go. But

32:46

it is the topic of the podcast.

32:49

We're not too far off on a tangent. And

32:51

I'm curious if you ever see if like

32:54

about this because I haven't seen any studies

32:56

that look at this and it seems mind-bogglingly

32:59

complex to do so but also

33:01

very important which is the the

33:03

concept of nutrient synergy. So we

33:06

know that nutrients aren't just isolated

33:08

from each other in our bodies. They have complex

33:10

and often synergistic relationships. So

33:13

we're just talking about magnesium. Let's use that

33:15

as an example. That's required

33:17

for the absorption and activation of vitamin D.

33:20

So even if someone is getting enough vitamin

33:23

D

33:23

on paper you know through diet or sunlight

33:25

or supplements, if

33:27

they are falling short on magnesium

33:30

then they will effectively present

33:33

with a vitamin D deficiency even though

33:35

their intake of vitamin D is sufficient. Copper,

33:39

similar. It's required for the absorption

33:41

of iron. So if someone

33:43

is copper deficient

33:46

even if they're getting enough iron they can be iron deficient

33:48

and even anemic and I've seen that over

33:50

and over in my practice particularly

33:52

with women who were not responding

33:54

to iron supplementation or increasing iron

33:57

in their diet. They were still anemic. We

33:59

would test their coffee. Find that they were low

34:01

give them copper and all of a sudden they

34:03

would be able to their iron levels would

34:05

go up K2 regulates

34:08

calcium metabolism So if you're getting

34:10

plenty of calcium but not enough K2

34:13

that calcium can end up in the soft tissues Like

34:15

blood vessels and kidneys and not get into

34:17

the bones and the hard teeth and hard tissues

34:19

where you want it So to

34:21

me that's another big factor because

34:24

on paper if someone's getting enough of

34:26

certain individual nutrients If

34:28

they're low and other nutrients that are required

34:30

for the bio transformation and activation

34:33

of those nutrients Then they're still going to have

34:35

a problem and I'm not aware of any studies

34:38

on nutrient Sufficiency that

34:40

even attempt to deal with that given

34:43

the complexity

34:44

It's a great point Chris And I think

34:47

it's another case for why we should aim to

34:49

consume most of our nutrients through whole

34:51

foods And I think there's a lot of reasons

34:53

why but that's another one and you know At

34:56

the very least be very mindful when we think

34:58

about which maybe we'll discuss we think about other

35:00

strategies like fortification or supplementation To

35:03

really consider the synergistic effect of these

35:05

nutrients.

35:06

Yeah, absolutely Okay,

35:09

so

35:10

what you know in your mind

35:13

What can be done to?

35:17

If you were to design a planetary health diet,

35:19

let's put it a different way How

35:22

would it be different than what they've proposed?

35:25

You know, I don't want the responsibility of

35:27

trying to design a planet Because

35:29

yeah, that's a big task. You're never also Nobody's

35:33

gonna say their diet and have oh

35:36

everybody will agree with you Right, like people are gonna

35:38

criticize for all different reasons So I'll

35:40

sort of stay clear on the and on the planetary

35:43

side because like you said you talked about

35:45

that, you know Yeah, I think it's it's

35:47

reasonable to I

35:50

think to push back on some some of the

35:52

Modeling of the eat Lancet to say look maybe

35:55

maybe we can produce more animal source foods in

35:57

a holistic way You know using circular or diverse

35:59

agroecos

35:59

systems and produce

36:02

more than what they propose. But I'm not I won't go

36:04

there. Because that's, you know, that's a whole topic in itself.

36:06

I will say, there are many

36:09

different approaches that we could

36:11

use to sort of design

36:13

a diet that is nutrient

36:15

adequate and healthy. And

36:18

I will also just kind of say for the

36:20

the E-Lancet diet was not proposing that everybody

36:22

should consume this this exact same diet,

36:25

they do have ranges and they did want to

36:27

say like, there's flexibility here. But

36:29

I think we need to aim for higher nutrient

36:31

density. So that would be one one

36:33

suggestion. And I think the way to do that would be

36:36

to, you know, increase some

36:39

of the types of animal source foods that are most nutrient

36:41

dense. Course

36:43

being organ meats being very nutrient dense,

36:46

shellfish, especially bivalves. And

36:49

in general,

36:49

I think we can, it

36:51

would, the diet would benefit from

36:53

some increase in animal source foods. The current

36:55

diet has about 14% of

36:58

calories from animal source foods. So

37:01

I mean, not thinking about the sort

37:03

of environmental impact just solely on

37:05

nutrient adequacy, I think increasing

37:07

that

37:08

is a sort of

37:09

easy way to increase the nutrient

37:11

adequacy because plant

37:13

source foods and animal source foods have complementary

37:16

nutrient profiles. And the lower

37:18

you go in either food group,

37:20

you have increased risk for

37:23

trying to meet your nutrient needs. Now,

37:25

I think when you know listeners may

37:28

be saying, well, I can meet my nutrient needs on a

37:30

vegan diet, I can meet it on a carnivore diet, I

37:32

don't have any issues. What

37:34

I'm thinking about is at the population level,

37:37

it's very difficult for most people

37:39

to meet their nutrient needs. And

37:41

so what we need to do when we're thinking of public

37:43

health is to be promoting diets

37:45

that are very protective

37:48

of those concerns, you know, increasing

37:51

nutrient density in general. The

37:53

other aspect that I think we already discussed

37:56

is to reduce the amount of phytate.

37:58

Now phytate can be can have benefits.

37:59

And I've heard, I've heard sort

38:02

of arguments for why we don't, you don't want to reduce

38:04

phytate too much. There can be health protect

38:06

effects of some phytate. So I think it's more about moderation

38:08

though. I don't think we need 2,000,

38:12

2,500 milligrams of phytate in our diet to get to

38:14

have any benefits. And we know that that really

38:16

hinders the bioavailability. So whether

38:19

that's reduced through the processing or,

38:22

you know, consuming foods, there are actually,

38:24

there's a, there's a bit of a variation between different types

38:26

of legumes, nuts, seeds,

38:29

and whole grains that are higher or lower in phytate.

38:32

So choosing, choosing ones that are

38:34

lower in phytate, I think is a, can

38:36

be a benefit. And there's also breeding

38:38

strategies. There's a, there's a strategy called biofortification

38:41

where it actually allows,

38:43

you know, agronomists to

38:46

change the nutrient content

38:48

of the crops to, you know, adjust

38:50

the amount of phytate. Again, they don't, you don't want to reduce,

38:53

you don't want to take it all out, but you can actually do that

38:55

in the breeding process. And that is, that

38:57

is being done more and more. And I think that's a good strategy.

39:00

There are other strategies and I think it

39:02

would be not efficient

39:05

and not effective to only pursue

39:08

dietary change or to try to have

39:10

everybody in the whole world consume a perfectly

39:13

healthy diet. Because we know that there are many barriers

39:15

to people having access to all

39:18

of these diverse foods. And we think about affordability

39:21

as a big one and animal source foods are

39:24

generally more expensive. Not always, but

39:26

they're often more expensive. So there's some challenges

39:28

with affordability and people having access

39:30

to safe foods, having access

39:32

to refrigeration, to store foods, right.

39:36

Fruits and vegetables are actually not

39:38

always accessible in many low and

39:40

middle income countries. So when you think

39:42

about worldwide, the

39:44

issues around access and

39:47

whatnot, I think we have to consider all sorts

39:49

of different strategies that we can use. And another

39:52

one of those is fortification.

39:53

So staple foods

39:55

like you can use grains,

39:58

it can be whole grains.

39:59

oils, whatnot, salt is fortified

40:02

with iron, it could be fortified with other nutrients as

40:04

well. I think we need to work on fortification

40:06

in a smart way,

40:08

really as a safety net for when

40:10

we can't have, when populations

40:12

can't consume all of their nutrient requirements

40:14

through foods, we can make up

40:17

for that in fortification. And I know

40:19

like the caveat, like you said, it

40:21

doesn't, adding a few nutrients is

40:23

not making up for the diverse

40:27

food matrix of foods that contain

40:29

lots of these nutrients in, you know,

40:32

synergistic ways, but it can really

40:34

help fill nutrient gaps for people. And it can be done

40:36

in cost effective ways and

40:38

with minimal environmental impact. So

40:40

I think we need to pursue that. And

40:43

I mentioned bio fortification, this is

40:45

really, I think, something that we need to pursue

40:47

in terms of scaling up so that the food that we

40:49

consume, the plant,

40:51

the crops that we consume are as dense as they can

40:54

be in nutrients. Now, when we

40:56

started breeding crops in the agricultural,

40:58

you know, agricultural revolution, to

41:00

really increase yields, to increase

41:03

sugar and starch, it had a negative

41:05

effect on the nutrient density of those

41:07

foods. And now

41:10

we're starting to pay attention to that. I think we need to scale

41:12

up the breeding of crops. Now

41:15

this is something, it can be something as simple

41:17

as using an orange flesh sweet potato

41:19

compared to a white flesh sweet potato, which

41:21

the dominant varieties of sweet potato,

41:24

for example, in Africa are actually white flesh. So

41:26

there are already efforts in place to

41:29

work on developing varieties that contain

41:31

orange flesh sweet potato, it's actually

41:33

they're higher in vitamin A, they're higher in folate.

41:36

And that can make a real difference, especially if those can

41:38

be scaled up.

41:40

And the fourth thing I would do is focus

41:42

on

41:43

supplementation when needed. And that's, you

41:45

know, providing concentrated nutrients either

41:48

consumed through a pill or through a powder or

41:50

even in lipid based nutrient supplements.

41:52

These can be really helpful for populations

41:55

with increased needs. So pregnant,

41:57

lactating women, young children.

41:59

that can be consumed where you

42:02

add them to food.

42:04

And really, those are those are

42:06

effective ways of increasing nutrients with

42:08

that they all have limitations, there's, you

42:12

know, there can be side effects with supplements, you

42:14

don't want to, you don't want access, for example,

42:16

you don't want access iron obviously, which

42:19

can happen in a supplement form. But I

42:22

think all of these strategies are important.

42:24

And the reason is because no, no single

42:27

strategy can be enough to make sure

42:29

the whole population in the

42:31

world can actually get the nutrients

42:33

they need. So I think we have to be smart

42:35

and try to do as much as we can

42:38

to provide access to

42:40

all of the populations who may not have access

42:42

to, you know, diets that

42:44

ultimately would provide all of the nutrients required

42:47

through the inherent or an intrinsic

42:50

nutrient density and the foods themselves.

42:53

That's really fascinating. And I agree

42:55

with all of that, I think there's a lot we can do

42:58

to shore up our

43:00

nutrient status, even in our existing

43:03

food system. And, you know, a lot of the conversations

43:05

I've had with you before, and also with people

43:08

that are working on this more from a food production

43:10

perspective, you know, regenerative agriculture

43:13

and farming, which will

43:15

produce much more nutrient dense foods and,

43:17

you know, making changes to the

43:19

food system overall is going

43:21

to be a big help. And I also

43:23

appreciate the distinction you made between what's

43:26

possible on an individual level, and

43:29

what is likely on

43:31

a population wide basis, which is what public

43:34

health is concerned with. And

43:36

this comes up in research studies as well, you

43:38

know, it's if you do a study

43:41

on a particular dietary approach, and

43:44

the compliance is horrible, then

43:47

in that study that, you know, the results will

43:50

often be presented as a failure and

43:52

you might have an individual say, what happened

43:54

to those five people that were able to stick with that

43:57

diet, you know, for two years?

43:59

Well, they actually had pretty

43:59

good results. So yes,

44:02

you know, from a, from an individual

44:04

perspective, it's, it's possible

44:07

that results are unlikely,

44:09

certain even that results will vary, you know,

44:12

from person to person. But when you're talking about

44:15

what is a good general recommendation

44:17

to make on a population wide basis, you

44:19

have to, you have to take into consideration

44:22

that, you know, people's typical

44:24

behavior, unless you have some

44:27

magic wand that is going to somehow

44:29

change that behavior, when

44:31

you introduce your recommendation, because

44:34

that's just the reality of, of the

44:36

situation.

44:38

Yeah, you're absolutely right. And behavior change

44:40

is hard. And we

44:42

it's not easy to change the demand

44:44

for foods, you know, people want certain

44:46

foods because they are, they're desirable

44:48

for many different reasons. I

44:51

think to your point, we looked at what,

44:54

based on the current sort of diets, when

44:56

you look at the food supply, so all the foods available

44:58

for consumption at a country at the national

45:00

level,

45:02

based on existing diets, so what people

45:04

are currently eating, we really

45:06

see that when animal source foods get below 30%

45:08

of the calorie supply,

45:12

you start to see a lot more micronutrient

45:14

inadequacies. And that's,

45:17

that's just pretty clear. And that's

45:20

this to your point about what people are actually going to consume

45:22

when they have choices when they have enough money to buy

45:24

what they want to buy. We have to consider

45:27

these factors, not everybody's just going to buy

45:29

the most nutrient dense foods possible,

45:31

right. So it's an important

45:34

consideration. I think you you

45:36

were correct to say that there's a big difference between

45:38

the public health recommendations

45:41

and what may be possible for an individual who's

45:43

very health conscious who listens

45:45

to, you know, health podcasts

45:47

and reads about it and make sure that their diet is, you

45:50

know, top notch.

45:52

So I know when you published this

45:54

paper that was raising some

45:56

concerns about the E. Lancet

45:59

Planetary Health diet, not

46:01

surprisingly, the authors of that paper

46:04

and probably

46:06

didn't agree with some

46:08

of your assessments. And I think Walter

46:11

Willett is submitting a letter to the editor

46:13

and David Katz published a LinkedIn article

46:16

with some objections. So I'm just curious

46:18

what those were and how

46:20

you would respond to their

46:22

response.

46:24

Yeah, so I'll say first off that

46:27

I had been discussing

46:30

with Walter along like

46:32

as I was creating this analysis, we sent a

46:35

draft of the paper before we even

46:37

submitted it and he provided feedback. So it's been

46:40

friendly. I really actually

46:42

admire the ability of Walter

46:44

and Walter Willett and David Katz to

46:46

engage in really constructive,

46:49

respectful dialogue. So we have some differences,

46:51

but we're really it's not like we're worlds apart.

46:53

And I think it's really important to

46:56

just highlight that these types of discussions

46:58

are really important and essential for science.

47:02

I think the media and social

47:04

media aims to polarize these

47:06

issues. And I think there's actually more in common

47:08

than there is that we disagree

47:10

on. But yes, there's some disagreements.

47:12

And I think, you know,

47:15

in the letter, which which Walter sent to

47:17

me, he's going to submit, you

47:19

know, I think there's valid points and we're going to respond.

47:22

And I think we'll have a lot of agreement about that.

47:24

But ultimately, I think there's there's still

47:26

some disagreement about, you

47:28

know, like you mentioned, what are the recommended intakes

47:31

and what should we be aiming for with these diets?

47:33

And I'm, I think it's important to whatever

47:36

diet, you know, whatever diet we promote,

47:38

I want it to be nutrient adequate.

47:41

And I don't want to take a lot of risk on

47:43

that because I see how widespread deficiencies

47:45

are. So I think that's

47:48

just something that I would want to maintain

47:50

and be able to advocate for throughout

47:53

this process. Yeah,

47:55

I couldn't agree more. I wish there were more

47:59

venues and for for these

48:01

kinds of respectful

48:03

and informed discussions.

48:06

I won't even necessarily

48:09

say debate. I mean, it could be a debate, it could be a discussion.

48:13

I recently listened

48:15

to a discussion about the

48:17

future of AI and

48:20

the impact of AI between Stuart

48:23

Russell, who has really kind of literally

48:26

wrote the textbook on AI. And then

48:28

I can't remember the name of the second.

48:31

His first name was Gary. I can't remember his

48:33

last name. And it

48:36

was completely different context,

48:38

of course, AI versus health and nutrition.

48:41

But I was struck by just how valuable

48:44

it was to hear two experts that really

48:46

respected each other and

48:49

listened to one another while they were talking

48:52

and actually took in what the other person was

48:54

saying. And in one case, I sort

48:56

of listened to one of

48:59

the experts change his mind in real

49:01

time based on what he was hearing

49:04

from the other person in the

49:06

discussion. And I just, my

49:08

main takeaway from that was, wow,

49:10

why doesn't this ever happen in the world

49:12

of nutrition? It seems like there's just so

49:14

much more vitriol and polarization

49:18

and name calling and ad hominem

49:21

arguments. And

49:25

almost to the point of a religious debate

49:30

or a discussion where it just starts

49:33

to go beyond even just the

49:35

data and the facts and turn into a, more

49:38

of a belief or agenda-driven thing. So

49:41

I hope that we can have more examples

49:44

like this of people just

49:46

really working together to

49:49

find a solution that's in everybody's

49:51

best interests.

49:53

I hope so too. And I will

49:55

say there are a lot of healthy

49:58

discussions going on behind the scenes.

49:59

I know because I've been a part of

50:02

many discussions where it is productive,

50:05

it is constructive, it is respectful, and I don't

50:07

think the public is seeing those, right?

50:09

Because those are happening over email, that's

50:12

happening in comments to

50:14

paper revisions to meetings.

50:16

I'm on papers all the time, you know, with many

50:19

of the E-Lancet authors, for example, and

50:21

we have some disagreements,

50:23

some discussions, some debates. That's

50:26

good. That's healthy. That's

50:28

important. And before we can have scientists

50:30

with different perspectives work together, I think

50:33

the work that is going to be produced is going to

50:35

be much more balanced because we all have

50:37

biases. We all need to have them challenged

50:40

and checked in a respectful way because we

50:42

learn from them. I've changed my position

50:45

through writing papers. Another

50:47

researcher who I really respect is Christopher

50:50

Gardner, who wrote a paper recently on

50:52

animal source foods. You

50:54

know, he's been on

50:57

a plant,

50:57

mostly plant-based diet for decades,

51:00

and we have some different views,

51:02

but I was sort of impressed

51:05

by the fact that we could really agree about most

51:07

things and recognize that there are

51:09

different approaches, there are many different approaches to a healthy

51:11

diet. Some

51:14

of the biggest things to address

51:16

we can agree upon, like let's

51:18

really address these ultra-processed foods

51:20

or the junk foods and try to have a

51:23

more wholesome, minimally-processed diet. So

51:25

I think probably it looks,

51:28

because on social media and other public forum

51:31

there is just I think an incentive to be

51:34

critical or polarizing,

51:36

but there is quite a bit that goes on among scientists

51:39

in these discussions. I think what

51:43

people will also see is that there are these formal

51:45

processes of writing a letter to the

51:47

editor and then having the authors respond.

51:49

I think that's helpful too, but we just need a lot more

51:51

of this type of, I

51:54

think, productive discussion between

51:56

scientists.

51:57

working

52:00

on next.

52:02

So there's can you tell us or

52:04

do you have to kill us afterwards? No.

52:10

So,

52:10

really, my organization

52:13

gain works on trying to do

52:15

programs and interventions to change

52:18

the food system, the food environment so that people can

52:20

access healthy foods. So I'm

52:22

just I'm working on some projects to really

52:25

help guide those programs and

52:28

also try to quantify

52:30

nutrition

52:31

more accurately, more

52:33

appropriately in environmental impact

52:35

assessments. So that's another topic I'm

52:37

interested in, you can sort of see the

52:40

many studies that look at, you know, what is the

52:42

what are the greenhouse gas emissions of

52:45

each food that's produced, right? And I think

52:47

that there's a more holistic way to look at that.

52:50

Part of that is through looking at the food more

52:52

than in more terms that just than just kilograms

52:55

or calories or whatnot. And so working

52:58

on some

52:59

efforts to try to quantify that in, I

53:02

think, more holistic ways. And

53:05

ultimately, I'm

53:07

sort of open to

53:09

any sort of projects that I can be

53:11

a part of that help advance this

53:13

sort of what I would

53:16

say my agenda of trying to improve access to

53:18

healthy diets for everybody. So yeah,

53:21

I won't go into all the details. But I

53:23

really, really enjoy

53:25

working with people who are trying

53:28

to

53:29

be constructive and productive

53:31

as opposed to sort of debating to try to win

53:33

an argument. And that's those are sort of the projects

53:35

that I'm pursuing and working on now.

53:38

What

53:38

a relief. That

53:42

sounds like much more fun than the

53:45

alternative. And I definitely

53:48

applaud the work you're doing. I think it's really important.

53:50

As you know, I think this nutrient

53:54

deficiency and nutrient density issues

53:56

have become

53:59

primary for me.

53:59

after 15 years

54:02

of treating patients and training

54:06

thousands of healthcare practitioners in 50 countries

54:09

worldwide and seeing lab results from

54:11

all over the world and my

54:14

research on these topics,

54:17

I've become convinced that addressing

54:20

nutrient deficiency and

54:22

aiming for increasing nutrient

54:26

density of every bite of food

54:28

that we put into our mouth is the

54:31

rising tide that can lift all boats. It's

54:33

not to say that it's a panacea and that

54:35

you know that's going to solve all of our health

54:38

problems, that's of course ridiculous,

54:41

but I think it's one of the few

54:44

things that

54:45

we can do that we

54:47

know will

54:49

have a positive impact

54:51

on just about every health condition

54:53

that we suffer from at

54:56

this point. Whether

54:58

you're looking at heart disease or metabolic

55:00

dysfunction or depression or dementia

55:02

and Alzheimer's or hormone

55:04

imbalances, all of those are characterized

55:07

by some degree of nutrient deficiency.

55:10

Unlike

55:12

big gnarly

55:14

issues, at least in the industrialized world

55:16

like environmental toxins and the

55:18

global food system and things like that, increasing

55:21

nutrient status is relatively low hanging

55:23

fruit. The work you do worldwide,

55:27

that's a tougher

55:29

goal in developing countries, particularly

55:33

I imagine, but in

55:35

the west, in the wealthier

55:37

industrialized countries, it seems

55:39

to me that just

55:42

even some small steps towards

55:44

increasing the nutrient density

55:47

of diet could go a very long way

55:49

in improving people's health. This

55:52

has become sort of a legacy issue for me

55:55

because it doesn't require

55:57

seeing a functional medicine clinician one-on-one.

56:00

paying thousands of dollars for that

56:02

and for lab testing. It

56:04

doesn't require anything fancy, really. It

56:06

just requires a more nutrient-dense

56:09

diet, and in some cases, maybe some well-targeted

56:12

supplements. And that can make

56:14

an enormous difference in individual health

56:16

and also in public health.

56:18

I find that so striking, Chris,

56:20

that in working in the context

56:23

of the US, I know you work with other patients,

56:25

but in the US where obesity and

56:27

other non-communicable diseases are very

56:30

high, you still see a significant

56:34

role for addressing micronutrient

56:36

deficiencies. And I think that's an important takeaway

56:38

because that's not the narrative you

56:40

hear in many public health messages,

56:42

right? You don't hear, we should be

56:44

concerned with nutrient adequacy and nutrient

56:47

efficiencies in the US or other high-income countries.

56:49

But I don't think that's true. I think it's clear

56:51

from the data that there really are some

56:53

important gaps and it affects not

56:56

just the undernutrition, but the relationship

56:59

with other non-communicable diseases

57:01

like you pointed out.

57:03

Great, well, thank you so much, Ty, for joining us

57:05

again. I know you're pretty active on

57:07

Twitter. Is that the best place for people to follow

57:09

you and stay up to date with your work?

57:11

Yep, I post the latest things I'm

57:13

working on on Twitter. My handle

57:15

is Ty R. Beale.

57:18

It's T-Y-R-B-E-A-L.

57:21

So please check it out and I'll

57:23

be happy to engage there as long as it's

57:25

respectful. Yeah, exactly. No

57:29

hating, please. Yeah,

57:32

and then the other piece

57:35

of that, of course, is personal

57:37

ad hominem tax are not very persuasive,

57:39

right? It's just like if you

57:41

want to argue with something that has been

57:44

published in the literature, publish something

57:46

yourself or make a constructive argument

57:48

using data that's actually supportable

57:51

rather than just slinging mud and calling

57:53

names, which is not very

57:56

persuasive at all for those of us that are

57:58

paying attention.

57:59

Again, thanks for your work, Ty. Thanks everybody

58:02

for listening. Send your questions to

58:04

chriscrustor.com slash podcast question,

58:06

and we'll talk to you next time.

58:09

That's

58:09

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58:11

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58:43

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58:49

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58:52

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