The best prescription for reducing inflammation, cholesterol, and weight is right on your plate. Cardiologist Hooman Yaghoobzadeh, MD, explains the science of eating well, and how the right foods are life enhancing and will actually change your genetics.
Dr. Stieg: Today I'm with Dr. Hooman Yaghoobzadeh, who is Clinical Associate Professor of Medicine at Weill Cornell Medicine and Associate Attending Physician at NewYork-Presbyterian Hospital specializing in cardiovascular disease. I'm also with his patient, Mr. Jamie Streeter, who is managing director in Cohen's Healthcare Investment Banking. The group focuses on life science companies. Since we're going to be focusing on food as medicine, I'd like to start off before we even get to the point where we need to use it as medicine. What is the right stuff? What foods should we be putting into our body on a regular basis?
Dr. Yaghoobzadeh: The a diet that typifies, from my perspective, what an ideal diet is, and we can talk about the science as well, is what's called a whole foods plant based diet. So whole foods, meaning when you look at what you're eating, you can identify exactly what it is. It's not a list of ingredients or a bunch of powders, but it's a kernel of corn or it's a quinoa or a nut. And so that's whole foods and that reduces processing and increases nutrient density. And we can talk about why all of those things are important. And plant-based, so getting the vast majority of your proteins from plants and they should be a variety of plants, nuts and seeds, legumes, vegetables, greens, the whole gamut of plants, fruits and fish, I believe, is also another part of a very healthy whole food plant based kind of diet. Maybe two to three times a week, but probably not more than that.
Dr. Stieg: I can't eat meat? Please? *laughs*
Dr. Yaghoobzadeh: So meat is, yeah, there's very few things that are, you know, that you may put on the toxins list. And you know, some of those things, you know, are like bacon, and soda, and white sugar. They're, they probably, um, and there are researchers, for example, at Cornell that are striving to list high fructose corn syrup and sugar as a carcinogen actually. So there are some foods that are relatively highly toxic, but most foods, you know, when I talk about this diet to patients, they're like, well, you know, my diet is extremely healthy. And when I talked to them about it, they're having chicken, you know, twice a day, every day. And it's really the main source of protein. And I see a lot of the animal proteins is neutral compounds. They're just taking space away from a truly healthy, very high fiber plant compound. And so I try not to look at it as evil or not, and I have steak now and then, you know, it's a plant based. That's why I never use the term vegan.
Dr. Stieg: So that takes me to the question about, you know, everyone says "Everything in moderation." So in your mind, what's moderation?
Dr. Yaghoobzadeh: It would be everything in like paleolithic—
Dr. Stieg: Can I have bacon once a month?
Dr. Yaghoobzadeh: Um, yeah. I mean it's, what I try to challenge patients to do is to eat healthier than where they are now. And so as opposed to focusing so much on what the ideal diet is, if we can take steps to move in the right direction, those are wonderful steps.
Dr. Stieg: What do you think about, I was with another one of our esteemed diet gurus here and some other people and they've started these packages and I was with them and they gave me this protein package and I mixed it in a glass, a glass of something where, I know I just poured it down my mouth and it tasted quite good. But they said, "That's your protein dietary requirement for the day."
Dr. Yaghoobzadeh: I'm not a fan of protein powders and things that are processed to get the pea protein out of the pea, you need to extract that protein—that is a chemical process. And, what you're also doing, you're extracting the amino acids, but you're leaving a bunch of other really amazing things. And the, the wonderful thing that, the interesting thing about many foods that we know are healthy for you, for example, fiber, vitamin C, vitamin B, all of these micronutrients that we've identified as being extraordinarily healthy and this sort of fits right into food as medicine. When we've isolated these compounds and given them to patients in randomized prospective placebo controlled trials, every single one of those studies show that, for example, vitamin C or vitamin B, like I said, or even fiber, it doesn't do anything in that controlled study. So what that means that even though every other study that has identified the amount of dietary fiber shows that the more dietary fiber in your diet, the healthier you are and the less heart attacks when you give fiber as a supplement, it actually doesn't lead to the same health. That's because these foods are found in, you know, environments where they need to be juxtaposed to hundreds of other compounds.
Dr. Stieg: I think this is where we as Americans frequently go wrong is we, we go into the coffee shop and we see the high protein bar — I saw this high protein shake and we're looking for the quick solution versus the high fiber diet and the high vegetable diet. So Jamie, I mean how did you do it? I mean you had to change your lifestyle, you lost 50 pounds and your numbers all got better. What was the emotional component that you went through to achieve this other than the fact that you were afraid of dying?
Jamie: Right. I was going to say the survival instinct's pretty strong generally. Uh, I think again, with age you start to confront, you know, what do you do to stay better? I think is the, the reality in this. And it's interesting you say it's hard. I mean I, I honestly think it has to be somewhat like what you described, which is you have to change your mindset about food. I also find today that, you know, I eat the breakfast prescribed, I eat lunch, but at like 10 or 11 I'm going to have an apple. And I do that all the time or a banana and it means I eat actually less at lunch. I think if you graze, you just eat differently and the body doesn't try to compensate one way or the other. And I've read that that's a bizarre behavior change. But I now travel with like fruit in a bag and use it when I'm traveling or the offices, in fact, our office is now stocked with fruit instead of a lot of what these stuff, because I kind of said, "Hey everybody, hey!"
Dr. Stieg: No protein bars on a shelf.
Jamie: If you go to our firm today, there is a different set of snacks than there were six months ago.
Dr. Yaghoobzadeh: But the reason I think it is a problem, it's obvious. I mean what are the two major healthcare crises in America right now? It's diabetes and obesity. Those are self-inflicted and they're diet inflicted. So the reason this, this discussion is so important and I, I guess there's probably a lot of people that don't appreciate the fact that, they think, "Oh, I've got to have a high protein diet means I need to eat steak and chicken and a lot of meat." That's a fallacy. Can you expand on that?
Dr. Yaghoobzadeh: Yeah. And if, if you want to hear somebody a lot more interesting than me, uh, talk about that... You know, if you look at Tom Brady's diet, if you look at Richard Roll, who's one of these ultra marathon runners, you know, five IronMans, five countries, five days, some crazy thing like that. The world's strongest man, I think his name is Mr. Baboumian, these are all whole food plant based types of diets and, and they have tremendous energy expenditures and they're eating plant proteins. Some of them because of the intense number of calories that they need to take in, will supplement with plant based protein powders. But this idea that we need all of this protein is really a fallacy. Our body will digest and create the perfect proteins from any proteins that we give it. And even what we used to think of as quote, unquote "essential" amino acids, these are amino acids that almost are exclusively found in animal products. That concept doesn't really exist anymore because we used to think our bodies couldn't make those amino acids. And it turns out that they can make most, all of the amino acids and we only need them in trace amounts.
Dr. Stieg: Can you enlighten me a little bit on this compound X or I guess it's called TMAO and the relevance of a plant based diet versus a mediating diet.
Dr. Yaghoobzadeh: Yeah, and Jamie might have, I might remember this talk. I use this as an example to have people understand how our body actually works with our microbiome. And there's this compound in the blood called TMAO, which we've known about for many, many years.
Dr. Stieg: Is that its name or an abbreviation?
Dr. Yaghoobzadeh: It's an abbreviation. I can't pronounce it. Tetramethylhydra-something or other, a little bit tongue in cheek. But, um, we've known for a long period of time that it is inflammatory. It leads to heart disease, it causes heart disease in animals. And we've been able to show very, very definitively that the higher the levels of TMAO in the blood, the higher the risk of having a heart attack or stroke 5, 10 years down the line. So the work was done and found that one of the places where TMAO comes from is L-Carnitine. L-Carnitine is an amino acid that's found in meat. So scientists wanted to do a study and try to figure out how quickly does meat get changed to this compound TMAO and where does it distribute in the body? How quickly does the body get rid of it? To do that kind of study, you need a system that's clean, has none of the TMAO in it. And then you need a system that's already reached steady state where the TMAO and the blood and the fat are out of equilibrium and so on and so forth. So the natural experiment is take a group of vegans, feed them steak, which students will do anything for, you know, money. And uh, you do a clinical study and then you take a group of people who are not vegans and you give them the same piece of steak. You measure TMAO before and after, and you see what happens.
Dr. Yaghoobzadeh: Normal folks, TMAO levels are elevated. They eat steak, TMA level goes up dramatically over 24 hours. Vegans, TMAO levels at baseline are close to zero. They eat steak and nothing happens that our TMAO level over the next 24 hours. And this was very confusing and surprising because you know both the vegans and the non vegans are human and they're eating the steak and it's not like they're genetically different or anything like that. And it turns out that gut bacteria break down L-Carnitine into a compound called TMA. And then we absorb that and make it into TMAO. And when there is steak L-Carnitine regularly in the diet, the bacteria that break that L-Carnitine down have a new food supply and it's like evolutionary biology. Those bacteria now have all this L-carnitine. They replicate, they set up shop all over the gut. The factories there stay, comes in, gets changed to TMAO the vegans because they haven't had L-Carnitine, those bacteria are starved. They haven't set up shop, they don't exist in the gut in real numbers. Steak comes in and it gets processed into something else. Now, the amazing thing about that is just like TMAO many, and some people say up to a third of metabolites that we can measure in the blood are actually related to the bacteria that live in your gut. They're not necessarily a function of you. They're a function of your bacteria. And if you are who you are because of your genetics, if you line up all of your genetics, all of your DNA head to toe, there's more genes, there's more DNA on your body, potentially that's bacteria than is you. So when you change what you eat and you change the bacteria that live in your gut, you're genetically changing who you are. For me, when I understood that it was a light bulb that went off, that you literally can change your genetics.
Dr. Stieg: So I can literally think that you're as smart as an amoeba. *laughs*
Dr. Yaghoobzadeh: Yeah, yeah, absolutely. And so I use that as a, as an example of, of what kind of power we actually have over things that we don't think we have any power over, like our genetics and the genetic determinants of our physiology. So that's, that's a really profound example for patients.
Dr. Stieg: Before I switch to Jamie, I just want to remind you that one of my heroes, Winston Churchill had probably the world's worst diet and he lived to 89 and seemed to be a content old man—
Dr. Yaghoobzadeh: And smoked a cigar—
Dr. Stieg: Up 13—
Jamie: He clearly had good genes. Very good genes.
Dr. Stieg: That's why I wish we really could quantify how important genes are. So Jamie, you know, you're running through airports all the time and I have not found an airport where there is healthy food, nor have I found an airplane where there's healthy food to the point that I don't really like to travel that much anymore. What did you do? Carry on?
Jamie: Yeah, it's a combination of carry on but I think it's also how hard you look and also frankly what you restrict yourself to. If you, you can always get fruit generally speaking. And so fruit literally replaces a lot of what I eat normally. You can also frankly find like, you know, salad bars where the salad bars come with some form of, you know, legumes and all that kind of good stuff. And so you have to make the time and effort to do that. You actually can ask the airline to make, you know, vegetarian meals. As we all know, they taste like nothing and they're unpalatable. You have to figure out lemons and limes and that kind of stuff.
Dr. Yaghoobzadeh: I always carry a bag of nuts, pumpkin seeds, um, things like that with me.
Dr. Stieg: You really got me excited.
Jamie: You'll laugh, so I go out to dinner for work a lot and my kids say, so what are you having for dinner? And my response is I'm having salad followed by salad.
Dr. Stieg: Adventuring out. But as I understand it, in your earlier life, you were a dessert connoisseur. What did Hooman do to your life?
Jamie: It's about sugar I guess at the end of the day. And so sugar clearly was a problem. The funny thing is it's not really sugar. I think it's just something that tastes sweet or you know, has some fiber in it. So we now have in my house dried fruit, amazing stuff. It's actually good things like that. So I think the fresh fruit is also actually very high in sugar, if you are okay with that. And so I eat a lot of like, I'll buy sliced pineapple. It's really good.
Dr. Stieg: So you can expand on that a little bit. So for people that have a sweet tooth work where can they go?
Dr. Yaghoobzadeh: Yeah. So the first thing to realize I think is that just like some people are addicted to alcohol and cocaine, the rest, all of us are addicted to sugar. And so when you look, when you're looking at your dessert and you see it as a line of cocaine, um, you have the correct context. So I have dark chocolate, I'll have nuts and raisins, like a trail mix, something sweet like that. My wife makes oatmeal cookies, which have sugar in them but less sugar and, and it's, you know, I don't eat it before I have dinner. There's a level of self control for sure. And I also, nothing is off the table forever. And so at holidays, parties, things like that. If I haven't had a dessert and it's like I'm at a cultural event and you know, there's this Polish dessert because I didn't realize there are Polish desserts. I'll, I'll eat it and indulge. Yeah.
Dr. Stieg: Everything in moderation.
Dr. Stieg: I don't know if either of you experienced this, but I'm sure many people do that they are married to somebody that has no sense of urgency in regard to their diet and they're not simpatico with you. And in this regard, how do you handle that? And I don't want everyone getting divorced over diet.
Dr. Yaghoobzadeh: Yeah, I act. So when I have patients come in for a diet talk, I insist that they bring their spouse, children, friends, um, we sit down and we have a conversation and I present to them the data. We go over PowerPoint slides. But I think that's an outstanding point. I also tell patients of mine who are parents and grandparents for that matter, the unintended consequences of you changing your diet is that others will change their diet around you. They have your genetics and you are going to have generational influence. And you know, Jamie was saying that you've changed the snacks in your office and that's sort of another perfect example of that.
Jamie: Yeah, I mean I think that that's in the work setting. It was very clear that A, my colleagues noticed what happened. And B, I sort of went on my way and said, guys, this is dumb to have, you know, it's literally was popcorn and a lot of these, you know, the granola bars that are basically sugar.
Dr. Stieg: Is popcorn okay?
Dr. Yaghoobzadeh: If it's not caramel and no butter. Yeah. Because it's just, it's a whole food.
Jamie: The other thing I will also say is that's the work at home. You start to go out and buy and shop for different things cause you've changed your diet. I think family is influenced by that. My kids are out of the house at this point. It's really just my wife and I, she's actually just as conscious as I am about, you know, weight and the rest of it. So she was always game. And I think that, you know, seeing what I went through, she's rapidly adapted to essentially the same diet.
Dr. Stieg: Well I find when, when when my nephew moved in with me and he was a vegan and my children at the time were seven and eight and all of a sudden my kids became vegan. That made life difficult.
Dr. Yaghoobzadeh: Can you guys tell Phil is not converted yet?
Dr. Stieg: I keep trying. They've kind of, they got back into food, regular food when they went to college, but now they've gone back to vegan and they're, they're are so much more conscious of what they put in their mouth than I ever was at 30.
Dr. Yaghoobzadeh: So I'm not the only one whispering in your ear.
Dr. Stieg: Plenty of people whispering to me. Jamie, tell us, when you, when you converted to this healthy diet, did you see a change also in the medications that you had to take? Did you reduce the statins and the blood pressure meds and all that?
Jamie: Well actually, it gets, just to be clear, I was essentially on statins, right?
Dr. Yaghoobzadeh: Right.
Jamie: And, and you know, obviously we had increased, we had increased the dose. So we talked about reducing it, but I, I guess I was sort of like, ah, it's a good stuff. It doesn't hurt.
Dr. Yaghoobzadeh: You know, your LDL levels, which were in the 130s now are 53. I am one of the physicians that really likes to keep LDL down and patients like yourself, we could actually potentially reduce the statins, to make sure that LDLs continue to be less than 70.
Dr. Stieg: The nutraceutical market is huge. And there was just an article in the New York Times and the Science Times this week about glucosamine. I don't know if you saw it, you know, it's obviously good for your joints, but now it may reduce your risk of heart attack and stroke. What are your thoughts?
Dr. Yaghoobzadeh: Again, I am not a believer in, in the supplements there are many of these supplements are based on some basic science research studies, animal studies. They have not had well done large randomized perspective, human studies, the large randomized prospective human studies that we have about supplements are all negative or 99.9% of them negative. And so for every one of those wonderful compounds, I can show you 10 others like curcumin and NAD and quersutin and so on and so forth that are also positive. And at the end of the day you're going to end up with 15 different supplements and we're not going to know exactly which one's working or not. I'm not, I'm a Western medicine type of trained physician. I've gotten convinced by the science behind food. I have not been convinced by the science behind supplements.
Dr. Stieg: So Jamie, when you get hungry or do you get hungry?
Dr. Stieg: You do. Okay. Uh, do you plan for that? You said you carry an apple in your bag.
Jamie: Well yeah, it's apple, banana. I actually like dried fruit of some kind. Um, that, And nuts. I think that's, that's essentially what I would, you know,
Dr. Stieg: And at the end of a meal, you're really satisfied.
Jamie: Well, I went out to dinner last night in New York and you know, everyone had dessert and I had dessert with everybody else. I had strawberries and blueberries. It's that simple and I just, it's not a big deal. No one really knows this. And it goes fine, but that's essentially what you had.
Dr. Stieg: Did you go cold turkey? Yeah — you met Hooman and boom.
Jamie: No, actually it's funny, there was about a six month or maybe even a year lag between the first time and I think the numbers didn't improve and I got more, I guess—
Dr. Stieg: More convinced. So it was a slower transition?
Jamie: Well, initially I think, and then I didn't see him again for a year. And I think in the course of that year I adhered to the plan.
Dr. Stieg: What do you see in patient populations? Do they do the cold turkey or do they kind of gradually grow into it like Jamie?
Dr. Yaghoobzadeh: Because of the way that I've set it up, I, I have a lot of patients sort of do a month challenge to sort of get their heads around being able to do this. And it doesn't feel unsurmountable if you're only gonna do it for a month. And then they see all their numbers change and now they're motivated. And there are patients who have been in my practice for 8, 9, 10 years. They just recently started to move towards a whole food plant based diet because that was the right time for them. I've been eating like this only for about eight years, nine years. That's because at some point in my life I was in the right psychological space to be able to sort of open up to this. So everybody's has their own a magic box and black box of, of you know, how they can influence their health and life.
Dr. Stieg: We're sitting here on the Upper East Side. A lot of people listening to this don't live in this particular area. And in my work with the American heart association, we have these food programs going on. The thing that I worry about is it's, this easier is to do in our environment, but how do we get this to the schools? Frankly, the efforts we've made is we try to change the diet in the high school and the parents call in and they go crazy — the PTA. Say, what are you doing, messing with my kid's diet? That's real food is medicine. What, what, what do you think? What do we do?
Dr. Yaghoobzadeh: There's an absolute cultural shift that needs to happen and what's amazing is, you know our great, great, great grandparents knew how to eat. They were peasants, they were poor. Animal proteins were very expensive. They were reserved for weddings and birthdays and things like that, so it's not really a novel concept, it's just getting back to traditional ways of eating and cooking, but you're 100% correct that there needs to be a cultural shift and that's why I do talk about addiction because I think part of our pushback is the addict and us subconsciously pushing back. New York City schools now have Meatless Mondays, New York City hospitals, now we're moving towards plant based meals. We have easily identified this Southern diet actually through work that's been done at Cornell. The Southern diet, which is a very high saturated, highly processed diet is very closely linked to to heart disease and so it's, I think it is a slow process and we just have to continue to talk about it. There are more and more restaurants that are popping out—
Dr. Stieg: Are you aware of any movements that are going on that are really going to help us get, get the population to change? Cause I agree with you totally. If we're talking about food as medicine, which it is, we got to change behavior.
Dr. Yaghoobzadeh: Some of it is happening in pop culture. So there's going to be a documentary coming out, um, called Game Changers that sort of goes through athletes who are whole food plant based. There is now the Lancet diet study which links plant based eating with planetary health. So there are many, many movements that are really understanding this message that, one of the ways to reduce our carbon footprint is to move away from animal products. There is a documentary that started this, which is called Forks Over Knives. There are many books out there now about this kind of eating. Eat to Live is one of them. How Not To Die is another one. Interesting play on words. So that is starting to become much, much more obvious. The way that we eat and the way that we take care of our planet are linked.
Dr. Stieg: Hooman, Jamie, I think that we've kind of really focused on how important food is as a medicine, and hopefully — Hopefully I will change and hopefully we've changed the number of people that are listening to this. Thank you so much for being with me.