Food For Thought, Eating for brain health with Dr Neal Barnard

Voice Over:

Welcome to the NIHR Dementia Researcher Podcast, brought to you by dementiaresearcher.nihr.ac.uk in association with Alzheimer’s Research UK and Alzheimer’s Society, supporting early career dementia researchers across the world.

Dr Samuel Moxon:

Hello, and thank you for tuning in to the Dementia Researcher podcast. I’m Dr. Samuel Moxon, and I’m delighted to return as the host of the dementia podcast. Our guest this week is someone whose work I’ve followed for many years, New York Times bestselling author Dr. Neil Barnard. Dr. Barnard has led numerous research studies investigating the effects of diet on diabetes, body weight, and chronic pain, including a ground-breaking study of dietary interventions in type II diabetes funded by the National Institutes of Health that paved the way for viewing type II diabetes as a potentially reversible condition for many patients.

Dr Samuel Moxon:

Dr. Barnard had authored more than 100 scientific publications and 20 books for medical and lay readers, and he’s the editor in chief of The Nutrition Guide for Clinicians, a textbook made available to US medical students. As president of the Physicians Committee, Dr. Barnard leads programs advocating for preventative medicine, good nutrition, and higher ethical standards in research. His research has contributed to the acceptance of plant based diets in the dietary guidelines for Americans. In 2015, he was named a fellow of the American College of Cardiology. In 2016, he founded the Barnard Medical Center in Washington DC as a model for making nutrition a routine as part of all medical care.

Dr Samuel Moxon:

Working with the medical society of the District of Columbia and the American Medical Association, Dr. Barnard has authored key resolutions now part of AMA policy calling for a new focus on prevention and nutrition in federal policies and in medical practice. In 2018, he received the Medical Society of District Columbia Distinguished Service Award, and he’s hosted four PBS television programs on nutrition and health. Originally from Fargo North Dakota, Dr. Barnard received his medical degree at the George Washington University school of medicine, and completed his residency at the same institution. He practiced at St. Vincent’s Hospital in New York before returning to Washington to found the Physicians Committee.

Dr Samuel Moxon:

We had a fascinating discussion about the role of lifestyle in dementia, so without further ado, let’s get to it, and we hope you enjoy this episode.

Dr Samuel Moxon:

So Dr. Neil Barnard, welcome to the Dementia Researcher Podcast, and thank you for joining us today. How are you feeling?

Dr Neil Barnard:

Terrific, great to be with you today.

Dr Samuel Moxon:

That’s what we like to hear, we like to hear that everyone’s doing well. So obviously, I’ve been a follower of your work for some time, and I’m particularly interested in the work you focus on with relation to diet, lifestyle, and health. And I’d like to start with Alzheimer’s, and the simple question of, can we do something to prevent such a debilitating disease? And if so, what can we do with our lifestyle?

Dr Neil Barnard:

The short answer is that there is a tremendous amount that we can do. And that’s so important, because up until recently, and really still today in the minds of many people, dementia is simply a function of old age and genetics. If you’ve got the genes, it’s just a matter of time, and old age brings with it dementia as just part of the years going by. That is pretty clearly not the case, and there are things that research has brought us that are surprisingly simple, and that we can implement tomorrow morning.

Dr Samuel Moxon:

Okay. So let’s touch on that last point, that you say something we can implement tomorrow morning. That’s quite a powerful message, because it means it gives you this idea that there is something you can do, and you can do it right away. So what are the specifics of that? Is it changing diet, and if so, what should we be looking to eat more of and less of?

Dr Neil Barnard:

Yes, diet is the cornerstone. And I give the credit really to researchers in Chicago, the Chicago Health and Aging Project. They got started back in 1993, and it was an observational study where they rounded up thousands of people. They looked at dietary patterns, and they looked at who succumbed to dementia. And they even factored in who had genetic risk, who didn’t. And when you put this study together with a number of other studies, the pattern is really very clear. First of all, we indict bad fat, and when I say bad fat I mean saturated fat. That’s the fat that’s solid at room temperature. Cheese, dairy products are the biggest source, meat is a big source. So if you have a diet that doesn’t have any dairy or meat in it, you are miles ahead, and the risk of Alzheimer’s is probably cut to less than half, probably maybe less than a third of what it would’ve been.

Dr Neil Barnard:

But it’s not just avoiding the bad stuff. It’s also bringing in good things. And generally speaking, a dietary pattern based on vegetables, fruits, whole grains, and I’m going to say legumes but that really means beans and lentils, that is a good basic pattern. And let me throw in modest amounts of nuts and seeds. 25 grams, 30 grams nuts and seeds, because they have vitamin E, and vitamin E, people who have vitamin E not from pills but from foods, that’s an important distinction in the research studies, they cut their risk of Alzheimer’s by about 50%.

Dr Samuel Moxon:

Wow. So just by simply eating the right things, you can hugely reduce the risk. And that’s independent of genetic risk factors like say, APOE E4 for example?

Dr Neil Barnard:

Yes. And that is so critically important, because people have rightly been concerned about this genetic trait. It’s a single genetic trait. It’s the epsilon 4 allele on the APOE E, and if you got it from both parents, you’re at 10 to 15 times the risk. So people have been very concerned, and when they get the bad findings on their test results, they get very nervous about it. Rightly so. But let me say a word. Researchers have looked at individuals who specifically had the APOE-E epsilon 4 allele, and if they were avoiding bad fats, their risk of developing Alzheimer’s was cut by oh, a good 80% compared to people with similar genetics, but who were tucking into the cheese omelets and the animal fat and that kind of thing.

Dr Neil Barnard:

And the problem of course is that in our cultures, here in North America certainly, throughout Europe, up and down Britain, these high saturated fat foods are front and centre, and have been. But luckily there has been a huge movement for many years now to remember humble beans. Vegetables. Fruits.

Dr Samuel Moxon:

Yeah. And you can make some absolutely delicious recipes with those ingredients. I can attest to that. So it’s interesting as well. So we’re talking about reducing risk with things like saturated fat, and you talked about… I saw you in a TED Talk which is based on your book, Power Foods for the Brain. You talked about your mother would make bacon, and then use the bacon grease for the eggs the next day, and the fact that it solidified at room temperature would mean it’s high in saturated fat. So does that mean we’re also getting essentially kidded or lied to about things like coconut oil, which we’re told is healthy? Because that’s solid at room temperature as well.

Dr Neil Barnard:

Coconut oil and palm oil have become major commercial products in recent years, and along with the commercial push comes sort of a health claim push, which is that it’s natural. But it is about as bad as butter, so I would steer clear of it. And the alarm bells went off with cardiovascular disease, when in a randomized trial you can feed people a healthy diet that doesn’t have a lot of fat in it, check their cholesterol levels. You can feed them butter, their cholesterol levels will rise. If you feed them coconut oil or palm oil, their cholesterol levels rise too. Maybe not as bad as butter, but they go up. And so I would encourage people in the same way as you avoid animal products because they’re rich in bad fats, I would avoid the coconut oil and palm oil as well.

Dr Samuel Moxon:

And it’s interesting you’re talking about this, because especially in recent years, we have grown to learn more that there are connections between the digestive system and the brain, and have studies showing that for example, the bacteria in the gut are altered in Alzheimer’s Disease, there are studies linking high blood and hypertension, insulin resistance, things that you might not necessarily think of the brain when you think of that, but they all link. So when you’re talking about reducing saturated fats and things like trans fats, and the positive impact that can have on the brain, are we talking about a direct effect? Or is it a mixture of indirect effects and direct effects, with it affecting other parts of the body as well?

Dr Neil Barnard:

I think we should be clear about what we know and what we believe. What we know is that certain dietary patterns are clearly linked to better cognition as the years go by, and what we believe is that a big part of the drive is just basically cholesterol. In the same way as you eat bad fat, your cholesterol level rises, that hurts your heart, that hurts other parts of your body, it hurts wherever you have blood flow, it also hurts your brain.

Dr Neil Barnard:

And researchers here in the United States did a troubling study of more than 10,000 people, and they found that those who had high cholesterol levels had substantially higher risk of Alzheimer’s later in life. But the cholesterol levels they drew to use that prediction were drawn at about age 40. In other words, you’re eating bad foods, you’re in the prime of life, you think, “Well, I’ll worry about that when I’m 80.” Apparently the seeds are sown early in life. The arterial damage, including the arteries leading to the gray matter, are damaged quite early.

Dr Neil Barnard:

But the cholesterol issue is part of it, but there may well be other contributors as well. Blood sugar may play a role. People who have diabetes, people who have diabetes probably double their risk of developing Alzheimer’s, and our work has shown conclusively that the same diet I just described, vegetables, fruits, whole grains, beans, healthy foods, low fat foods, is by far the best diet for a person who’s got a desire to reduce their risk of diabetes.

Dr Samuel Moxon:

Yeah, and it’s interesting that you just talked about studies that were done on people in their 40s, because we obviously know now that this is a disease that takes many decades to manifest, and so it’s a series of changes and a series of problems. And so I guess the earlier the start, the earlier that you start the better. And it’s also when you talk about cholesterol. If you think about the fact that cholesterol clogs arteries and stops blood flow, well the brain is one of the most blood hungry organs. It needs this massive blood supply [inaudible 00:10:39]. Is it possible that by eating these high amounts of saturated fats and trans fats, we’re actually blocking that blood supply to the brain, and that is causing some of the inflammation and some of the damage that’s linked to diseases like Alzheimer’s Disease?

Dr Neil Barnard:

Yes. The short answer is yes. And it is important to remember that you have more than one kind of blood vessel in the body. You have very large blood vessels, the carotids, those are the main lines going up to the brain. But then they branch off into very tiny blood vessels, where a very modest narrowing can lead to a dramatic reduction in blood flow to certain regions of the brain. The brain tries to compensate by making collateral blood flow, where you’re stealing a little bit of blood flow from next door, and you can cope with that for a while. But eventually, then arterial narrowing become quite regional, and that’s something you just don’t want to have happen.

Dr Neil Barnard:

But in the 1970s, 1980s, we thought that that was a one way street as well, and so that if you had narrowed arteries that was part of being old, there’s nothing you could do. And then along came Dr. Dean Ornish, who showed that people with quite significant atherosclerotic plaques narrowing their arteries could through simple lifestyle changes, without even cholesterol lowering medication at that time, could cause those arteries to reopen enough that the increase in blood flow was very significant. The chest pain would go away, erectile dysfunction, which is blood flow, a blood flow condition, would go away. All these things would go away within a matter of just weeks.

Dr Neil Barnard:

And so we now believe that all of these things are two way streets. So you’ve eaten badly, you’re now later in life. You’re thinking, “What can I do?” The answer is, let’s plan your breakfast tomorrow so that we can get the bad fat out of your diet, open those arteries up, get your blood sugar under better control with a healthy plant based diet, and you’re not going to become a teenager again, but you’re going to become a whole lot more like a teenager than you are now.

Dr Samuel Moxon:

Yeah, and it’s a change that I made in recent months, and I can testify, the difference you feel is remarkable. You suddenly have these high energy levels. You’re finishing lunch and you’re not feeling like you need to go and have a nap. You wake up earlier, feel better. It’s remarkable. And I guess there’d be some people listening who perhaps think, “Oh, it’s too late for me, I’m older now or I’m too far gone.” Is it ever too late to try and make these changes?

Dr Neil Barnard:

Oh, no, no, no, no, no. The older you get, the more important it is to do this. But frankly no, it is never too early, it is never too late. We have been working with people who’ve had quite advanced diabetes. They’ve had chronic weight problems, and even to the point of having significant complications. I’m talking about diabetic neuropathy for example, where the nerves are being attacked. And I have to tell you, these people very often feel really quite hopeless and depressed. The medications they’re on, fairly heavy duty pharmaceuticals, not really touching their symptoms.

Dr Neil Barnard:

But when we begin the diet changes, we’re doing something that the medications can’t do, which is we’re going to the basic, fundamental pathology of it, which usually has to do with the insulin resistance in the cell, or the cholesterol level in the inner lining of the arteries. And if you’re attacking that directly by changing the fuel that’s going into the body, the body has a capacity to heal that imperfect as it is, is functioning as long as you’re alive, in the same way as you cut your skin, it will heal if you’re 90. If you break a bone, you can heal. Maybe not as well as when you were four or five, but you’ll heal. The arteries can heal. We should be putting this to work regardless of age.

Dr Samuel Moxon:

Yeah, and then you talk about insulin resistance, and that’s obviously something that’s also linked to Alzheimer’s Disease, is insulin resistance in neurons as well. Similar thing that you see in type II diabetes. So is it as simple as, is fat then the problem for diabetes, not carbohydrates as perhaps a lot of people still think?

Dr Neil Barnard:

Yes. What you said is the single most important breakthrough in diabetes in the past 20 years, which is well known in the research community, but has not filtered through sufficiently into a lay understanding, and that’s this. That diabetes does not come from eating bread, or eating sugar, or eating a potato, or starch in general. Diabetes starts as a condition called insulin resistance, where your cells aren’t responding to insulin anymore. Insulin’s job, the insulin made in your body, its job is to open up the cell membranes to let the sugar into the cell. And if your diet is fatty, chicken, fish, beef, chips, [inaudible 00:15:45] in the fryer, the grease builds up inside the cells. When the cells get filled with little microscopic particles of fat, they no longer respond to insulin’s signal anymore. Insulin stops working, you are insulin resistant. Your blood sugar goes up, your doctor diagnoses you with diabetes.

Dr Neil Barnard:

If you follow the diet I described earlier, there’s not much fat in the diet of any kind, because you’re not eating animal products at all, you’re keeping oils low. The cells start to eliminate that accumulated fat, and we have documented this with magnetic resonance spectroscopy. It’s a very expensive technical test, but you get in, you put the patient into this large magnet, and you’re looking at their liver cells and at their muscle cells, and you can just see the fat is going away because they’re not eating it anymore, and then their blood sugars start to come down, because the sugar is now able to get into the cells and out of the blood. And as time goes on, the primary physicians of these patients who we work with are astounded. They say, “How did your diabetes go away?” It’s because the sugar is now going into their cells, where it has supposed to have been going all along.

Dr Samuel Moxon:

So it’s almost like if you’re trying to put fuel in the car, and there’s something in the way of the… you can’t actually get the fuel canister into the car, and then expecting that car to run. If you can just remove the blockage, you can then get the fuel into your car, and your car can go. And that’s what the fats doing [inaudible 00:17:16].

Dr Neil Barnard:

That’s a terrific analogy. And up until, oh, two decades ago or so, we didn’t really have the technology to understand this process. But we have it now, and we published a major article in JAMA Network Open last year, six or eight months ago, where we brought in a very large group of people, we put them on this diet. It’s a vegan diet, there’s no animal products, but we also keep oily foods really low. And when you do that, the fat just comes out of the cells, and your blood sugar control is returned to a much more normal status, and the old adage that I learned in medical school, which is that diabetes is a one way street, once you have it you’ll always have it, has been resoundingly disproved. That people who have had diabetes for years can improve quite dramatically. They can reduce their medicine, sometimes get off them. Sometimes the disease is just gone.

Dr Samuel Moxon:

Yeah, that’s fascinating as well, the idea that you can… because [inaudible 00:18:18] my father has diabetes, and the doctor has him on a low carb diet. And I keep telling him, but he’s a butcher, so it’s going to be difficult for me to get the meat off his plate, but I am trying. So it makes you-

Dr Neil Barnard:

Well let me just say a word, because your father is not alone. There are so many people who have grown up in good honest business environments doing things that they thought were good for health, and they feel like they’re providing something that people like, that helps them, that nourishes them. And then we come to develop magnetic resonance spectroscopy, where we can look into your body, and we suddenly see what the products are doing to you. What he sells will not affect his health. What he eats will affect his health. So if he quietly adopts a vegan diet and gets the grease out of his diet, and follows it carefully on a daily basis, the chances of his improving are very close to 100%. And his life and worldview will be transformed, as has been the case for so many people.

Dr Samuel Moxon:

And it makes you wonder, if the fat cells are doing to liver cells, and I’m guessing we’re talking mostly about type II diabetes, but I know it can reduce insulin resistance in type I as well. But it makes you wonder, if it’s doing this to liver cells, what’s it doing to brain cells that we don’t know about yet? And the question I want to ask next is, does this mean, if you switch to this diet, does it mean no Alzheimer’s Disease, or does it just mean significantly reduced risk and there are perhaps other factors as well?

Dr Neil Barnard:

I think it’s too much to say that there will not be any Alzheimer’s disease anymore. I really don’t think that’s the case. And I also think that although you do see improvements in cognition in cases where a person has made changes sort of early in the course of a dementia, I think… well, there is a time when the brain has been damaged, and that is not going to come back. So intervene early, intervene robustly, and be immoderate. There are lots of people who think, “I’ll just make a little change here or there.” That’s like switching from full tar cigarettes to low tar cigarettes. I wish that I had been able to devise a better human body that could tolerate more insults than our body can. We really don’t do very well when we try to eat like a carnivore.

Dr Samuel Moxon:

Yeah, and that’s something that’s the key thing as well. Usually by the time somebody gets diagnosed with Alzheimer’s Disease, a lot of the damage has been done, and so the research is focused on prevention. And so this [inaudible 00:20:57] I guess is a powerful tool for that prevention, because if we can prevent it before it happens, then we don’t have sort of the burden on the health services to try and treat people who at the moment, by the point they are diagnosed, are relatively difficult to treat. There’s not a lot you can really do for those people.

Dr Neil Barnard:

Yes. That said, there have been a number of studies that have looked at individuals who are having early signs of dementia. Mild cognitive impairment if you will. You’re still yourself, but you’re having mental lapses. Names are dropping out, words are dropping out. Your personality’s the same, you’re probably still driving, but you know that your memory is poor. If you look in these people’s brain’s, you often see that the hippocampus, which is the seat of memory, does not look the same. It’s visibly shrunken. So researchers have brought in such people, worked on a range of diet, of lifestyle changes. Healthier diet plus physical activity. There is something about lacing up your sneakers and going out for a brisk walk that seems to oxygenate the brain.

Dr Neil Barnard:

And at the University of Illinois, a large study, 120 people, showed that with a 40 minute brisk walk three times a week, scans of the hippocampus show a reversal of that reduction in size. It starts to be restored a bit, and standardized memory tests improve as well. So we should be doing all these things. We should be doing a healthy diet, we should definitely be supplementing with vitamin B12 which you need for a healthy brain, and we should also be exercising to the extent we are able to.

Dr Samuel Moxon:

Yeah, and that’s quite remarkable, they had that hippocampal shrinking reversing, because obviously the hippocampus shrinking is a big part of Alzheimer’s Disease. It’s where the disease starts is in the hippocampus. It’s almost like the core of your being is the hippocampus, so that’s amazing to hear. So, you sort of answered this question then, but just for those people who are listening who are thinking, “Well I could give this a go, but I can’t give up everything,” is it essential to go full in on this diet? And if so, where’s a good starting point? Is there an easy way to transition into something like this? Because some people might want to try and keep different things if they can.

Dr Neil Barnard:

Can I learn to swim without actually getting into the pool is the way I think of it. My analogy is this. We bring in hundreds and hundreds of people here into our centre. We’re here in Washington DC, and we see people in research studies, and we also see people clinically who have health issues. And we do want them to really become robustly healthy, so we implement the healthiest possible diet, but everybody’s nervous. They’re very much like going to the swimming pool in June. You think, “I’m sure the water’s cold. I don’t know if I dare to jump in.” Everyone’s nervous. So we break the change into two steps, and I have to say, I have never seen anyone unable to do this. It works for, like I said, virtually every time.

Dr Neil Barnard:

You take, you break the next month into two blocks. The first block is a week, the next block is three weeks. Block one, the patient or interested individual doesn’t make any diet change at all, but what they do is they take a piece of paper. And during this week, their job is to fill in breakfast, and lunches, and dinners. Ideas of things that they would eat if they were not eating animal products, and things that they would like, or things they might like. And now they’ve got seven days to test them out. “So okay, I’ll have porridge, that’s okay. But I always put cream on my porridge. Would it taste okay with cinnamon instead?” You’ve got a week, let’s try it out. “For lunch, I have this stew, but I hear there’s a vegetable stew that they serve at the café nearby. I’ve never tried it.” You’ve got a week, try it. “There’s an Italian place nearby, I always have meat sauce on my spaghetti. Would the tomato sauce be just as good?” You’ve got seven days, make your list.

Dr Neil Barnard:

At the end of the week, the patient comes back. They’ve always got a robust list of foods that will work for them. And these may include fast foods. You went to Subway and they’ve got a vegan sandwich, whatever it is. Step two is to take three weeks, and now during this three week period, you’re going to avoid animal products completely. But that is very approachable now, because it’s only three weeks, and secondly you already made your list of what you know works for you, and you’ve probably already stocked up. And so we meet with the individual and their reluctant spouse, and they will go totally vegan together, but it’s now kind of easy and they’re excited, because they wanted to do better.

Dr Neil Barnard:

At the end of three weeks, two things have happened. One is, they are physically healthier. They’re losing weight, their cholesterol’s coming down, if they have diabetes their blood sugar’s better. But their tastes are changing, and they find foods they like. And at that point, it’s very easy. It’s just like you jumped in the pool, you’ve been in there a couple minutes. The water is actually really nice, and I’m not sure I want to get out now. That’s what they feel.

Dr Samuel Moxon:

Yeah, and it does, it genuinely does change, because a good one for me was nutritional yeast, which I thought was disgusting the first time I tried it, and now I think it’s one of the most delicious things to put onto something. So your taste does change. So are there any downsides to trying this then, or is it all upsides?

Dr Neil Barnard:

You are going to have to buy new clothes. You are going to become the answer person for all your friends, because they’re all going to want to know how is it that you lost this weight. No, no, there are no downsides. I will say that there are awkwardness-es, because it’s a new world, and you’ll find sometimes that a person decided they could eat 600 grams of beans and they got a little gas because they overdid it. But no, quite the contrary. What people discover is the applications of it are far beyond helping the brain.

Dr Neil Barnard:

We have been doing some studies recently on the last thing that you would ever think of as having anything to do with diet. It’s not diabetes, and weight, and cholesterol, blood pressure, and all the usual things that get better. What we’ve been looking at is menopausal symptoms. So many women are concerned about this, because they have hot flashes, and they’re miserable during the day, and at night their sleep is interrupted a half a dozen times, and the doctor says the treatment is hormones, and this has been linked to dementia in some people as well. And these hormones can increase your risk of cancer, and they might be harmful to the brain, and the person says, “You’re giving me no choice here. What do I do?” And we have been using a specific dietary intervention for that, finding that hot flashes were reduced by about 80%, and about 6 in 10 women become totally free of all moderate to severe hot flashes within about 12 weeks’ time.

Dr Samuel Moxon:

Wow. So it really is a powerful tool, then. Because the other things that tend to be linked to things like dementia that I know this can help is migraines as well. It’s a problem that I know my partner suffers with, and since changing this, drastic improvement. So is that another big thing to look at? Things like migraines and how we can affect that with a plant based diet?

Dr Neil Barnard:

Yes, and I should hasten to say that the way we do the diet for menopause has certain specific ways. It’s a little bit different than we’ll do it for diabetes. And the way we do it for migraine is a little bit different too, but they’re both easy, and I can describe them. With menopause, it’s no animal products, we keep oils scrupulously low, and we add about half a cup of cooked soybeans per day. And that three step combination is what seems to work, and I can describe why that’s a good thing if you’d like.

Dr Neil Barnard:

But with regard to migraine, we do a vegan diet, and we do that because there are dietary triggers for migraine of which dairy products seem to be at the top of the list. And it seems to be the dairy protein. But there are some people where their migraines are triggered by unusual things, citric acid for example, or citrus fruits, or nuts, or something else. So we have a specific way of trying to go to a very elemental diet, a very simple diet, that eliminates common triggers. And then once they’re doing well, we bring in those triggers one at a time to see if it will trigger a migraine, and if so, then we’ve got the culprit.

Dr Samuel Moxon:

Just out of interest then, if you’re able to say, the menopause research and how you include soy, is that to do with the ability soy has to regulate estrogen activity? Because I know that’s linked to reduced breast cancer as well, the way it binds to the B2 estrogen receptor, and that can have an impact.

Dr Neil Barnard:

The soy story is one where we don’t fully understand it. But soy isoflavones, they are, genistein is one, daidzein is the other big one, do attach to estrogen receptors, and this made people very nervous for some decades because-

Dr Samuel Moxon:

Yeah, there was a whole, soy can… there was a big campaign about soy is suddenly the devil because of this.

Dr Neil Barnard:

Right, exactly. And the concern was, it’s got to increase your risk of breast cancer. However, the results turned out to be just the opposite, that soy was quite predictably reducing breast cancer risk, and women who consumed the most soy, and when I say soy I mean soymilk, edamame, tofu, tempeh, miso, these kinds of things, or just regular mature soybeans. The women who consumed the most had a 30% or more reduction in breast cancer risk, and women previously diagnosed with breast cancer, if they would consume a lot of soy, contrary to what people imagined… people thought, “Oh, that might drive your cancer. It might cause your cancer to recur.” Exactly the opposite occurred, that you saw about a 25 or 30% reduction in cancer recurrence, so soy looks like a cancer preventer, and it’s very helpful.

Dr Neil Barnard:

And so the answer of course has come in more recently, which is you have two kinds of estrogen receptors, alpha receptors and beta receptors. It’s like the gas and a brake, and the soy attaches to the brake very decisively, to the beta receptor. With regard to hot flashes, the secret seems to be this, that soy products attach to the beta receptor, that’s all great, this might have some kind of effect against hot flashes. We don’t fully understand how they’re working, and frankly we don’t fully understand what causes hot flashes in the first place. We just know that this works.

Dr Neil Barnard:

However, soy products work kind of modestly until you also get the animal products out of the diet and keep oils really low. When you do that, something miraculous happens. Your gut bacteria start to change, and within about two or three weeks, you’ve got healthier gut bacteria, some of which appear to convert the isoflavones into a particularly healthful form that has the name equol, E-Q-U-O-L, equol or equol. And what we believe is happening is that when a person does my magical three step program, vegan, low fat, and soy, they eat the soy. The soy goes into their gut. The gut bacteria are now healthy, they convert the daidzein into equol. The equol goes into the blood, it lasts a longer time, and the person suddenly says, “I slept through the whole night last night. What is that about?” And their lives are transformed by this.

Dr Samuel Moxon:

That’s really fascinating. And sleep being a big one for Alzheimer’s risk as well, getting a good night’s sleep, because that’s when you can sort of switch off some of those processes that might be driving the disease.

Dr Neil Barnard:

Well in this case, the sleep I’m referring to is for the menopausal women who have been troubled by hot flashes, sometimes coming every hour, every two hours, something like that. And we also have looked at a variety of other physical symptoms and even sexual symptoms, and for reasons I cannot explain, women report improvements in all of those domains. So don’t get me wrong, menopause is not a disease. Menopause is a part of life. It is entirely normal for the ovaries to say, “We are finished. I am now 52, I don’t need a toddler on my kitchen floor.” That is totally normal and good. What is not normal is all of these difficult symptoms that come along with it. And so that’s what we have been very happy to find. In case people are interested in learning more about that, we just published in the Journal of Menopause these findings, and we have a lot more research coming right behind it.

Dr Samuel Moxon:

And I’m sure we can link that study in the show notes as well if anybody’s interested. So coming back to the very first point we touched on, which was Alzheimer’s Disease and how high amounts of animal fat and saturated fat, trans fats from things like say, donuts, would be massively increasing the risk. Is that the core explanation behind why? If you look at the epidemiology, it seems to be largely a westernized disease. It does occur in other parts of the world, but it’s really concentrated in North America, the United Kingdom, places like that.

Dr Neil Barnard:

Yes, and it also seems to explain why even within certain locales within the same city you will see dramatic differences that go exactly along with diet. And so when people avoid those food sources, they’re going to do a lot better. There are other steps as well. I think it makes sense to be cautious about metal exposures. Aluminum, copper, iron. We’re still learning how these things affect the body, but it does make sense if your cast iron pan is your favorite pan, and you use it every day, you might need to switch. And if you’re taking an aluminum taking antacid, you might want to switch to calcium carbonate. But these are easy changes to make.

Dr Samuel Moxon:

I mean, some of those metals are present in the plaques, in the amyloid plaques that cause the disease, so you don’t want to have too much iron, or too much things like zinc and that kind of thing. So if I can draw on a personal experience for a second, I made the switch to plant based to manage my own current disease, which was an inflammatory bowel disease, which was diagnosed. And I was told the same thing a lot of people are told, “There’s nothing we can do about this. You’re going to have this for life. Take these medicines. Hope you don’t have too many side effects,” and that kind of thing.

Dr Samuel Moxon:

And at the time, it was actually my partner, she was reading Michael Greger’s book, and she was reading the chapter on inflammatory bowel diseases. And she said, “Well why don’t we try this diet?” And it was Lent at the time, so it was a perfect chance to take that [inaudible 00:36:11] to give something a go. We were already vegetarian, but reliant on dairy, reliant on processed foods. And so we tried this, and this was before I was receiving any treatment, and my symptoms pretty much went away. And I was very excited to tell my doctor this, and he said, “Oh yeah, well that will help your mental health, but we still… we won’t do anything else. There’s no evidence for this.” And having read through a lot of the journals, I thought, “Well there is a lot of evidence for this.” So why is it still difficult to get physicians, or certain physicians, onboard with this kind of thinking? Is it just lack of exposure to the literature, or is it something else?

Dr Neil Barnard:

Having been doing this work for a long time, I got my MD degree back in 1980. And over all these decades, we have seen one innovation after another where dietary changes can reduce the risk of cancer, can alter cancer progression. In 1990, Dr. Dean Ornish showed that heart disease can be reversed. He published his findings in the Journal of the American Medical Association and in Lancet, so it’s not as if this was not peer reviewed, extremely high quality research. Our work on diabetes being able to be dramatically improved by a plant based diet was published by the American Diabetes Association in its premier clinical journal, and presented at its convention. The work on Alzheimer’s Disease has been in the very best journals, and there has been abundant work on gastrointestinal diseases as well. And I have lamented over all these decades that what is published in medical journals, presented at conferences, well known among scientific experts, has often not filtered into the day-to-day physician’s practice.

Dr Neil Barnard:

And in fact physicians, instead of saying those magic words, “I’m not sure, I don’t know,” they start to tell you things like, “There’s no evidence,” as if they have a clue, or it’s all in your head, or you’re getting a placebo effect, or some imaginary thing like that, that they simply should not say. I have a suspicion that the reason for all this is if it were a new drug instead of a healthy diet change, drugs have pharmaceutical companies with huge promotional budgets behind them that pay for continuing medical education for doctors, and within 48 hours, every doctor in the country knows about it. If it’s food, there’s nobody really pushing that, and so doctors tend to ignore it. Plus, let’s face it. Doctors have their own dietary preferences, and they kind of don’t want to hear bad news about their favorite foods.

Dr Samuel Moxon:

Yeah, because it’s almost like they don’t want to consider whether they should be making the same changes and that kind of thing.

Dr Neil Barnard:

But I will say, I think there’s an ethical issue here, that doctors need to understand. We all learn these words, “First do no harm,” and we are doing harm to our patients if we don’t present to them things that could change a disease process, that is otherwise going to hurt them. And a doctor who says to you, “You should be on a biological for the rest of your life,” as expensive as that may be, and it’s designed to modestly disable your immune system, and you’re supposed to live with that. Or a person who has diabetes and is told, “Well you’re going to be on insulin, or you’re going to be on sulfonylureas, you’re going to be on them the rest of your life. A plant based diet, it’s too hard for you. You probably wouldn’t want to do it.” You’re condemning the patient to all the side effects of those medications, to a treatment that often is not very effective, often to a foreshortened lifespan, and that should simply not be the case.

Dr Samuel Moxon:

Yeah, and if there are people listening who are struggling with these kind of illnesses and not able to get the information they need, then I would recommend they read your work, the works of Michael Klaper, the works of Michael Greger, and specifically for inflammatory bowel diseases, Dr. Alan Desmond in the UK, and you’ll find a lot of that really useful information. And-

Dr Neil Barnard:

Let me second that. Alan Desmond is just so good at not only doing this work, but also conveying how to make it really simple. And when a person suddenly discovers, “I can feel better than I’ve felt in 20 years,” so my hat is off to Alan and his whole team, which they’ve just done a great job.

Dr Samuel Moxon:

Yeah, he’s just a released a cookbook, so he’s now in the same leagues as you. I know you’ve produced a couple of cookbooks in the past as well. And not realizing how much the disease was making me tired, and slow, and sluggish and all that, “Wow, is this what it feels to be healthy?” It’s incredible. And I think opinion does seem to be changing. I mean, if we look at your TED Talk about the effects of food on Alzheimer’s, we’re looking at nearly eight million views, and I think either two or three million views on your other TED Talk. People are starting to consume this information. And as patients, do we have as much a responsibility to try and drive this change as much as the scientists and the doctors, to push for these approaches?

Dr Neil Barnard:

We certainly have the opportunity to do it. We have a voice we didn’t have before, and it’s really social media. It used to be that doctors were on television and so forth. Well now, people are listening and watching things on Facebook and on YouTube and on Instagram. And so anybody can reach their contacts and send things around it. I also want to note another phenomenon that’s coming in in a really interesting way. If there’s anybody who needs energy, it’s Novak Djokovic, in the fifth set at the [inaudible 00:41:41] tennis tournament, where he’s the number one tennis player in the world, and he’s got to see if he can win this. Or it’s Lewis Hamilton on the 60th lap of a Grand Prix.

Dr Neil Barnard:

And those people have a whole lot more than eight million views, and when both of them have adopted vegan diets and been pretty upfront about what it has done for them, and they I think have probably inspired more people to adopt a healthier diet than any doctor ever has done. They will never know how many lives they have saved, but when a person sees Lewis Hamilton, he talks very much about his healthy diet. I’m sure all of his fans have probably the lowest cholesterol levels of anybody in the sports world.

Dr Samuel Moxon:

Yeah, and things are changing. You can go to a restaurant now, you can find a wealth of options. And this brings me to sort of my final science based question with regards to things like dementia. So for things like, say inflammatory bowel disease, another thing we have to avoid are processed foods, and things like the additives in the processed food, particularly things like emulsifiers and preservatives. Is the same true for something like Alzheimer’s Disease, or can you have say, a Moving Mountains burger, or an Impossible burger, or that kind of thing? Which has a lot of other things in there that aren’t just necessarily whole foods.

Dr Neil Barnard:

I think the short answer is we need to read labels, and we need to be cautious. Within the past three or four years, a new phenomenon has come up, and that’s that burgers have been designed not as a healthy black bean burger that’s really low in fat, and requires maybe a little bit of taste adaptation. The Impossible burger was marketed not for people following a vegan diet. It was marketed to seduce a dyed in the wool carnivore. So the Impossible burger was designed with coconut fat thrown in there and other things, to make it have that same greasy mouthfeel that a beefy burger would have. So it’s sort of methadone for a meat addict if you will. It’s there to lure you away from the animal derived burger to a plant based burger.

Dr Neil Barnard:

And it is healthier than the meat version, don’t get me wrong. It is. But it’s still got some saturated fat in it, so it’s a transition to convince you don’t need meat, and then once you think, “Okay, the Impossibles all right,” you want to go simpler, and simpler, and simpler. And eventually, you discover that your tastes just sort of want to go that way anyway. We start to discover that fruits and vegetables are sort of these jewels of nature, and whole grains and beans, you start to discover the more subtle flavours that they actually have. There are seductive foods all around us, but you find yourself less and less interested in them.

Dr Samuel Moxon:

But the color of a bowl of berries, different berries, or a big salad, becomes really appealing. You want to get as much color on your plate as possible, and just the different flavours. You do really adapt to those fresher flavours, and less reliant on things like salt and fat. So if you could give then the listeners one take home message from this, what would that take home message be?

Dr Neil Barnard:

It’s think short term, because don’t worry about what you’re going to be eating 25 years from now. Focus on what we’re doing right now. And that will allow you to make bigger changes. Some people will say, “Oh, just do one little new change every day.” You’re not going to feel enough of an effect to get a reward, and you’re going to discard it. Make a big change. Take a week, figure out what a plant based diet would look like for you, and then take three weeks and do it.

Dr Neil Barnard:

So focus on the short term, don’t give up your scepticism. You don’t have to believe in penicillin, you just have to take it. And so you don’t have to believe in a vegan diet, just try it. And then as time goes on, as the three weeks go by, you’ll discover, “Good heavens. My scale on my bathroom floor is smiling at me for a change, and I feel better.” And if you have diabetes, your blood sugar is coming down. Your digestion gets better. All these things happen. And if we focus on the short term and do as well as we can, the long-term will take care of itself.

Dr Samuel Moxon:

Now, I feel like we could talk about this for a long time, this is a topic that really interests me. We could get into the antioxidants in foods and all that kind of stuff, but we know you have a busy schedule, so I think this might be a nice time to round off the show by thanking you for taking the time to join us today and ask, where can people find you if they want more information?

Dr Neil Barnard:

Well thank you for asking. Our website here is pcrm.org, that stands for Physicians Committee for Responsible Medicine. On Amazon and everywhere else, you’ll see my newest book, which is called Your Body in Balance, and there we talk about diabetes, and we talk about hot flashes, and all of these systems in the body that need to get back into balance. And as we said earlier, I hope people will not just learn this themselves and put it to work, but I hope they’ll make a little noise and share it with other people who need that message.

Dr Samuel Moxon:

Yeah, and we’ll put links to your latest works and your website in the show notes as well, so people can easily access all the information they want. But once again, thank you very much for joining us. We hope you all enjoyed this podcast. If you did, please remember to like and subscribe on your favorite podcast app. We will see you all next time.

Voice Over:

Brought to you by dementiaresearcher.nihr.ac.uk in association with Alzheimer’s Research UK and Alzheimer’s Society, supporting early career dementia researchers across the world.

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