Joel Kahn, MD: You're right. Evidence-based says fruits, vegetables, legumes and whole grains, with minimal and no added oils and sugar, will have the greatest like causing optimum weight, blood pressure, cholesterol, sexual performance, health, longevity, lifespan, avoidance of disease and it's delicious. We love it.

Cyrus Khambatta, PhD: Welcome to the Mastering Diabetes Audio Experience, where we teach you how to sit in the driver's seat of your diabetes health for the rest of your life. We'll teach you how to reverse insulin resistance, achieve your ideal body weight, gain energy and get your best A1c following more than 85 years of evidence-based research in the Mastering Diabetes Program.

Robby Barbaro: Our program teaches you how to reverse prediabetes and type 2 diabetes, and how to simplify your life with type 1 diabetes by maximizing your insulin sensitivity, using food as medicine.

Cyrus Khambatta, PhD: We're on a bold mission to reverse insulin resistance in 1 million people. We're glad to have you joining us.

Robby Barbaro: Welcome back to the Mastering Diabetes Audio Experience. We have another terrific interview today. This one is with Joel Kahn, MD, and it comes from our 2018 Mastering Diabetes Online Summit. If you have not listened to that event, I highly, highly, highly suggest signing up on our website. So you just click summit in the navigation bar, go to www.masteringdiabetes.org, you click summit, you can register there. 

And this event has over 35 of the leading experts in diabetes health and beyond. And you get to listen to all these interviews for free. So you just sign up and then you'll get emails over the course of seven days or so, you get to hear a bunch of amazing experts. 

So you definitely want to check that out. But today, you're going to get to hear the Joel Kahn, MD interview right here on the podcast. And he covers a lot of important information. So, we recently did an episode with Kim Williams, MD, talking about heart disease, and Joel Kahn, MD is going to talk about a lot of that today in this episode, and more. But it's just so so important. 

The number one killer of people living with all from diabetes is heart disease. And that includes type 1 diabetes, prediabetes, type 2 diabetes, that's the number one killer. So in this show, Joel Kahn, MD is going to address:

The true cause of high cholesterol. He will also address the truth about fluffy cholesterol versus small dense cholesterol. There's a lot of confusion there. He's going to talk about how to reduce your blood pressure with diet. He’s also going to talk about how quickly you can stop taking blood pressure medications. Another important topic, which again, there is a lot of confusion about, is triglycerides raising on a low fat, plant-based, whole-food diet. So he's going to address why that happens, what you can do about it. He's also going to talk about reversing erectile dysfunction, Joel Kahn, MD is an expert in this area. He's written books on this topic. And it's a very important issue that people aren't talking about enough, and he's gonna talk about a lot more.

So we really, really hope you enjoy this episode. And if you love it, the most amazing thing you can do is tell other people about our podcasts. I really, really mean it. Actually send somebody a text, or actually call them, send them an email, like really, truly share it. That would mean the world to us. The podcast is really growing, and we want to keep on seeing it grow. So, if you could share it with at least one person, that would be amazing. All right onto the show. Hope you guys enjoy it.

Cyrus Khambatta, PhD: We are very excited to be here today with Joel Kahn, MD. Dr. Kahn is America's Heart Healthy Doc, and he's the founder of the Kahn Center for Cardiac Longevity. He's a graduate—summa cum laude graduate—of the University of Michigan School of Medicine, which means that he's actually just a genius, and he's also written four best-selling books including The Whole Heart Solution, Dead Execs Don't Get Bonuses, The No BS Diet: Science-Based Recommendations to Stay Healthy and Medication-Free without the BS, and his most recent book called The Plant-Based Solution, which came out in January 2018.  

He is a regular contributor to Mind Body Green, The Huffington Post, Thrillist, and many more websites, and he has a PBS special that airs all over the country about how to eat to reverse heart disease. On top of that, Dr. Kahn is also hilarious, and he's one of our favorite speakers on the subject of plant-based nutrition. So, thank you so much for being here with us today, Dr. Kahn.

Joel Kahn, MD: And let me welcome you in California and this new cannabis free society you live in since January 1, and I'm honored to be on your very important Summit.

Cyrus Khambatta, PhD: Fantastic, alright, so let's get right down to it, okay? You are the smartest cardiologists in the world, period, and you have helped thousands of people all around the planet reverse heart disease. So, let's start with cholesterol, because it's a misunderstood topic. What actually causes high cholesterol, that's the question?

Joel Kahn, MD: Okay, so I see your face, but it sounds like my mother talking—there's so many nice accolades, so having a little cognitive dissonance is a fancy word. So, what causes high cholesterol? Two things, we do produce cholesterol, every human being makes cholesterol in their liver. It's a pathway that was described predominantly in 1985.  Won a Nobel Prize in medicine. I arrived in Dallas for my cardiology fellowship in 1986 and Dr. Brown and Dr. Goldstein have been awarded the Nobel Prize in Medicine at the same institution just a few months before, so we were immersed in cholesterol and LDL receptors and the surface. 

Now we know there's another receptor called the PCSK9 receptor and such. But what causes cholesterol? One, it's demand factoring in the cholesterol, a natural process necessary for the production of steroid hormones, vitamin B, testosterone, estradiol, and all the rest, and then there's dietary cholesterol which never, never, never is found in plants, but it exists, of course, in animal-based foods of every type. 

And you can increase dramatically the amount of daily cholesterol your body is dealing with by eating an animal-rich diet, and you can reduce—you can't eliminate—you’ll always have cholesterol made in the liver going into the bile ducts through the gallbladder, if you still have one—you'll always have cholesterol in your intestines through the bile duct because of liver production. But if you carefully choose your nutrition, you don't have to add—we have no dietary need for cholesterol because we produced it. 

So, that is where it comes from, and is it a factor in the number one killer of men and women in the western world? Recognizing there's countries that fairly ever see coronary disease and heart attacks even nowadays Uganda, Papua, New Guinea, used to be Okinawa, and the Blue Zones—but some of them are changing a bit because of the introduction of Western food. Sadly, in Okinawa—yeah, you absolutely have societies that don't have heart attacks. 

There is debate in the blogosphere and some of the academic world how important is cholesterol. It absolutely matters. There's really been a, yeah, there's so much data over 50 to 100 years, it's hard to pick out one point. There's been a series of studies that started to come out late 2017, out of Madrid, called the PESA trial, P-E-S-A. And one of the investigators is from New York City, a very prominent cardiologist, Dr. Fuster, who is from Spain. I thought he was Italian, but he’s Spanish. He's part of the director. 

And what they've done is they've taken over 4,000 bank workers in Madrid, and routinely, these people answer, “I don't have heart disease, I feel fine, I'm 45 years old, I'm just a routine Madrid citizen.” They do an ultrasound of the carotid, they do an ultrasound of their leg artery called the femoral artery, and they do a CAT scan of their heart—my favorite heart screening test, we'll talk about that later maybe—and they've determined that 50% of these asymptomatic people have silent atherosclerosis. Most common in the leg, secondly in the carotid, and third—but still quite common detected by CAT scan—in the heart arteries. 

And you can just graph out the higher the LDL, the low-density lipoprotein cholesterol, the higher the degree of silent atherosclerosis, down to lower, lower, lower LDL, the lowest silent cause of atherosclerosis. These are recent studies. Even in a group, they selected out of the 4,400 people, I think it was about 1,700 that really on paper were “ideal,” they ate the most vegetables, they had the lowest body weight, the best blood pressure, the best overall cholesterol. There still was nearly 40 to 50% silent atherosclerosis within the group. And the LDL cholesterol tracked so closely, so cholesterol matters. 

You've probably heard Dr. Esselstyn say a cluster around 150 or less is part of the bullet-proof guarantee, that his theory evidence-based and strict program—a wonderful program that I endorse heartily and teach in Detroit. I can provide, but don't want, I know, I'll tell you, I saw two patients today. One has a cholesterol of nearly 300, and I was able to determine his arteries much younger than his age. I see people with the cholesterol 300 have advanced, So, there's more than cholesterol, but never, never believe a blood cholesterol that’s elevated doesn't matter. It may be the single and only factor that puts you prematurely in a cath lab. or worse. There are other factors, and something called your lipoprotein A, which is cholesterol, it's just not routinely checked. 

Everybody listening—please ask your doctor for a simple and inexpensive blood test called “lipoprotein A” or “healthy little ‘a.’” It's the reason Bob Harper, Biggest Loser fitness trainer with Jillian Michaels, claims that's a reason he had a heart attack in February 2017, because he never had it checked, and he was sky-high and clogged his arteries up, despite a lot of fitness and a little bit of Bulletproof coffee, which I know he is now stopped, thank God. Inflammation is the other factor, and this does tie into diabetes and nutrition, of course. We know that if, you know, it's not just cholesterol, its cholesterol plus 19 other factors. 

But the big elephant in the room plus cholesterol is inflammation and if you have certain conditions: rheumatoid arthritis, lupus, arthritis, psoriatic arthritis, psoriasis, colitis, Crohn's, also colitis, inflammation, and you can measure it with that simple blood test called the high sensitivity C reactive protein, and many other blood tests nowadays, getting better and better and better. If you have inflammation, and these chemicals that are circulating in your bloodstream every day, they can also impact your arteries adversely. 

We had a big trial presented November 2017, called the CANTOS trial. Proved, without a doubt, the theory even if your cluster was low and your inflammation’s up, that alone, it participates in hardening of the arteries. And if you lower inflammation—and the CANTOS trial, it was with an injectable drug. Every three months, it cost about $200,000 a year, not a very practical thing when you can just eat broccoli, sprouts, and mangoes.

But anyways, it proved the point that lowering inflammation does actually impact atherosclerosis and that, so it's more than one thing. But never, never believe the cholesterol naysayers that cholesterol doesn't matter. You're just lucky if you have a high cholesterol and good arteries.

Cyrus Khambatta, PhD: So, another thing that you talk about here is the fact that LDL cholesterol may be the single variable, the most important variable determining your risk for heart disease. Now, in the blogosphere, there's a lot of confusing information about the fact that the only type of LDL cholesterol that matters is the small dense LDL, and that the large fluffy LDL in fact is not dangerous and it's actually protective. True or false?

Joel Kahn, MD: It's false. So, there's a couple layers you gotta get through there, and I'm reaching over. Number one, 90% of people don't have those particle subtypes measured, on a routine doctor’s cholesterol panel. If you go to a health fair, if you're in a corporate wellness program, you're getting cholesterol, HDL, triglyceride measured, and LDL—the single most important predictor—is actually a calculated number. In particularly, if you're overweight, pre-diabetic, metabolic syndrome, it's very fraught with error. You have to—and this is not a commercial statement, I don't own Cleveland HeartLabs, recently Quest Labs bought them—you have to do advanced labs, this is just one example. There is one called Boston Heart, one called True Health. Your doctor, or you maybe can go to the web and find a place that offers advanced labs—you have to get these advanced panels, or you'll never know that. So, the majority of people don't know it. 

If you have the advanced labs, all cholesterol LDL particles are atherogenic, and generally if the small dense LDL is up, the large fluffy LDL is up. The single most predictive number is called the LDL particle number, LDL-P, which is only available on advanced labs—it's a $40 test. There's no reason anybody can't go to their doctor and say I want one of those advanced lipid profiles, so I know what my LDL particle number is. 

That is the single most predictive measure you can make of atherogenesis. Even, even Dr. Lard—who's Dr. Lard? Well, I didn't come up with that name, that's a name that John McDougall gives to Dr. Ronald Krause, who's in your neck of the woods, Dr. Cyrus. Ronald Krause is in Oakland, California as the director of a lipid lab, and I've never met the man, I'm quoting the esteemed Dr. John McDougall, that title. 

Dr. Krauss has argued vigorously about this small dense LDL is the atherogenic form, and it's the only one that mattered. And when you eat coconut oil, it may not raise your small dense LDL. Dr. Krauss published a paper in early 2017, that actually, his own lab disproved, that small dense LDL was the only harmful particles. 

I think it was a dairy study—dairy raised cholesterol, dairy raised all the particles, and he backed off and actually made a statement—I thought it was pretty shocking for him—that all LDL particle types are atherogenic. Some may be slightly more than the others, but when you approach lifestyle, diet, exercise, stress, sleep, weight, environmental issues, love, marriage, hugs, you actually probably are going to improve all your LDL particles.

Robby Barbaro: Excellent ok. Many people in our audience have hypertension and on blood pressure medication, so how can people reduce their blood pressure via diet?

Joel Kahn, MD:  Yeah, so probably, and I'd encourage everybody I don't know if you've done this read the book Presto by Penn Jillette, famous for Penn & Teller. Penn Jillette was on six prescription drugs and was going to die before he turned 60 of hypertension, most likely til Dr. Fuhrman got to him, a nutritionist that is working with Juliana Hever, Ray Cronise got to him. 

He calls him the Cray Crow. It's the most amazing book, Presto, about using a plant-based, no oil, high carb diet. High carb diet. And he was able to reverse his diabetes very quickly. It’s weight loss. And when you bring down that visceral fat, when your waistline, in his case went from 44 to 36 in three months, it's a very aggressive protocol he talks about. And I've seen it with my patients, choosing generally whole food plant-based, high carb, no added oil, no SOS diets, you can use fasting, a mimicking diet from Dr. Longo in LA teaches. 

When you lower visceral fat, you will see blood pressure come down. So, it's hard work, but it's just food. Get over it—it's just either skip some meals, change what's in your meals. And I can't tell you how utterly interesting that book Presto is. It's not a brand-new book, it's a little over a year and a half old, but I had missed it until recently, and it is so dirty that you'll snicker all the way through it. You should read the chapter on Joel Fuhrman, I talked to Joel Fuhrman today—he never read that book! He's got a whole chapter on Dr. Fuhrman, very complimentary in a Penn Jillette world.

Robby Barbaro: Okay. So, you mentioned it’s about losing weight and that, you know, that can take time. So, in general, what can somebody expect? How quickly can somebody get off blood pressure medication, lower the medication? How does that process work?

Joel Kahn, MD: Yeah. So, the weight loss is, you know, in most cases, fairly gradual. We talked about a couple pounds a week, that's 100 pounds a year, and Jillette talks about doing that in 3-4 months under careful guidance, and nobody should do that without medical supervision at True North. 

Even on their own, but with their medical doctor. You know, we know that there are some food which is particularly favored for low blood pressure. We know that hibiscus tea, we know that eating leafy greens and beets, which promote extra nitric oxide production through about a 12-year-old pathway we didn't know before that's involved with chewing leafy greens, beets, and beet greens, drinking beet greens, getting them on your tongue and let him interact with these little bacteria to make me more, ultimately, nitric oxide. 

Don't use Scope, don't use Listerine—I hope they're not sponsors of this podcast, because they kill those bacteria in your mouth—there's data, I don't know if you know this, Robby and Cyrus, a few years ago it was shown if you use antibacterial mouthwash, if I eat a bowl of, if I eat Robby’s food, a bowl of kale and beets, and my blood pressure will go down because I'll produce more nitric oxide within a couple hours. 

If I use Scope or Listerine or other antibacterial mouthwashes, and eat greens and beets, it will not go down. So, it interacts adversely with normal blood pressure from plant-based foods. It was just reported in late 2017 that the risk of developing type 2 diabetes may go up 50% by the chronic use of mouthwash. So, throw that stuff away. Don't put it with vodka as a tonic and drink it. Get rid of it, just brush your teeth, Waterpik, floss, you know, or maybe find something that doesn't have antibacterials. 

So, the power of beets and greens, ground flaxseed—couple tablespoons a day, which we all should be doing—can lower blood pressure. So, there are those foods, and watching salt, I mean, there's no doubt that the no SOS diet matters for people with difficult blood pressure. But, can we get everybody off blood pressure medicine? I don't think the answer is 100%. 

It's complex, it’s called polygenic, there's genes, there’s environment, you better check yourself for sleep apnea and get a sleep test if you snore, if you stop breathing because until you correct that, you may not control your blood pressure, so you know a lot of these issues I read kind of multi-pronged, but they always center on the plant-based, no SOS diet is the core nutritional concept, for sure.

Cyrus Khambatta, PhD: Now, one of the things that you see a lot, and I know a lot of other cardiologists see, is that when so many transitions to a low-fat plant-based whole food diet that happens to be high in plant carbohydrate-rich foods, sometimes they see their blood pressure go down, their cholesterol go down, their body weight go down, but their triglycerides goes up. Why is that happening?

Joel Kahn, MD: Well, number one, let me just say it doesn't, shouldn't, concern people, and the proof concept there is in the kind of landmark study by Dr. Ornish, the Lifestyle Heart Trial initially published in 1990, and then a larger follow-up in 1998, very prestigious in peer reviewed journals, Dr. Dean Ornish in southern California. Despite the fact in his patients, HDL went down, triglycerides went up on the diet you just described. So, did the reduction in coronary stenosis go down. 

So, the goal is, don't have a heart attack, don't have a bypass, don't have a stent, don't drop dead, and get cleaner arteries. That all is occurring while your HDL drops a bit and your triglycerides go up. You know, I think it's variable, those, I don't see much triglyceride elevation, and those that can do that diet and achieve a more optimal weight. I think if you're kind of stuck at a weight level you gotta ask why, and your triglycerides may hang high at that level. I just simply wouldn't worry about it. Omega-3 deficiency may be part of it. 

You know, omega-3 supplements, whether they're called flax seeds, chia seeds, hemp, algal-based omega-3 oils, all will lower triglycerides, green tea lowers triglycerides. So, I try and use natural things, but I don't see much triglyceride issue.

Robby Barbaro: So, you are incredibly knowledgeable about all the best tests to take and one of them is a coronary calcium test. So, what is that, why is it useful, and what do you think of it?

Joel Kahn, MD: I forgot to use a prop. Five pounds of visceral fat around your belly—you should feel how heavy this sucker is. So, if you say, you know, it's early 2018 and part of my resolutions it's you know, maybe a month ago, but primary resolution is weight loss, you know, it's this is what makes inflammation, this is what drives triglycerides up. 

But this is also what goes away with the educational program and nutritional program you guys teach so well, which is critical. So, bring it to California, although I know people are gonna be watching this all over the world. You know, tragically, in December 2017, a 40-year-old, Jonathan Feldstein, who was Maroon 5’s Adam Levine's manager—I mean, he probably had a pretty cool job, I’d like to hang around Adam Levine—he drops dead of a heart attack, no warning. I mean, sad as can be, and that's just one story of so many people that this happens to. 

So, how can we identify, how can, I had a 42-year-old in the office today whose father, at age 56, had a heart attack. He was kind of misled, he's been eating three eggs for breakfast, and steak for lunch, turkey for dinner, and it kind of got on the, you know, cheese-cheese-cheese. I had to smack him around with Forks Over Knives DVD today a little bit. 

He’ll go home and watch today. But, you know, he asks a question so you know, Dr. Kahn, how can I be sure that I'm not on that path road to my father's heart attack in his early 50’s or maybe earlier? Because his diet was, you know, “clean.” He totally bought this grass-fed, organic, free-range bull, bull crap. 

So, you know, how can you know, you look at the heart arteries, how do you, you know, why do you rob banks—because there's money, you know, in the bank. So, this CAT scan was developed in San Francisco—again right there in Cyrus's backyard—anybody who has some time after the Summit, there's a Netflix movie called The Widowmaker. It talks about the history of the development of the CAT scan that everybody can sign up and get at any age—40, or 45, or 50, 55, 60—if you haven't had it. In my town, at $70, you lie on a CAT scan table, you hold your breath, and you go home. No IV, no iodine, your kidneys can be good or bad, you can't be allergic to it. 

And if you have known heart disease, don't get it, you've had a stent or bypass, you don't need to answer the question: Do I have heart disease? But, if you're a “free-range human,” making the assumption that I'm healthy, you know, $70 for a test that has the same radiation dose as a mammogram is a very good choice. 

I'll tell one other thing: there's a old-fashioned sign called the diagonal earlobe crease, since everybody's kind of watching this at work or at home—get out a mirror and look at your earlobe, and if you got a real deep line that doesn't come from wearing heavy earrings or something, that is an old-fashioned sign you might have silent heart disease going on. It was ignored for a while, but it's come back in the last year. It's about 70% accurate for predicting the presence of silent heart artery blockage. 

Diagonal Earlobe Crease (DELC) it's called, in the Internet just google it, you can see a picture of it. And if you have that, go to your family doc and say: hey I want my advanced cholesterol, I want my particle numbers, and all that stuff, but can I pay 100 bucks and go to some local hospital and get this CAT scan of my heart arteries. That is a simplest, safest test. I've been involved in thousands and thousands of patients with this calcium scare. And there is no better way—and this is the American College of Cardiology and other august societies agreeing—it just hasn't entered mainstream, which is actually causing people to die unnecessarily, sadly.

Robby Barbaro: Fascinating. Yes, I've seen The Widowmaker movie, and I can't recommend it enough. It's very, very informational.

Joel Kahn, MD: That's Hippocrates: primum non nocere, means first, we must do no harm. So, we have to go for an accurate diagnosis. As long as I have Hippocrates here, because this was a Christmas present from a patient, from Hippocrates oath says: I will apply dietetic measures for the benefit of the sick. So, I just want to know how old this concept is, it doesn't say anywhere I will use pharma, surgery, and ignore nutrition. So, this dude is so cool, he sits on my desk now.

Robby Barbaro: That's awesome. Okay, so, you are a prolific writer. You're on blog posts all over the place, medium, you contribute all over the place. And you have written several articles about better sex, and how foods promote blood flow to genitalia—it is obviously a very important topic. We have millions of people suffering with erectile dysfunction, and poor sex drive, and people don't know how to solve that problem. So, can you talk to us about blood flow, and how food affects people's sex life?

Joel Kahn, MD: Absolutely, and I'll just do a shameless plug, cuz I so much appreciate you and Cyrus. I’ve actually written five books, and the one Cyrus didn't mention is called Vegan Sex, which was co-authored with Ellen Jaffe Jones and Beverly Lynn Bennett. It came out in 2017. It's actually coming out now with a formal publisher in 2018. I'm excited about. It’s a hard cover book [laughter], of course [inaudible]. 

I wanted a vibrating spine, but they wouldn't do that for me [laughter]. So, we know more about this in the male physiology, let's call that an erection, that's what it's called. And we know that that is a tremendous amount of blood flow being shifted from other places through the groin, and it causes the arteries to get dilated, and that actually is very cool when that happens, it smashes the veins collapsed, so that the blood can get in, and the blood can't get out, which is a very cool system. Genius. And why do you get that rush of blood flow? Well, you need healthy arteries that are not clogged up with atherosclerosis, patient high LDL cholesterol, lifestyle, smoking, and nutrition. 

And we also need the lining of arteries, and that's an important concept. Inside every artery that's shaped—I have a little model here I don't see I won't go grab it—inside every artery is a wallpaper lining called the endothelium that makes this magical gas called nitric oxide. And if you have healthy arteries and you're eating greens or eating beets, you're not eating sausage Egg McMuffins and donuts, which absolutely destroy your endothelium—saturated fat from animals destroys your endothelium. Dr. Robert Vogel, a cardiologist, in 1996 did a study. If you feed a person a sausage Egg McMuffin, within 45 minutes, the lining of the artery, the endothelium stops making nitric oxide, stops dilating—not a good thing to eat before big date, guys. Go to a salad bar before a date. 

So, you gotta get the junk foods out, put the good foods in. Nitric oxide production won the Nobel Prize 20 years ago this year. You will have a massive and successful erection, and you can augment that with lifestyle by avoiding atherosclerosis. You're probably more worried about stroke or heart attack, but truly, be worried about erectile dysfunction. And, also, just like the diagonal earlobe crease, a guy in his early 40s, mid 40s, early 50s starting out having erectile dysfunction—woo woo woo—alarms are going off, you might have silent heart disease. Go get checked, get that heart scan, get, you know, a real inner look at your arteries with somebody who's a specialist. So, nutrition is big, big, big. 

So, what can you do? Eat more greens, make more nitric oxide, stop using antibacterial mouthwash, some of the things we talked about with high blood pressure because they are related. Are there special foods? Well, if you like to put powders, maca powder may have some value. Finding your, there's these crazy things, horny goat weed and all they, actually have a little data behind them. But eat whole food plant-based, no SOS diet, and you will be optimizing the chance you’re going to have successful sexual encounters that bring joy—but be careful, they might bring children.

Robby Barbaro: You've mentioned several times a no SOS diet. Can you explain what that is and why that's important?

Joel Kahn, MD: Yeah and that's given a shout-out to a lot of people from True North and Chef AJ. But salt, oil, sugar, it's just an easy way to describe the difference between a vegan junk diet which has advantages for the environment, has advantages for animals, and could still be healthier than a meat-based junk diet. But we learned—there was a big publication in a major cardiology journal about the middle of 2017 from Harvard School of Public Health, and in general, people that identified a plant-based diet as their eating pattern had better health and survival than people that didn't identify plant-based diet. 

But those that actually described their plant-based diet as more of the junk food, who didn't have whole grains, didn't have fruits, and vegetables, and higher amounts of alcohol and sugar, actually didn't do as well as the baseline group. Those that describe their plant-based diet as what we call a no SOS, lots of fruits and vegetables, whole grains, legumes, not added sugars, and oils, actually had a tremendous reduction. So, a healthy plant-based diet is really the goal, and not just any plant-based diet. So, salt, oil, sugar. You know nobody loves sugar, I still think added fats and oils are a bigger issue in this obese society, but they're both issues. 

But it's such an interesting way, you know, are you gonna dump olive oil all over these gorgeous bowl of vegetables which naturally have nearly no fat in them—they have as much as we need, but nearly no fat. You know, warning, warning, you don't need it. You know, like we said, you don’t need to add cholesterol from animal products or unnecessary extra saturated fat from even plant food sources like oils, previously whole foods.

Cyrus Khambatta, PhD: I love it. Okay so here's a question we you love to ask a lot of people, okay? What's the number one challenge that you see people face when it comes to lifestyle change, and what do you recommend for overcoming this problem in particular?

Joel Kahn, MD: Yeah, I actually think the biggest challenge is knowledge confusion, dietary confusion, headlines if they're on the Internet, you know, you can get a different message every day, different messages from their medical team, their nurse practitioner, PA, health coach, physician. You know, turn on the TV, and you see the bone broth message of the day or the collagen and animal protein message of the day, protein, protein, protein which of course is Dr. Garth Brooks favorite topic—Garth Davis, yeah, Garth Brooks is awesome too—but Garth Davis is much healthier looking. 

So, I think they're confused, and so, I've got to give them education because I think, you know, there's willpower and skill power, that's a term David Catch uses, you not only have to identify they want to make change, all you got to give them some skills. But first, I gotta get some knowledge in them, and so that's where I just use Forks Over Knives. I use What the Health, I use PCRM. I actually now have a plant-based health coach online system I'm using in my office, it's very cool and patients get daily text messages and daily articles and health coach call once a week, all plant-based, all very up and up. 

So, you gotta, you know, you gotta kind of pound them away from that common culture that leads them to believe eggs are bad and cholesterol doesn't matter, and you know, dietary cholesterol is no longer a measure of concern, and there's that confusion. You know there is this guy that came in today at age 42 with a father that had a heart attack. You know, I've gotta turn that ship around on what he's been doing for four or five years, and I've got to start with just getting him to buy into that, maybe he hadn't been hearing this from credible people. 

They say some of these tools that are out there are so wonderful, then I can sit down and pick some small goals. Let's get off dairy. There's every substitute in the world, not all of them healthy, but every substitute in the world. You no longer need to drink cow puss anymore, you know, then maybe up fruits and vegetables, you know, simple goals, a salad a day, an apple a day. I don't mind people using meat substitutes short term. 

Actually this young guy I kind of was pushing around a beyond meat burger, just first time in his life trying a non-beef burger. I want him to get the beans and whole foods as soon as possible. But you know changing 42 years of culture and lifestyle, I'll take baby steps unless they're very, very sick, and then I want to immerse them very quickly otherwise.

Cyrus Khambatta, PhD: So Dr. Kahn, that's actually a brilliant response, because there's a lot of other speakers who have mentioned this same thing, which is that there's too much information, too much information on the Internet. And it can be very confusing to understand exactly what to do, especially when you go to Google and you type in “how to eat for improved health,” “how to reduce cholesterol,” and you get bombarded with multiple different people saying multiple different things. 

Now, the main difference between, you know, what you find on the Internet and then between yourself and us, is that what we do is evidence-based, right? That's what Mastering Diabetes does, that's what you do, and it's very important for people to understand that if you're following information that's not evidence-based, you're likely to run up against hurdles into the future, and you can actually decrease your quality of life overall. 

So that's a very long-winded way of me saying thank you for doing what you do. Thank you for writing books, thank you for taking the time to research, thank you for translating it for people to understand, and thank you for, you know, going around the world and talking about this and really educating people. What you're doing makes a huge difference and we genuinely appreciate you from the bottom of our heart.

Joel Kahn, MD: Thank you very much. And just eat an apple a day, boys and girls. Start there and don't give up on it. Yeah, you know Dr. Steve Nissen, the head of Cardiology at the Cleveland Clinic, is like one of the worst influences on this movement, because he ridicules it in the New York Times. I think he literally said the fanatic vegans in some article in late 2017. You know, it's a problem that can be, that's why they read and confuses on the public. 

Another example like that. But you're right, evidence-based says fruits, vegetables, legumes, and whole grains with minimal or no added oil, salt, and sugar will have the greatest likelihood of causing optimal weight, blood pressure, cholesterol, sexual performance, health and longevity, lifespan, avoidance of disease, and it's delicious. We love it. I've been doing this for 40 years. I am very grateful for being introduced to this dietary lifestyle very early in my life.

Robby Barbaro: Awesome, thank you so much for joining us.

Joel Kahn, MD: I appreciate you guys. Peace and keep up the good work, you're really changing and transforming health throughout the world, thank you.

Robby Barbaro: We really hope you enjoyed that episode, you've learned a lot and you're going to now take this information and put it into action. If you are living with diabetes, or you want to make sure you don't develop diabetes, you may want to consider joining our coaching program. 

So we have an incredibly robust coaching program at an incredibly affordable price. At the time of this recording, we have a waitlist, so if you want to get into our coaching program, you have to go to www.masteringdiabetes.org, click Coaching in the top navigation bar and get your name on the waitlist. 

We offer a lot in this coaching program, the price ends up being less than $0.70 cents a day. And we offer an online course that gives you everything you need to know about how to transition to a low fat, plant-based, whole-food lifestyle one step at a time. And it's only the pertinent information, only exactly what you need. The whole point is to not make it overwhelming. So that's the way we've designed this online course in a step by step manner. 

Start with goal setting, you learn some of the science, you start changing breakfast, when you're ready, you start changing lunch, and when you're ready, you start changing dinner, and there's lessons about intermittent fasting all along the way, all the nuances about your blood glucose and what to expect and medications, and all that is covered in the online course. 

The second tool we offer in our coaching program is a private community where our coaches answer questions within 24 hours. So every time you make an original post, sharing something or asking a question, one of our amazing coaches is going to reply within 24 hours. This community is on Facebook and outside of Facebook, for those who don't want to use Facebook. 

So it's an incredible, incredible resource to get your questions answered every step of the way. We have two people in that group that have completely reversed type two diabetes as our coaches. That's Adam Sud, and Marc Ramirez. And we also have Kylie Buckner, RN, who's a registered nurse as one of our lead coaches in the coaching program. And you also have Cyrus and me chiming in when necessary. So we have you covered on all fronts, no matter what type of diabetes you're living with, we're there for you every step of the way. 

People are also sharing lots of food pictures and recipes in the community. We're sharing meal planning tips, our team, we're sharing new recipes, we do challenges together. So the community is a really robust aspect of this program. And really, really important for people to have long term success on our program. 

The third tool in our coaching program is twice monthly live Q&A calls. And these are fantastic with the first and third Sunday of every month, we use Zoom Video Conference so you can see us and we can see you if you choose to turn on your camera. Or you could just call in with your phone and we answer questions until everybody's questions are answered. And it's really fun. It's great to have that back and forth communication, and we can cover a lot in a short period of time. 

The online community is obviously very helpful, you should get any urgent questions answered right away through the community. But it's also nice to have that dialogue and go back and forth on a video conference call. So that's the other tool we offer. And that's the Coaching Program. 

So we have amazing results. I'm sure you've heard them on our podcast, seen our testimonials on YouTube and on our website, we want you to experience the same success, okay, our incentives are so aligned it's not even funny. We want you to have the best health ever so we can show the diabetes community how successfully a low fat, plant-based, whole-food diet reverses insulin resistance. It's a win-finity situation, we want you to succeed so, so much. We all benefit and we work very hard as a team to make sure that you get the results you're looking for. That's our point with the coaching program. So again, make sure to get on our waitlist, go to www.masteringdiabetes.org, click coaching and I can't wait to work with you soon. 

Have a great day!