Welcome, everyone. Thank you for joining us tonight. We are here with Dr. Neal Barnard, who's going to be joining us for our Lifestyle Psychiatry webinar. That's our monthly webinar that we do. That's from the American Psychiatric Association. I'm Dr. Gia Merlot. I'm chair of the Lifestyle Psychiatry Caucus. Very excited to introduce Dr. Barnard to our group. He is a board-certified psychiatrist, and he's the president of the Physicians Committee for Responsible Medicine, written hundreds of scientific papers, 20 books for medical personnel as well as a lay reader, and is the editor-in-chief of the Nutrition Guide for Clinicians, a textbook made available to all U.S. medical students. Dr. Barnard is somebody, and I tell the story every time I do a presentation. My introduction to the world of lifestyle medicine is when I went to his annual conference that he has in D.C. every year. That's when I realized that there's actually other people that are thinking like I do. He's my introduction into this. If you don't know about it, ask me, and I can tell you it's worth knowing. I think it's in August, everybody, right, Dr. Barnard? August 15th, right here in downtown Washington. Hope you will join us. I'm very honored to have him. We are recording this. We're going to be able to make this available for CME after the fact, so stay tuned for that, but until that time, Dr. Barnard, please. Well, thank you very much for the very kind invitation to speak with you today. I'd like to address some aspects of how food relate to our lives. I'm going to focus particularly on weight control because that's where people run into trouble quite a lot, not just with gaining unwanted weight, but with ways of attempting to lose it that may do more harm than good, and I might mention a few things about food and mood along the way, so let me share my screen. Okay. Okay. Okay. I'm getting notifications that are coming up. Hopefully you're not seeing them. No, we're not seeing them, but you're not. You're not doing. Screen mode. So if you go to the bottom. If you go to the bottom, then you could do. Oh, Neil. Dr. Bernard. We lost you. You might want to pause the recording. Oh, that's a great idea. Who said that? Who's the brilliant mind that just said that? Thank you. So we're going to see Ashina. One second, please. Sorry, my computer is playing a few tricks and I'm going to try to reason with it. Okay. No worries. Sorry for the delay. No worries. So let me just continue the conversation. So people are asking me about Dr. Barnard's annual conference. It's called the International Conference on Nutrition and Medicine. I am going to put that link. I'm going to put a couple of links in the chat so you can see them. Thank you for that question. And this is actually the link to register. Let me see if I can do it. Hold on one second. So you can look around his website and go and then see which one pays. There's his website. It's well attended and I got to tell you, of all the conferences that I've been to, including American College of Life Sciences, this conference has the best food. It's fresh, it's whole. It's the best food that you will ever eat. It's worth going just to taste the food. Let me see if I can make this work. I'm getting various notifications, but hopefully it will work. And if worse comes to worse, I'm going to log off and come back on. Sounds good. Let's go. I'm hoping that you're seeing us. I hate to say this. Let me take three minutes. Let me go. Okay, sure, sure. Okay. So let's use, let me stop the recording. Boom. Go ahead. All right. The old fashioned, you can hear me okay? Yes. The old fashioned approach to weight loss, which unfortunately is still rather prevalent, is to say, well, if you've gained too much weight, you need to get out the calorie chart and just eat less. And so we try to get out the food scale and other instruments of torture. And we try to live with small portions. And by about Wednesday, you're ready to eat the sofa. And these things have really kind of fallen by the wayside. And over the last decade or so, there's been much more focus on what I'm going to call dietary patterns. And the idea is if I'm eating a more plant-based diet, that's going to be helpful. And there are many other dietary patterns that are really under good investigation. However, suddenly the conversation stopped. And the reason is because of semaglutide. Wigovi took over everything. And the idea is that all you have to do is inject this drug and it will make up for whatever genetic defect our parents gave us. And that's the answer to losing weight. Just to spend a couple of minutes on what the drug does and what it doesn't do. Your intestinal tract makes glucagon-like peptide 1 in response to a meal. And this is a good thing because the intestinal tract needs to reflect to the brain that we've got food that we're busily digesting. And so the GLP-1 goes through the bloodstream to the brain and reduces the appetite. It's the digestive tract's way of saying, stop eating. I've got all I can manage. And it does reduce the appetite and also increases insulin secretion. So it was marketed successfully for diabetes and now is a big blockbuster drug for weight loss. And to walk through what the drug does, at first glance, it looks terrific. In Novo Nordisk's sponsored trial, diet and exercise alone caused a drop of only 5.7 pounds. Whereas if you start injecting some glutide, you can knock off another 28 pounds. And this is very successful. However, when the study ends, not only does the weight loss end. This was a study of drug cessation. People lost weight, almost 40 pounds on the drug, and then they stopped. And within about two years, 25 pounds are back. And leaving a net, still a significant weight loss, but most of the lost weight comes right back. Do people discontinue? They sure do. By a year, about half discontinue. By two years, more than two-thirds have stopped it. Why? Because they feel sick. Because of gallbladder disease, pancreatitis, thyroid cancer. There's probably a new report that you may have seen about vision loss. It's rare, but these are things that obviously people are concerned about. But one of the biggest concerns is the price. The U.S. retail price currently is $15,600 a year per patient. If we were to treat all obese American adults, that would be $1.5 trillion. You're talking about $150 billion per year just for the drug. For every 1% of individuals starting Wigovi, everybody else in their insurance group's premium rises about $14.50 per month. So if you have 2% of the people in your Blue Cross Blue Shield group or whatever, that means you're going to be paying $29 more per month at current prices. So this has caused people paying for this to revolt. And the state of North Carolina had to say, we wanted to pay for it for our state employees. We can't do that anymore. We just never expected what these costs would be like. And that's really where people are now. They're really recoiling from it. When you look at what you could get for $15,600 a year, you could see a dietician every week. You could buy a bag of groceries. You could have a gym membership and you can have some money left over for vacation. And that adds up to about $15,600 a year for all of those things. So let's go back. Let's go back to where we started, which is people are looking at different dietary patterns. And it's been really clear that this matters a lot. The Adventist Health Study has been very influential. And the reason people have put Adventists under the microscope is you've got a huge group of non-smokers. Mostly teetotalers, but they vary in diet. And researchers have found that if you compare non-vegetarians, people on an omnivorous diet, to semi-vegetarians or pesco-vegetarians or lacto-ovo or to vegan, you see dramatic differences in weight. And the difference between the extremes here, between say an omnivore and the vegans, it's about 35 pounds, which is better than we get with drugs. But we can go one step further. It's not just your dietary pattern. There are certain foods that are much better than others for weight loss, and that's what I'd really like to focus on. And the page really turned back in 2015 when Harvard researchers did an amazing study where they looked at more than 100,000 people in their prospective cohorts and found that the more they ate of certain foods, the more weight they lost. Which is completely counterintuitive, because the more you eat of anything, healthy or unhealthy, if you're eating more, you should gain weight. That is not what they found. They found that the more people ate of certain foods, the more weight they lost. And of course, looking ahead, it's because certain foods tend to satisfy the appetite with relatively few calories, others stimulate the metabolism, and others have other effects that I'd like to go into. But when we look into the Harvard data and look at which exact foods are they referring to, at the top of the list of weight loss foods was the humble, unassuming blueberry. Blueberries. And not just blueberries, but also strawberries and raspberries, and even blueberries have an offense as long as you don't put in two tablespoons of butter. And the question is why? The answer is anthocyanins. Anthocyanins are the blue pigment in blueberries, and there are also red ones in strawberries. And in the autumn, the leaves have various other anthocyanins showing off their colors. Don't eat the leaves, but the blueberries and strawberries you can. And researchers have suggested that the anthocyanins modify the metabolic rate, rather gently, but significantly. Two years after the Harvard study came out, researchers in the UK did a twin study, a huge twin study, 2,734 twins, and everyone got a DEXA scan, where you measure their body composition. And what they found is that within each twin pair, the twin with a higher anthocyanin intake had lower body fat in general, but specifically less abdominal fat. So they also found that it's not just berries. It's also the red blush on a pair, that's anthocyanins. Grapes, these are anthocyanins as well. And it's not just berries. Researchers have looked into a number of foods, and certain spices have similar functions. Cinnamon, for example, contains a compound rather unadventurously called cinnamaldehyde. It's an aldehyde that attaches to a receptor in your digestive tract and it increases metabolism. The digestive tract contains this receptor called TRPA1. And the cinnamaldehyde, when you finally eat some cinnamon toast, or put cinnamon on your oatmeal or something like that, this receptor has been waiting there for many generations just to squirt a little adrenaline into your bloodstream, triggered by the cinnamaldehyde's attachment to the TRPA1 receptor. So don't worry, the effect is not enormous. I don't have to peel you off the ceiling. But you do see an increase in metabolism that's significant as a result of just the cinnamon alone. So to give you a feel for the numbers here, there was a good randomized trial in 2017 of 116 people. And it was a double-blind trial using capsules that either contained cinnamon or placebo. And over 16 weeks, the average person in the cinnamon group lost seven and a half pounds. Now, the amount they used was pretty heroic. It was about a teaspoon per day, but that's certainly doable. I should also mention that they did not use the cinnamon that you would get just walking into your grocery store. You'll find Indonesian cinnamon or Saigon cinnamon. And what they use is Ceylon cinnamon, which is the one that we would recommend if you wanted to try this. When we see claims of this type, we always want to know, is it funded by the American Cinnamon Council or something like that? So we're looking for consistency of results. And there's a good meta-analysis. And this is the forest plot for this meta-analysis that came out two years ago. And every line is a separate randomized trial looking at body mass index in response to cinnamon exposure. If you're on that zero center line, that means nothing happened. But as you can see, all the studies are to the left of that line, suggesting a fairly consistent effect. So we'll believe it. We see this effect with other things, ginger, hot peppers. Hot peppers contain capsaicinoids, which reduce the appetite mildly, but also increase calorie burning. And the research is done in a peculiar way. You feed the participant some spicy peppers. And while they are mopping their brow, you put a temperature probe in their ear like a little kid. And you notice that thermogenesis has actually been triggered by the capsaicinoids. So the bad news is that a bell pepper will not do it. A bell pepper has crunch and vitamin C, but it has no capsaicinoids. It's got to be a hot pepper. It can be fresh, it can be a pickle, but it's got to be hot to work. So I started working with two recipe developers named Dustin Harder and Lindsay Nixon, who are just the greatest recipe developers in the world. And we started to look at the fact that there are certain foods, which I am going to refer to as power foods. And I'm calling it power foods because they have the power to manipulate body weight. And so Dustin said, well, if blueberries and their anthocyanins work, let's make a blueberry syrup out of it. And Lindsay said, well, if cinnamon works, I'm going to put cinnamon on French toast. And the point being that one can prescribe French toast as a weight loss food. Depends on how you glop it up, but it actually works. And Dustin came up with a triple berry sorbet with blueberries and strawberries and raspberries and relatively few other ingredients. And you just blend them together and put it in the freezer and it comes out really delicate and nice. And for kids, he made a blueberry pops with relatively few ingredients, all totally healthful. And the idea is that when patients come in, they're expecting to be given something punitive, like a difficult calorie restriction or you can never have bread or potatoes anymore or something like that. And that's not what we do. What we're doing is using foods that help them facilitate weight loss. Let's go back to Harvard and go through their list because it wasn't only berries. The number two group was cruciferous vegetables. This was the group causing the second greatest weight loss to the extent that the foods were accentuated in the diet. And as you know, cruciferous vegetables are cancer fighters because of the sulforaphane that they contain and perhaps other ingredients as well. But that means broccoli. It means cauliflower, brussel sprouts, the whole long list. Group three was the green leafy vegetables apart from the cruciferous vegetables, spinach, mustard greens, asparagus and others, and even salad greens. They all work. Number four is the melon group, cantaloupe, watermelon. And when you get a cantaloupe home, cut it up. Most people tend to just leave it on the counter until it goes bad. Then they throw it away and buy another one two weeks later, cut it up, put it in that cold museum. And then when your family members go and look in there, they'll find a healthy snack waiting. OK, group number five was citrus fruits. And the surprise here was that, yes, it was grapefruit and oranges, but it was also juice. And the reason I mention that is many people will say you should have the whole fruit, which is true. But at Harvard, the juice worked as well as the weight loss. Group number six was foods that our grandparents knew all about, but have been neglected in recent decades. And that's beans, beans, peas, lentils, the legumes. And that can be things such as black bean soup or burritos or soybeans as well. And soybeans, I mentioned, because as you probably know, soybeans are cancer fighters. Soy reduces breast cancer risk significantly, and it also reduces prostate cancer as well. Although many people have that mixed up and they think it has the opposite. But soy is associated with a strong reduction in both cancer incidence and cancer mortality. And soy products are also associated with weight loss. So why do these foods do what they do? And how do we make sense of this goofy idea that eating foods could facilitate weight loss? Well, they do one of three things. They either reduce appetite or they trap calories in the digestive tract or they increase metabolism. And I'd like to walk you through all of these. Starting with appetite taming. And let's go back to GLP-1. GLP-1 is not made by Novo Nordisk. It's made by Mother Nature in your digestive tract. And it's not stimulated equally by all things. And Wegovy is just a synthetic GLP-1. My research colleague, Hannah Kalioga, brought in a group of individuals and gave them different meals. A meat-based meal causes almost no GLP-1 release. A plant-based meal causes a major spike in GLP-1. Why would that be? Well, GLP-1 is released not just in response to stomach stretch or some trigger that you've eaten. It has to do in large part with what nutrients you consumed. So high-fiber diets, high-complex carbohydrate meals trigger a good GLP-1 release. Meat contains neither one. It has no complex carbohydrate. It has no fiber at all. But plants have lots of both. The other thing is just really basic. Fat has 9 calories in a gram. Carbohydrate has 4. And fiber has between 0 and 2 calories in a gram. So our research team wanted to see how this might affect body weight and weight changes. We did a randomized trial with 62 people. Everybody wanted to lose weight. And half of them were asked to begin a Mediterranean diet. A Mediterranean diet, as you know, emphasizes vegetables and fruits. But it also has some fish, some chicken. And if you're thinking, wait a minute, fish fat? Chicken fat? Dairy? Cheese? Cheese fat? Okay, 9 calories per gram. I don't want to get ahead. The population was randomly assigned to either a Mediterranean diet or a vegan diet. After 16 weeks, they switched to the opposite diet. So the Mediterranean group went vegan and vice versa. And at the beginning of the study, as the people began their first diet experience, the Mediterranean group thought this is a wonderfully indulgent diet. I'm driving down the coast of Tuscany imagining a wonderful meal. Except that I'm not losing very much weight. The vegan group soon discovered that a vegan diet doesn't mean you have to acquire a taste for folk music. And they found themselves losing weight like crazy. After 16 weeks, we asked everybody to stop. Wait 4 weeks and now begin the opposite diet. And the Mediterranean group that now went vegan lost weight very quickly. The group that had been vegan and now went Mediterranean started to regain lost weight. Why? Because there are 9 calories in every gram of fat. You're now eating olive oil. You're eating fish fat and other kinds of fat. So a vegan diet is very effective. A low-fat vegan diet is very effective for weight loss. A Mediterranean diet is ineffective for weight loss. Also ineffective for lipid lowering. Although it is good for certain things. And it does seem to cause blood pressure lowering. Probably due to polyphenols, we're guessing. Okay, so that's appetite taming. The calorie trapping effect is a wild thing that was discovered at Tufts University. When you consume beans, vegetables, fruits, you're chewing up fiber into a million tiny little sponges. And the fiber goes down your digestive tract. And as it does, it attracts the unabsorbed calories. It holds on to them. And those unabsorbed calories are carried by the fiber down your digestive tract. And you literally flush them down the toilet. Now, Tufts University researchers brought in 90 people. And they wanted to test this out. And they tested it out by asking half of them to have white bread. And the other half to have whole grain bread. And they took stool samples from everyone. And discovered that by just having whole grains. You could reduce about 100 calories per day. Which is not huge. But this adds along with the effect of appetite taming. And also metabolism boosting, which we're going to get to in a minute. Now, they did this with whole grain bread. But there are lots of high fiber foods. And plants have fiber. Animal products don't have any. So the more we go to plants, the more we can take advantage of this effect. Okay, the third area after appetite taming and calorie trapping is metabolism boosting. And to explain this, let me raise the question that I'm sure you've been thinking about all day. Which is, what's the difference between you and a crocodile? And if you look at her face, you might not really see very many differences between her and your family members. But there is one big difference. And that is, if she is chilly, she has to find a sunny spot. And lie in the sun and let the sun warm up her body. Because she's cold-blooded. She can't generate body heat. But you are not cold-blooded. And I have to say, when I give this talk in Washington, D.C., I sometimes have to modify the text a little bit. But let's say that this audience is not cold-blooded. That we have the capacity to turn food into body heat. We can turn on and turn off thermogenesis. So the way we do this is with, we measure with indirect calorimetry, the change in your metabolism that occurs after a test meal. So you come into our lab, six in the morning, your metabolism is as low as it's gonna get all day, and you haven't had breakfast. I then give you a test breakfast and I measure your oxygen consumption and carbon dioxide output with a mask. And through indirect calorimetry, I can measure your metabolism increase. But butter doesn't give you any burn. You can take a whole stick of butter and your metabolism stays flat. You just absorb all those calories in the first 40 centimeters of your intestine. So we've been studying which foods do cause a metabolism increase. And I'd like to just share some of this with you. We did a new study. 64 overweight women were randomly assigned to a low-fat vegan diet or a conventional diet. And the conventional diet was based on the National Cholesterol Education Program guidelines, fish, chicken, that kind of thing. The vegan diet meant no animal products, keep oils low. We asked everybody not to change their exercise and it was a 14-week trial. And our participants discovered to their horror that we were allowing them on the vegan diet to have unlimited calories and unlimited carbohydrate. Pancakes, oatmeal, rye toast, vegetable chili, lentil soup, linguine, whatever they wanted. At about week three or four, one of our participants discovered that Twizzlers were vegan. And I have to say, when we did our research protocol, we were trying to just, we were trying to set simple rules saying no animal products, keep oils low. And I have to confess, I didn't think about Twizzlers, which wasn't what we were actually suggesting that they eat because it's just sugary, starchy, artificially colored junk. But when you set up a trial, you have to live with it. So our research participants over the next 14 weeks in the vegan group greatly increased their carbohydrate intake. The comparison group dropped their carbohydrate. Fat intake dropped in both groups, but particularly in the vegan group. And when we looked at the weight change, over 14 weeks, it was about 13 pounds in the vegan group and only about eight pounds in the comparison group. What really matters though is longer-term effects. So in the comparison group, they ended up putting the weight back on by year two. In the vegan group, they never regained their lost weight. They're like the people at the Adventist Health Study, they just stayed slimmer. So why? Part of it is that the foods they're consuming are high in fiber. They are high in complex carbohydrate. And so these are low calorie foods that fill you up without a lot of calories. But we brought everyone in, we put on the mask that allows us to capture their respiratory changes. So we're tracking their oxygen consumption and their carbon dioxide output. And what we noticed is that at the beginning of the study, their metabolism increased in response to a test meal. But after 14, I'm sorry, after 14 weeks, their metabolism in response to the very same test meal was now 15% higher than before. So let me be clear what I'm saying. These are the same people in the same, sitting in the same exam chair, putting on the same mask, eating exactly the same test meal, the same number of calories. But after 14 weeks, their after meal metabolism was substantially higher than before. So we have learned why this is. We, using magnetic resonance spectroscopy, we discovered that the low-fat vegan diet depletes the muscle and liver cells of accumulated lipid. When that happens, their mitochondria burn calories faster and substantially faster after the meal. So the beauty of this is you can have it be fun foods, foods that are healthful, but tasty, and don't require a lot of preparation. And that's what we've been doing. And so now I'm not gonna talk to you about your car insurance, but what I would like to do is talk to you about a study we did with GEICO. GEICO's national headquarters is about four blocks from our research facility. And their health director asked us if we would implement a study at GEICO, because they have a lot of folks there who have diabetes or weight issues. And so we did a randomized trial, first at two different sites, and then later at 10 different sites, using simply a vegan diet at work. And there were a few missteps along the way at the beginning. The cafeteria manager wasn't too sure what it meant to serve vegan foods. So he made a vegan burger topped with bacon and cheese. Well, he figured it out and realized you leave off the bacon and cheese. And in the first study, we did show that the control group didn't lose weight, but people lost weight very nicely. And the experimental group, their waist circumference diminished. So we then worked with GEICO to do this in 10 different cities, because we wanted to know how would this work? If you're not here in Chevy Chase, Maryland, but you're in Dallas, or you're in Macon, Georgia, or San Diego, or on Long Island, or wherever it is. And what we found is the same thing. It doesn't matter where you are. The diet works very well for reducing body weight. Hemoglobin A1c diminished. And many, many individuals found that after struggling with other approaches, they lost weight very easily. This is Hillary and Bruce. They were the youngest participants in our program. And after a year, Bruce sent me this picture that he'd lost 800 pounds, Hillary had lost 85 pounds, not by limiting calories, but simply by making a qualitative shift in what they're eating. Along the way, we wanted to know if a diet change might affect their mood. This was not the primary objective of our study, but it's something you can assess. And my hypothesis might've been that when people begin a vegan diet, that their mood might descend, because after all, you get a lot of annoying questions from friends who want to know, if you're a vegan, where do you get your protein? I don't think cholesterol really matters anymore. And isn't there something bad about soy? And these things are irritating enough, like what if I'm blood type O, that you might think you'd lapse into depression. Well, that's not what we found. In our 10th city trial, we showed that depression, signs of depression improved quite substantially. Same with anxiety. And also we found that job absenteeism diminished as well. So when we look into the literature, we do see that others have found this as well. And I want to tip my hat to Bonnie Beesold, who started off with a small study, just looking cross-sectionally, when you look at vegans, self-selected vegans in green, and omnivores in orange, using the DAS study, the depression, anxiety, and stress scales. You see that by and large, the people on vegan diets tend to score better. And same with the POMs, the profile of mood states. She then did a little bit bigger trial, found sort of the same thing, the same sort of trend, and then did a randomized trial, using an omnivorous diet, a fish diet, or a lacto-vegetarian diet. And in a whole group of measures, the green bar here is the people on the vegan diet. And you see, whether you're looking at stress or other measures of mood, you tend to see that the advantages for the vegan group in virtually every measure. I think we want to take all this with a grain of salt though because we don't really have a clear understanding why this diet is helping. I just want to separate what we know from what we think. What we know is that we see consistent improvements in mood in some, although probably not all, studies. I'll tell you what my guess is, my hypothesis, is that reduced inflammation is probably responsible for this effect. We do see very substantial reductions in CRP, C-reactive protein, when people get animal products out of their diet and emphasize vegetables and fruits. And inflammatory processes are also at work in depression. There's a great increase in antioxidants, a great decrease in blood viscosity, which makes you feel more alert. Casomorphins, which are natural opiates in dairy products, particularly in cheese, they're gone. And your gut microbiome gets healthier, but plus you're just losing weight and your diabetes is getting better and all these things probably improve mood. Again, these occur, but the hypothesis is that this is the reason why people feel better, why their mood improves. Let me finish by looking at how we prescribe a diet of this type in a clinical setting. A healthy diet is fruits and grains and legumes and vegetables and supplementing B12, which you need for healthy blood, healthy nerves. You don't need much, but you do need some. When a patient comes in to see us, they've got diabetes or they've got weight issues and they want to feel better, we will ask them to take seven days. And during that seven days, check out the possibilities of what they could eat if they were following a completely healthy plant-based diet. And we're going to give them a piece of paper and ask them just to write down things that they would like. And so a week later, they will come back in, but in the interim, they'll be looking at simple things. We sit them down with a dietician and they'll kind of go through their day. So they might say, well, I'm really simple. I just eat cereal and I put it in a bowl and I throw milk on top. Nothing fancy. So the dietician will say, well, how about, instead of cow's milk, let's use a plant-based milk, almond milk, soy milk, rice milk. Then that fits our criteria. Okay, fair enough. Or let's play around with this. How about if I have oatmeal instead of cold cereal? How about if I top it with some berries or some cinnamon? And what I'm doing here is I'm building the power foods into the participant's routine. And let's say sausage is my thing. Well, next to the pork sausage is the plant-based sausage, low in fat. And there's plant-based bacon. They're kind of a liberal interpretation of the original. There are all sorts of mixes that a person could use to turn into pancakes and waffles. So the patient is just taking seven days, not changing their diet, but trying out things to see if they like them. And if they do, they write them down. If they don't, they leave them alone. So they go to their favorite restaurant, they try the veggie burger or the veggie wrap or whatever it might be. They go to their favorite Italian restaurant and try the angel hair pasta with the arrabbiata sauce or the pizza without cheese. Or they go to a Latin American restaurant, veggie fajitas, bean burritos, beans and rice, Chinese rice dishes, vegetable dishes, tofu dishes, or extra points for Japanese because not only are there lots and lots of plant-based options that are exotic and delicious, but they're really not big on oil. So it's easy to get away from the oil. And some of our patients eat at Taco Bell, which is not the pinnacle of culinary art. But if that's where you are, then what would you choose? Okay, meat taco, no, bean burrito, okay. Hold the cheese, add jalapenos. Okay, that's a power food. Fair enough, okay. Or I'm going to Subway or wherever. We work with a patient for what they like. And everybody has, within seven days, they've got a huge long list of plant-based foods that work for them. Step two is three weeks. Now eat those foods. That's it, that's it. For three weeks, the person is going to avoid animal products. They're going to eat the foods they have chosen that are entirely plant-based and they find they like it a lot. A couple of quick examples. This is Stephanie, who as a young woman started to gain lots of weight, did many different diets, Weight Watchers. She found it to be the most effective thing. Weight Watchers asked her to take a picture of her family. This was her success story on Weight Watchers. But later on, she learned about the approach that we use and decided that's what I want to do. And I want to have my whole family do this. And because her family had weight issues, they lost lots and lots of weight. And they took out the family photo album and this is them before they got into the same. And this is them after. This is them in the Weight Watchers picture. And several years later, after doing a completely plant-based diet, the weight's gone. Not just from Stephanie, but from the family as well. This is Shanae, who grew up in Kansas City. Similar story, lots of weight gain as a child, more than a hundred pounds overweight. Learned the approach that we've used, gradually put it to work. Found that she liked it a whole lot better than taking weight loss drugs or trying to restrict portion sizes. And she lost more than a hundred pounds. Got her confidence back. And has been working with us to really spread this healthy approach with lots of folks. We do have an app called the 21 Day Vegan Kickstart. It's free on your iPhone or your Android. It's in Spanish, it's in English. And this is our team. I did write this book called the Power Foods Diet, which has all the foods in it that I've just described. But the last thing is I just want to thank you. Thank you for allowing me to share this time with you. And when you try out different foods, different diets, and we share information with other people, they in turn share it with others. And they share it with others, they share it with others, and you'll never know whose lives you have impacted, but it ends up being huge. And I have you to thank for that. Let me stop at that point. Again, I'm sorry for the technical issues at the beginning, but I hope this was useful information. Thank you so much, Dr. Barnard. You're always such a good speaker and you bring things and break it down into such a digestible way. So we really appreciate that. I'm going to ask Dr. Viz if you can start off the questions. Okay, thank you, Dr. Barnard. This is quite informative and one can eat a lot and still lose weight. That's probably better than depriving oneself. Can you comment, and also you touched on it, it's both emotionally and physically, it's helpful. Can you comment about timing of food? Because my understanding is the later you eat, the not so good it is, so can you comment on it? Yeah, back when I was in medical school, we had this idea that you should eat multiple small meals every day. You have 10 small meals and sort of graze throughout the day. We were wrong. Trials really show that fewer meals and particularly those consumed earlier in the day, just as you said, seem to be associated with better weight. My research colleague, Dr. Hanna Kaliova, has done a number of studies on this and really does find that weight loss is best when people have fewer meals than they have them earlier in the day. However, we've seen lots of people very successful even without the meal timing. Thank you. Sure, great question. Great. All right, if anybody else has questions, please. We are going to stop exactly at eight because we have our study group orientation starting after that time. Is there anybody else that wants to, Raymond, I see you've unmuted yourself. Did you want to ask a question? Yeah, I do. I find the most difficult thing is motivating people. I mean, that's incredibly hard. There's no question, I agree with everything you said. Any thoughts about that? Yes. First of all, the person has to come to see you and they have to have that much motivation. That's all the motivation they need. They are right to be skeptical and they're right to be discouraged because they've been told things that really are not reliable. Like it's your fault, you eat too much, you have a genetic problem, you should eat smaller portions, you should get a food scale and all of that is really punishing for a great many people. We always use a very short-term focus and we don't challenge their skepticism. We treat the diet the way we treat an antibiotic. You don't have to believe in penicillin, you just have to take it. And so what we'll say is, okay, let's really do this and we meet every week. Our doctors don't do diet counseling. They need two minutes or three minutes with the patient to explain why the diet's going to work. And then the dietician does it and meets with everybody weekly, usually as a Zoom group. The patients love it because they're finally getting support. We never challenged them. We always are totally optimistic about it and we can maintain a short-term focus. They know they can quit anytime they want. We're doing now a study with Blue Cross Blue Shield of Minnesota with 900 participants and the patients think they died and went to heaven because they're mostly middle-aged and older and they lose weight and they're doing great. And the other thing about it is, with this approach, other health issues get better, diabetes improves, sometimes it goes away, their lipids come down, they're able to reduce medication and these things are just very rewarding. And forgive me for this long-winded answer, but just, I think it's such an important question. Many practitioners say, let me meet the patient where they're at and they prescribe small changes. I don't do that because where the patient is at is the emergency room. They are sick. They need trouble and they need success and they need it fast. So we described to them what's the best diet they could be on and we say, let's do this and I'm not going to abandon you. And we work to find the foods they really like. We bring in their reluctant spouse, they do it together and within about three weeks, they're just totally sold. They also have some recidivism and you don't blame them for that either. You have recidivism with every kind of addiction. So you just welcome them back. Thank you very much. Actually, I read your book 15 years ago about reversing diabetes and I've stuck to it since then. Oh, thank you. Thank you for that. Yeah. That was based on our NIH trial. Somebody did mention- Sure, just a follow-up question on that one. Even when things succeed, sometimes patients stop just in the middle with success. Is there ever a plateau or how do you deal with the patient who has done well and then just decides to fall off the wagon? People are always free to do whatever they want and we never judge them, but we're always also there for them. And people will, they'll do all kinds of things, especially with something like cheese, which has sort of drug-like effects for some people. This will happen, but they also don't feel like having health problems. So typically people will come back. But it's entirely their choice, what they may wish to do. So there's a question in the chat, Dr. Bernard, about is fish considered an animal product? Well, any zoologists in the group? If you go to the store, I have to say salmon is one of the best ways to stop weight loss. And I'm gonna break your heart here. Atlantic salmon, if you read the label, it's 40% fat. And Chinook salmon is 52% fat. So, so many people go to their doctor. The doctor says, just do a Mediterranean diet. It's as good as vegan. It's just so much easier to follow and have a little salmon and you are gonna lose nothing. And you will blame yourself because Mediterranean diet is so widely praised. You know, it's US News' number one diet every year and it's just, it's completely ineffective for weight loss. Unfortunately. You can feed it to your cat. Feed it to your cat. There's another question about the 75 hard diet that many teens are doing right now, where they drink a gallon of water daily amongst other things. Do you have any comments on that? A gallon of water daily? Yes, it's a 75 hard that they're calling it the teens. Um, well, you don't, you don't need to drink a gallon of water daily. You do need to have water, but this kind of old notion that you need to drink water as water neglects the fact that you had water in your oatmeal and you had water in your stew and water in your soup. So you're getting plenty of fluid without having to fill up a glass over and over and over and over again. With that much water every day, you might want to be careful about your electrolytes. Overhydration. Yeah. Exactly. Yeah. You're going to have trouble with electrolytes. So we're going to need to stop today. Dr. Bernard, thank you so much for coming and talking to us. Can we have you again, come back at another time and maybe talk about mood and food? Thank you very much. It was a very kind invitation. I'd be pleased to join you again. And once again, my apologies for the technical issues that we had at the beginning. Thank you so much. Very engaged group, and we really appreciate you being here. Thank you so much. Thank you. Sure.

plant-based diet

weight control

mood enhancement

Dr. Neal Barnard

vegan diets

anthocyanin-rich berries

cruciferous vegetables

mental health