Transcript of the No-Bullshit Vegan podcast, episode 74

Karina Inkster: You're listening to the No-Bullshit Vegan podcast, episode 74. Today, I'm joined by Susan Levin: registered dietitian, and Director of Nutrition Education for the Physicians Committee for Responsible Medicine. She discusses their recommendations for the 2020 to 2025 dietary guidelines for Americans, as well as four ways of vegan diet is optimal for athletes.
 

Thank you so much for tuning in today. I have an incredible vegan powerhouse on the show for you. First: in case you're ready to kick some ass with your fitness and nutrition, I did want to mention that right now, I've got only three spots available for one-on-one coaching. My client roster is almost full and I work with a maximum number of people at any given time. Right now I'm three clients away from my max. If you've been thinking about losing fat and gaining muscle on a vegan diet, do submit an application as soon as you can at karinainkster.com/apply.
 

Through my coaching programs, I show you how to build a consistent workout routine around your busy life, so you don't have to reorganize your entire schedule. We will also create a nutrition action plan, that doesn't require doing a complete 180 of your diet. If you're sitting around eating Oreos and nothing but, then maybe we would need to do a 180 of your diet, but for most people, we are making tweaks we are changing your food slightly; but in ways that are going to get you major results. Your nutrition action plan is going to let you eat your favorite foods, while supporting both your fitness and your physique goals. Most importantly, I will provide an in-depth support and coaching system to keep you accountable and moving toward your goals.  Again: I've got only three spots available and you can apply for one of them at karinainkster.com/apply.

I'm excited to introduce our guest for today: Susan Levin. Susan is a registered dietitian and Director of Nutrition Education for the Physicians Committee for Responsible Medicine (also known as PCRM), a Washington DC-based nonprofit organization, dedicated to promoting preventative medicine, especially better nutrition. Susan has been with the organization for 15 years, the last few of which have been shared with the Barnard Medical Center, a primary care office where she sees patients. She's also a board-certified specialist in Sports Dietetics. When it comes to her favorite vegan meal, she says beans, greens and grains: any variety therein. We begin our conversation speaking about the dietary guidelines for Americans. The following is from a report by the PCRN, which we will discuss in our conversation, and which is also available for you at our show notes, nobullshitvegan.com/074.
 

Here’s what the Physician Committee says: “ the dietary guidelines for Americans, which provide nutrition recommendations and are the basis for federal food programs such as MyPlate, are updated every five years, by the US Department of Agriculture and the Department of Health and Human Services. The process begins with a Dietary Guidelines Advisory Committee, a group of nominated individuals, which reviews current nutrition research, and drafts a scientific report that the USDA and HHS use to develop the final guidelines. The 2020 Dietary Guidelines Advisory Committee is currently drafting the scientific report, which is expected to be released this spring, for the 2020 to 2025 dietary guidelines for Americans. Since 1995, the Physicians Committee has successfully worked to ensure that the Dietary Guidelines Advisory Committee reveals conflicts of interest from the meat, dairy and egg industries, and that the dietary guidelines for Americans recommend healthful, plant based diets and warn against consuming cholesterol and saturated fat found in animal products. As the Dietary Guidelines Advisory Committee finalizes its scientific report, and the USDA and HHS prepare to begin work on the 2020 to 2025 dietary guidelines for Americans, the Physicians Committee is making the following recommendations. Susan will share the four recommendations that the Physicians Committee is making, and we're going to discuss them in depth. Let’s get to the interview.

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Susan, thanks so much for joining me today. Welcome to the show.

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Susan Levin: Thanks for having me. It's great to be here.

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Karina Inkster: Glad to have you here. Let's jump right in. I know that a lot of our listeners are probably already familiar with the Physicians Committee for Responsible Medicine, for whom you are the Director of Nutrition Education, but for those listeners who maybe aren't sure what the Physicians Committee is about, or your role within that organization, can you tell us a little bit about that?

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Susan Levin: Absolutely. So the Physicians Committee (I'll just shorten, it is a nonprofit in Washington DC, and we are in our 35th year of existence. It was was founded by Dr. Neal Barnard, to basically get the conversation started about nutrition in health among physicians. Of course, now it's a much bigger organization with more than 150,000 (I think we have 175,000) members, and about 12,000 physician members. The name stuck regardless. Even if it is people like me, ( I'm a registered dietician), there are nurses, physicians, lay people and other healthcare advocates and experts involved in the programming. We're really eager to see people improve their health through a plant based diet, optimally, preventing disease, but even for people among us who have chronic diseases, treating those diseases with a healthful plant based diet.

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Karina Inkster: Amazing. So what sorts of things do you do within your own role then of Director of Nutrition Education?

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Susan Levin: I wish it were that easy to sum up. I wear a lot of hats. I see patients in our primary care clinic with my dietician hat on. I help with clinical research trials. We do a lot of randomized control trials seeing how a vegan diet affects certain chronic diseases, whether it's diabetes, weight to acne pain, you name it. We’ve probably tested it. I do a lot of monitoring legislation. We're here in Washington, DC, so we keep a close eye on what the federal government and its different departments are up to when it comes to federal food policy. We work on that and then we do a lot of literature: public information available to the late to lay people and to physicians and healthcare providers too. We do a lot of things in two different languages, and try to make all that stuff really accessible, free, online as much as possible.
 

Karina Inkster: That's amazing; you guys do amazing work. Just in case our listeners don't know, you actually contributed to my first book back in 2014, educating people on sports, nutrition and why and how a vegan diet is optimal. So thank you again for that, by the way.

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Susan Levin: That was my honor, actually.

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Karina Inkster: I'm curious, how do people join the actual organization? I mean, I'm assuming there's some connection with being in the health and fitness and medical and nutrition field, is that right?

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Susan Levin: Well, anybody can be a member, you just pay your $20, and you become a member. And by being a member, you do have kind of an "insider look" into different projects we're working on. Maybe we're trying to pass a bill. Like I said, we're in DC, but maybe we're trying to pass a bill in California or Oregon or New York. In those cases we would reach out to members in those States and say, “ hey, we could really use your help, go talk to Congress.” If you are a medical professional, then we might have a different set of asks for you, such as lobbying. As a physician or healthcare provider, you can really speak to how this diet is effective for your patients, or it really depends, but anybody, anybody can be a member, absolutely. 

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Karina Inkster: That's good to know. I think a lot of our listeners are going to be very intrigued if they're not members already. We're also going to have some links in our show notes, so people can go there and directly get all the URLs that we talk about in our episode. One thing though, before we go into something I wanted to ask you about related to the Physicians Committee, I totally forgot to ask you about your own vegan journey. So how, and when, did that happen for yourself?

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Susan Levin: My journey is not that interesting. It was interesting to me, but I'm not one of these people that has one of these amazing stories about what I was and now what I am. I’m a child of the deep, deep, deep South of the States. I was born and raised in Alabama on a very typical diet of a person born and raised in Alabama, i.e.not helpful at all. Family, my mother my aunt, people are always a diet. I could probably say “ Weight Watchers" before I could say mama, because everybody was always on a diet. It was always a struggle in our family, like a lot of families, but nobody ever talked about eating healthfully. They just talked about losing weight, people, hypertension, heart, disease, diabetes, these were just things people got.

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People would die of these diseases, then after the funeral, people would bring ham and potato salad with mayonnaise. Nobody ever really talked about how to fix the way the way people get sick (common moreso in certain parts of the country and Alabama is certainly one of those parts.) Once I moved out and I sort of started paying more attention to more ethical issues with factory farming, and I was done with meat. I came across people who were much more enlightened than I. They said: well, if you're done with meat, look what's happening in the dairy and the egg industry. It’s like “ I don’t want to know”…but you have to learn. Once you know, you know. And then I was vegan. 

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I didn't really get into the health until I went that direction, learned how to eat better, saw some results in my own body: weight loss, better skin, better respiratory function for running: all these things started to check one after the other; all these things were really improving. I didn't know anything about that, at that time. I just became obsessed with the nutrition part; long story short: went back to school, redid all of my undergrad in science areas ( which I had avoided like the plague in my original undergrad.) Now it was personal, and now it meant something to me. I went back to school, went to grad school, got my dietetic license. Now I had the credentials to talk about the health aspects of this way of eating. That really, truly is my passion because I've seen what it's done for me. I see every day, and I hear every day what it does for other people. The empowerment of it all is so motivating, so it makes me want to shout it from the rooftops. So that's my journey.

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Karina Inkster: Absolutely. That's amazing. Well, thanks for sharing. It sounds like it kind of started with the ethical side, and then eventually down the road, branched into the health and maybe some other things as well. Is that right? 

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Susan Levin: Yeah, it really did. I mean, the ethical side seemed pretty black and white to me: I was just done. I can't do that; I can't support that. I didn't realize, because I just wasn't paying that much attention, but I didn't realize how that would affect me personally. It seems like a selfless act to do that for animals, but turns out I'm pretty selfish too.  I was really driven by how it benefited me personally in my health and in my life. I wanted to share that with other people because I just knew at the time, when I was thinking about going back to school, I was in New York City and almost everyone I knew was on antacids or antidepressants, and blood pressure pills. Well, wait a minute. Why don't you think about your diet and how you can change? They're looking at me like "what, who are you like, why would you, what book are you reading now?” I thought, you know what? I need some education. I need to go back to school and really know what I'm talking about. And I do, I really do know what I'm talking about. 

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I accredit a lot of that, not just to school, but to PCRM because they are such an evidence based organization. They really just beat that over my head all the time. This is not your opinion, don't say your opinion, back it up with a journal article, a peer-reviewed journal article. To them, I accredit that fact I'm a stickler for science now. When people say anything, I ask them why they are saying it. Where did they get that information? If you can't back that up with some science, then don't say it. 

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Karina Inkster: That's the whole point of this podcast. I started it because of the unscientific bullshit out there in the vegan sphere. When you combine veganism with fitness and nutrition and health, there's so much overload of pseudoscience out there. It's so, unfortunate even within the plant based realm. I mean, there's a lot of pseudoscience as we all know about non-vegan diets and it's just everywhere. That's completely in line with what this show is all about. So I love that. I wanted to ask you about one thing with the Physicians Committee. I was on the website just yesterday and it was dated the fourth. Today's the 5th of June, so it was yesterday. I saw a release that you, along with the Physicians Committee put out, around the 2020 to 2025 Dietary Guidelines for Americans.

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I think this is super important because we in Canada here recently had a complete revamp of our food guide. It's really plant-based right now. It's not entirely plant based, but it's not influenced by industry for once (cause it usually is.) So this is huge. I'd love to hear more about this. Let me just read a quick sentence that I found in the release for our listeners, which is: “the 2020 to 2025 Dietary Guidelines for Americans need to focus more on recommending plant based foods, and also warning against meat and dairy products that exacerbate hypertension, Type 2 diabetes, and heart disease, which already kill hundreds of thousands of people each year, and now make COVID-19 more severe and deadly”. This is obviously timely here. There were four main points that I saw summarized, that you and the Committee are recommending. I would love to hear a little bit about them. The first one is do not include a low carbohydrate eating pattern or recommended limiting carbs. So what's the deal with that?

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Susan Levin: While there's not a lot of evidence to support that recommendation anyway, what we were fearful of is the committee had someone nominated on it from the Atkins group (which we thought went bankrupt years ago, but they're still out there.) The Beef Council here in the States bragged that it had nominated two people that were selected for the committee as well. That was concerning. There was a huge effort to get low carb advocates to make comments, oral comments, written comments, to the committee; really pushing your agenda in a very aggressive tone and manner. We just wanted to remind the committee: no, this is not a helpful way to eat. Americans are already completely freaked out by carbohydrates, which as you and I know, means they're freaked out by high fiber foods.

That's crazy. That's exactly what we are avoiding, and getting ourselves into so much trouble with in terms of our health. We wanted to draw attention to that. Keep your feet in the science. Don’t go off into clouds with these people that are advocating for eating more meat, and butter and these unproven theories that they have made them very rich. People made a lot of money off of crazy ideas; a lot of books off this stuff. They've been pretty good at organizing behind that. That's unfortunate, but I'm hopeful that the reviewers will stay science focused.

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Karina Inkster: Just to back up a little bit, the committee that we're talking about is the people who are reviewing the dietary guidelines, is that right?

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Susan Levin: Yes. Every five years, there's a committee nominated by outsiders and they are supposed to be an independent a group of about 12 (although this time, it was 20 people). They write a report; they look at the guidelines as they are, and they make recommendations in a report. The report is probably a thousand pages. The guidelines themselves are somewhere around a hundred. Once they submit their report, which is happening soon on June 17th, the USDA and the Department of Health and Human Services here in the States, will take their recommendations and do what they will to form that smaller version, which are just the dietary guidelines. That's often where we see a lot of trouble, is when those recommendations get filtered through these departments who have their own agendas: especially USDA, which is the Department of Agriculture.

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They were designed, and they are the brain child of supporting agriculture in this country. That's what they are mandated to do. Many years later, somebody said, “Hey, I have something else for you to do. Do our nutrition guidelines!” Great idea. Now we have this one group trying to support farmers (who aren’t typically farmers raising strawberries); they're supporting big farms, beef, dairy farms, chicken farms. They're out there doing that first and foremost, and then second, trying to create nutrition. It's a mess. I'm really concerned about that filtration process which will happen for the rest of 2020, and then when they submit the actual guidelines in early 2021, we’ll see. I don't have a lot of faith in this administration. Unfortunately the heads of these departments are appointed by our president. Science isn't their strong suit. So that's bad because, nutrition is science. Once you start ignoring the science, we know what can happen. It's just like the same with an environmental group. When you start ignoring the science, you're not protecting the environment anymore, and that's going to be the same for nutrition. So we'll see. I don't want to be all gloom and doom about it, because I have to believe that there's some shred of pride in someone in the government and they will not allow people to go completely off the rails. 
 

Karina Inkster: Well, it's an interesting time right now, because there is this huge mountain of research, which you're basically sitting on, and then there's all these other forces working essentially against that, with their own interests. It's just so frustrating, but you're doing what you can, which is important. Hence the Physician's Committee doing recommendations like these, which basically you're coming up with recommendations to give to this committee who is then reviewing the guidelines.
 

Susan Levin: We've been telling them all these points. That was number one, and I'll try not to drag this out to push, but number two is ( this is where we would look at what Canada did) get water: recommend water. That's all a human adult needs, or a human after weaning needs, is water. Not milk! Get that big, giant dairy satellite off of our picture, which is MyPlate in this country. It's fruits, vegetables, beans, grains, and milk or dairy (it says), which is ridiculous. Dairy is not only not a health food, it is clearly there because of industry interest. It doesn't recognize that most of the planet is lactose intolerant, and that's the good news. The bad news is that this particular product actually increases the risk for certain forms of cancer which by the way, affect people of colour disproportionately, as does lactose intolerance.
 

We had a lot of people come out and speak to the committee and say, essentially these guidelines are racist, because they're written for people who are Northern European descent who could digest milk. We should be beyond that.  I think Canada kind of paved the way, if the government can find the pavement to show “ yes, we have a very diverse culture in Canada." We can't be recommending milk. That's ridiculous. So hopefully, we're following suit. 

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Karina Inkster: That’s a really interesting point. 

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Susan Levin: It's just staring us all in the face. If you are familiar with Switch4Good, which is the project of Dotsie Bausch (an Olympic athlete in the States); she has an organization of athletes who are all about getting rid of milk. She has been very passionate on this issue with the dietary guidelines. I hope she sees some of her work come to fruition too. By the same token, like you were talking about, because the USDA was designed to support agriculture, they have a real aversion to saying "don't do certain things that are unhealthy." Even though they'll put little code words around things like "don't consume so much saturated fat", and "don't consume so much cholesterol”, they stop short of saying, "by the way, the number one source of saturated fat in our diet is dairy." The only source of cholesterol in our diet are animal products. They're very hesitant to say "eat less meat". They're just scared to death of it, because the beef industry is watching, and they will flip their lids. We're saying to the committee: you need to warn against consuming certain products, very clearly stated. There's nobody who goes into a grocery store in America (very few people), who know what the hell saturated fat and cholesterol are, but they know what meat is. So just say it:  eat less meat, specifically processed meat. Everyone agrees on that; it’s a carcinogen. How can you possibly tiptoe  around cancer causing food, and then continue to promote plant based eating as they have? To their credit, the past guidelines said that plant based eating or vegetarian eating is one of the healthy eating patterns that we can be doing, or choosing. We want them to stick to that kind of language.

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Karina Inkster: That's excellent. Just to review, the third point is warning consumers against eating processed meat in very clear terms; not hyping it up around cholesterol or saturated fat or whatnot, just call it what it is. And then the fourth one...

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Susan Levin: Say it, just say it!

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Karina Inkster: Exactly. And then the fourth one is continue to promote plant based eating patterns. So they are, I guess in some form. I mean organizations like the Academy of Nutrition and Dietetics (or is it Dietetics and Nutrition?) I can never remember. They have a statement on vegan and vegetarian eating.
 

Susan Levin: Yes. They say it's not only perfectly adequate, no matter what life category you're in (infant,  pregnant, athlete, elderly), anyone can consume a completely vegan diet and be fine. They go beyond that and say, "actually, it's finally and adequate, but there's health benefits to eating that way." Then they lay it all out there: diabetes, heart disease, some forms of cancer, weight issues. Even kids dietary choices, when they avoid meat, they tend to make better choices: eating more fruits and vegetables, less, less sweets and salty snacks. There's a lot of benefit to eating this way as well.
 

Karina Inkster: That's awesome. I think I'm going to add a link actually to this particular piece, on the Physicians Committee website. I'll add that to our show notes, so we've got it for our listeners to check out if they want to see those four points. Were you leading this? You're the one who's quoted in the release, so was this kind of your project?
 

Susan Levin: It is. I inherited it when I first came to PCR 15 years ago, and it just kind of happened. The first round I was involved in, and this is my third round of involvement. Kind of by default, but at this point I've become the resident expert on the dietary guidelines. They are critical. They sound boring as can be, but it really is the blueprint of all of our federal food programs in this country. When people start complaining about school lunch or food stamps or the content of Meals on Wheels, or programs for the elderly, it all comes back to the dietary guidelines. It's essential that they be evidence-based.
 

Karina Inkster: That's an excellent point. I was really excited to see some of the changes that were made to our one here in Canada. Like you mentioned, not having dairy anymore as a category. Obviously there's still a ways to go, but I am hopeful for both of our countries, down the road hopefully. You never know. You never know.
 

Susan Levin: It's a slog, but it's gotten better. I have to admit, as I've again done this a few times, it's gotten better every time. These are just unprecedented times for us, at least in the States where everything seems to be bonkers. We'll see.
 

Karina Inkster: That's one way of putting it. It's so true. Let's pivot into talking about some athletic related topics. We have a lot of content on show around training and vegan diets for strength athletes and endurance athletes, and that kind of stuff. I really wanted to ask you about your top reasons for why the vegan diet is optimal for athletes, or even just people who are recreational athletes or people interested in exercise. We're not just talking about people who make their living by being an athlete.  What are your top reasons why the vegan diet is optimal (and not just decent or okay), but actually optimal for athletes?
 

Susan Levin: We actually published a paper on this, because it keeps coming back; when you start getting athletes like Serena Williams, or here in the States, American football players (big, strong athletes that everyone worships) and suddenly they're adopting a vegan diet, people get interested. We are getting a lot of phone calls. Dr. Barnard specifically, said “ I don't know. I don't know why this diet works so well for athletes. I can speculate, but let's really look again; let's look at the evidence. Let's try to dig into the science, and what's been published, and piece together a paper ourselves on why plant-based seems to work so well for athletes.” 
 

It had a lot of points in it, but clearly based on this other dietary guidelines web page, I like to distill things into fours, I guess. I made it into four reasons. It works for  professional athletes, or those of a certain caliber. I think it works for those of us going to the gym, too.  I think it's all relevant, but it all stems around (basically) a healthy heart. Here are the four points: leaner body mass, heart healthy, less inflammation, and higher glycogen stores, (stores of carbs). I really think those are the four key points. 
 

Let me touch on the lean body mass real quick. A plant based diet does reduce body fat, and that's a little bit different than just weight. It does contribute to weight loss as well, mostly because the diet tends to be lower in fat and it's very high in fiber. If you do that, that means not only are you eating fewer calories and you're eating bulkier foods, you just tend to lose weight, no matter how much of those foods you eat. Eating plant based side also tends to increase our metabolism. We did a study here actually that showed (it wasn't a weight loss or calorie counting diet at all); what we saw is when people tend to eat like a high carb vegan breakfast, (a low fat, high carb breakfast), compared to the way they were eating before, their metabolism jumped up (on average) about 16% after that meal. The thermic effect of food, or the after meal calorie burn, whatever you want to call it, but a 16% increase in your metabolism? Maybe that doesn't sound huge, but every day, that's pretty good. That is significant for body weight, but body fat outside of even body weight, has been shown to be reduced when eating a plant based diet as well.
 

That only helps with things like aerobic capacity. When you have a leaner body mass, you have a higher, aerobic capacity, which you could imagine is really important if you're trying to run or do anything as an endurance athlete. I think that's number one, a leaner body mass. Second (and this is why this is important for everybody), it's protective of the heart. Yes, cardiovascular health is critical for athletes, but even well-trained athletes are at risk for heart disease. Being a great runner isn't going to save you from a bad diet. In fact, the 2017 study found that 44% of middle aged or older endurance cyclists or runners had a significant amount of arterial plaque around their heart. You always hear the story, right? The guy running a marathon, he dropped dead and he looked so healthy. Sure, but what was he eating?

We know from research that a low fat vegan (or mostly vegan) diet is the most effective dietary pattern that has been clinically shown to reverse plaques. By that, I mean when people start eating like this, the plaque that's in their arteries (no matter what kind of exercise regimen they have), tends to just disappear. It just goes away. That had never been shown in a randomized control trial until Dr. Dean Ornish did it, and published it in 1990. That's obviously critical: cardiovascular health is critical for an athlete. It helps with blood flow. If your diet is very fatty, then you're going to have thicker blood, or more viscous blood, that's going to degrade performance because you're getting less oxygen to your muscles. A diet that's lower in fat and devoid of cholesterol is going to keep your blood flowing, and that's critical.  I don't know if you've ever seen the movie The Game Changers, right?
 

Karina Inkster: Yes. Oh, that's huge. I've had so many people actually come to veganism because of it.
 

Susan Levin: Absolutely. They literally show you what your blood looks like after you eat a high fat meal, and when you don't eat a high fat meal. It’s just different, right? It’s not only louder; it’s thicker and there's just not a whole lot you can do. It impairs your heart, and your arterial function for hours after we eat a meal like that. It's not like Americans are walking around eating one "high fat" meal. We eat like that three times a day. There's never a break from a bad diet, for many of us. Okay. Back to my top four; I was in the heart area. Less inflammation. Inflammation; a lot of times people will talk about how that's kind of the key for them, in terms of what's the worst thing for an athlete being the inflammation that comes with what you're doing. Exercising is pro inflammatory, it just is. You want it to be; there's some benefit to that, as long as you're pairing it with things that are anti-inflammatory. A diet can be pro-inflammatory or anti-inflammatory. A high fat diet is very pro inflammatory, and a low fat diet and a high fiber diet, is anti-inflammatory. You need that balance, especially if you particularly have a pretty tough exercise routine. You want that anti inflammatory diet: the antioxidants that you get with eating plants: Vitamin C, beta carotene, and all those free radicals that you get in beets and garlic and onion. This is what's going to help reduce oxidative stress and keep inflammation down. If your inflammation is reduced, you can train more, and you get fewer injuries.
 

I've heard firsthand or anecdotally from a few professional athletes, like Brendan Brazier or Scott Jurek, that what makes the difference for them is that they can train an extra day a week, compared with their counterparts. That extra edge, because they are in less pain, is what makes them the winner. They just have more training under their belt to be a better runner, or a swimmer, or whatever it is. Lastly, I want to point out that I really do think there's something about just the focus on carbohydrate. Because vegans tend to eat more carbohydrate than even vegetarians, and they tend to eat more carbohydrates than meat eaters, you're just going to be storing more energy in your muscle and your liver. You're just better trained on the inside to be a good endurance athlete.
 

I think it's at the detriment of people who are eating low carb. There was a study that looked at 16 healthy trained endurance athletes, and put them on a low carb diet. What they found (compared to the high carb diet) it was like an energy match diet, so nobody was getting more calories. At the end of the study, the people on the low carb diet lost their intensity, their peak power went down, their mean power went down, the total distance they could run dropped, and their blood became more acidic. That is the whole point for some people on a Keto diet; ketosis is when your blood is too acidic, you start breaking down your fat, it damages your organs, but for some reason, this sounds good to people. 
 

It doesn't help. As an athlete, carbohydrates are the primary fuel. Vegans, no matter what their exercise routine is, tend to eat more carbs, and helpful carbs. I think that just gives them an extra edge as well. Those are my four reasons. There's a lot more in that paper we wrote, if people are interested in really the deep dive, but I think it's important. Obviously these are all factors that are important to any human being in terms of their health and wellbeing, whether they are sitting on a couch, going to the gym, running 5k, running a marathon, Ironman, or playing professional football; whatever it might be.
 

Karina Inkster: That's amazing. Thank you so much for those. I'm definitely going to link to that article. We're going to have quite a resource section here in our show notes for this episode, it is going to be awesome. Hey, I've got a quick question about your first point, which I kind of feel like a lot of people are going to latch on to. I think things like less inflammation….a lot of times we've heard that in different ways, such as “ Oh, a vegan diet is higher in antioxidants or it's lower in pro-inflammatory foods”, you know? What really stood out to me was that you mentioned leaner body mass, but it isn't just on a calorie perspective. I think it's pretty clear that if you're eating a whole food (mostly whole food), plant based diet, you're eating a lot of really nutrient dense foods, but they're not necessarily calorie dense. That could be one reason why a lot of people lose weight when they go plant-based, but it seems like it's deeper than that. You were saying it has to do with the processing of certain foods, including carbs, and you gave oatmeal as an example. Can we do a little bit more info on that? This is really interesting to me.
 

Susan Levin: It is interesting!  I really think when it comes to just weight loss (forget about muscle versus fat), but weight loss in general seems to be from two things. One is just the high fiber: the calories, it's high in fiber, and it tends to be lower in fat. Just that alone means you're going to be possibly eating more volume, but with fewer calories. Just as a reminder, and I can get pretty graphic, fiber doesn't digest. So even though fiber is a carbohydrate, and it has four calories per gram (like any carbohydrate does), it doesn't digest. It does a lot of other amazing miraculous things in your body, but it comes right back out. So there's no calories in there. Even if they did digest, it's still fewer calories because there's not as much fat, which has more than twice the amount of calories per gram as a carbohydrate.

For that reason, okay, that makes sense. There does seem to be this metabolism component to it as well. If you are eating lower fat, higher carb, something about that (and I'm sure it's actually not that complicated); there’s fat in our muscle cells; cellular lipids that can clog up your little mitochondria. If this mitochondria can't do their thing, they're the ones who burn. They burn the calories. If they're all jammed up with fat in their cells, they just can't do their magic. If you start to eat less fat, those mitochondria are able to wiggle around more, you're just burning more, and it's just a much more efficient way to be. It seems to be really on that cellular level, in terms of why that 16% bump in post prandial (as it's called postprandial energy), after you eat a high carb meal and low fat, you're just getting the fat out of yourself, over time. Your mitochondria can wiggle and jiggle more, and burn more calories, to put it sort of simply.
 

Karina Inkster: That's a great explanation. Thank you for that. Where do you think this research is going to go? In the next couple years even, I feel like this is a huge area, especially with documentaries like The Game Changers coming out. There are so many people nowadays, who are coming to a plant based diet for the first time ever, which is obviously great. I think on the athletic side specifically, there's still more longterm, longitudinal research that would be useful. Where do you kind of see this going? What do you want to see in the research?
 

Susan Levin: I want to see more randomized controlled trials with athletes. I've heard researchers saying there's a woman, I think she's in Austria, who's works with teams of professional athletes (or maybe its college teams), but she's working on a study to really test the vegan diet on those athletes. I would be really interested to see more work like that, on professional or college athletes, people that are kind of at a different level.  I think when you do that, and when you see that kind of research: you, me as a person who goes out and runs four miles. I'm really proud of myself, but if it applies to that group, then it certainly would apply to me, in terms of the benefits that they might see in eating low fat plant based. In the world of science for better or for worse, it means nothing until it's been documented and published.
 

I would love to see those kinds of studies get published. They just take a long time because diet studies, are just hard. You can't really control what people are doing necessarily. You have to kind of take some of it with a little bit of a….rather, you have to trust the people are telling you the truth about what they ate. We see that in the research we do as well; we've never locked anybody in a room and fed them. They're free living people. It's like, "here's what we want you to do”. We keep in touch with them weekly to make sure they're staying on track, but people slip. People have lives, and issues, and get sick or whatever. Even in the real life situation, it's just interesting to see how this would affect someone at that level of sportsmanship, if you will. I'd love to see more of that.

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Karina Inkster: Yeah, me too. Honestly, I think that's a good one. I think the general population, when they see research like this on really high level athletes, they're like, “ ooh, well, this clearly applies to me as well.” You know, if they, if they studied these really high level athletes, why wouldn't it apply? I mean, you'd probably need to do more research of course, but people are going to see;  it works for these people, which is fantastic.

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Susan Levin: As it is now, we kind of have to draw lines. If having a leaner body mass increases your aerobic capacity and we know a vegan diet leads to a leaner body mass without calorie restriction, it's kind of like if "a equals b”, and “ b equals c”, the “c must equal a”. Therefore that might be one of the reasons why professional athletes do so well. They just have higher aerobic capacity, because they have a lean body mass, because they more plants and less fat. We're just kind of drawing conclusions here, but it would be really cool to see it right in the population, as opposed to these anecdotes. We have a lot of anecdotes: athlete after athlete, saying it's improved his or her recovery time, that they're just playing like they did 20 years ago. That's really cool and influential, I think, for the public. I'm happy to keep hearing those stories as well. 

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Karina Inkster: A hundred percent. I think that's just a product of being relatively early in this research. I think now we work with what we have, which is mostly (not entirely), anecdotal professional athletes saying, "Hey, it's working really well for me”, but there's beginnings, I think, of a lot of research that's showing specifically for high level athletes that a completely plant based diet is actually optimal, which is huge. 

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Susan Levin: It’d be great to get coaches and team dieticians, because they cater to them. Maybe they'll be the impetus for doing more studies and stuff, which would be great. 
 

Karina Inkster: That’s a really good point. Well, I feel like we could chat all day about all things vegan, but let's leave it there for today. We're going to have all of these resources that we discussed in our conversation at our show notes. Other than the pcrm.org website, I think there was another website that you mentioned that our listeners can go to. Was it the work for the Barnard Clinic that you do? 
 

Susan Levin: I mean there's barnardmedical.org. We are a primary care clinic, for anyone who wants to come to Washington DC and see a plant based physician (although now we're doing a lot of tele-health if you live in a state where we are licensed), but all that is on that website. 

Karina Inkster: Perfect. Excellent. We’ll have all that in our show notes, and I thank you so much for taking the time to speak with me. It was great, and I much appreciate you coming on the show. 
 

Susan Levin: Thank you, I appreciate it. Always a pleasure!
 

Karina Inkster: Susan, thanks again for sharing your knowledge with me and our listeners. We've got a lot of resources for you in our show notes at nobullshitvegan.com/074, including the Physicians Committee's recommendations for the new dietary guidelines for Americans, a journal article on vegan diets and athletic performance, and a lot more. Don’t forget, I've got only three spots available for one-on-one fitness and nutrition coaching right now. If you'd like one of those spots apply at karinainkster.com/apply. Thanks so much for listening and I'll see you next time.