Karina Inkster: You're listening to the No-Bullsh!t Vegan Podcast, episode 148. Dr. Scott Lear returns to the show to discuss research on heart disease, dietary oils, the Mediterranean diet, and what Forks Over Knives got wrong.

Hey, welcome to the show. I'm Karina, your go-to no BS vegan fitness and nutrition coach. If you haven't yet downloaded your free copy of the No-Bullsh!t Vegan ebook, celebrating five years of this podcast, get it now at nobullshitvegan.com/ebook. It focuses on strength training and nutrition to support it, and it features advice from yours truly and four of the guests I've had on the show, including vegan body building legend Robert Cheek. Make sure you get your copy at nobullshitvegan.com/ebook.

My guest today is Dr. Scott Lear. He was on episode 69 way back in the early days of the show, and he's returning today, 79 episodes later. Dr. Scott Lear has been a leading scientist in preventing heart disease for over 20 years. Scott is a professor in the faculty of Health Sciences at Simon Fraser University, and he conducts research into how lifestyle can prevent and manage heart disease and other chronic diseases. He has heart disease himself and writes a biweekly blog, Become Your Healthiest You, and co-hosts the How to Health Podcast to share his expertise and patient experience regarding healthy living. Scott can be found on Twitter, Instagram, and TikTok @DrScottLear. Here's our discussion.

Hey Scott, thanks for coming back onto the show. I think you were on episode 69 way back in the day and we're now in the 140s, or 150s possibly by the time yours comes out, so thanks for coming back on the show.

Dr. Scott Lear: Oh, wow. Welcome, Karina. I didn't know so many episodes had passed, but I guess time goes by when you're listening to your podcast.

Karina Inkster: I guess it does, hey? Well, nice to connect with you. Back in the day, we used to swim at Hillcrest in Vancouver when I still lived in Vancouver, and that's how we met way back in the day. It was probably, what, eight years ago or something like that, because I've been in Powell River now for almost five years.

Dr. Scott Lear: Yeah, I'd say maybe even a bit more than that. But yeah, Hillcrest is still there. I'm still swimming three to four times a week.

Karina Inkster: Brilliant. That's awesome. Me too when I can, except my shoulder is an issue, but that's a whole other story for another day. Anyway, so today we are going to tackle some myths and some concepts around oil in the diet. So this is kind of a, I'm not going to call it a series, but I am tackling this topic from various sides on the podcast because it keeps coming up. It's a huge topic in the vegan world, and I think there's a lot of research misinterpretation and there are a lot of myths. So we're going to talk about some of those. And it's a very broad topic, so we can talk about things like the Mediterranean diet, we can talk about things like olive oil specifically versus other types of oil.

It's very expansive, but why don't we start with one particular blog post or one particular article, because I feel like a lot of topics will come out of that that they possibly didn't get correct, and then we can expand. So this is an article that I found on the Forks Over Knives website. So folks who have been vegan for more than three minutes will know Forks Over Knives, for sure. It's a huge organization, and it's very commonly known in the plant-based world. And so they have this article on their website called Why Olive Oil is Not Healthy for Your Heart. And I know that Scott, you've gone through this with a fine tooth comb and have found potentially some issues here.

Dr. Scott Lear: Yeah. It was an interesting article to read, because in my world... So I was trained in cardiac rehabilitation facility program, and the whole idea is to promote a healthy lifestyle, physical activity, and healthy nutrition. So within that sphere, a diet like the Mediterranean diet, which has a fair share of healthy oils, whether through extra virgin olive oil, and one arm of the study tested looked at nuts, which also have oils in them as well. And so this was interesting. And when I read that, that was the first time I'd heard about this notion that olive oil may be bad for you.

Karina Inkster: Well, that says something, given your research history.

Dr. Scott Lear: Yeah. Yeah, I guess so. Well, sometimes I get to that point where, as you start to know more, you realize how little you actually do know. And so I'm like, "Oh, did I miss something? Did I miss something?" So I went through all the articles that were cited because that blog post was out in the last year or so, I think it was fall last year, 2022. And most of the articles that were cited showing a potentially harmful effect of olive oil were looking at endothelial function. So that's how our arteries react, in general, constrict or dilate. And that's kind of like a preclinical marker of atherosclerosis heart disease, plaque in the arteries. So a lot of the studies that were quoted, I think there was a couple of them were at least 20 years old. And so I was like... I went through those studies. Yes, they were correctly cited.

And then I looked at more recent literature, and more recent research looking at the same thing, and it was like totally in the opposite direction. It showed that extra virgin olive oil actually improved endothelial function. It's considered heart-healthy if your endothelial function is improved. And how we measure that is... It's commonly done through a method where you might squeeze the brachi artery, the artery in your arm with a blood pressure cuff, and then you might measure how once you release that pressure to see how fast that artery actually expands again. There's also tests that can be done with nitroglycerin. 

So the faster that your artery expands, the better it is for you because your artery's more reactive. And so that's just a segue to say that better endothelial function is considered heart healthy. And so these recent studies showed the exact opposite, and I came across one in the last year or so that actually looked at two different types of olive oil, and so the extra virgin olive oil and what they called refined olive oil.

So this was olive oil that had been stripped. Basically, it was refined, so there's no taste, no smell, and essentially it was just oil. It wasn't really like olive oil, but it came from oil. So it had been stripped of a lot of the nutrients, like polyphenols that are associated with olive oil. And in that study, they found that the extra virgin olive oil did result in improved endothelial function, whereas a diet with the refined olive oil didn't. And so those researchers in that study speculated that maybe these older studies, because they didn't say what type of olive oil or how they handled it, might have been using a more refined version of that olive oil. So that was the only thing that I could find around that.

Karina Inkster: Interesting. So what you're saying is the research that you found cited in this particular article or blog post was decades old, and the research that you have found since on the same subject has actually shown different results?

Dr. Scott Lear: It's shown different results, and it's only that one... There's numerous studies that have looked at this topic, but only that one that kind of provided an explanation of why the earlier studies didn't find the same results. And one of the sentences the authors started saying, "This is in contrast to earlier research. We're not exactly sure why that is, but it could be because of early research." They didn't quite describe the olive oil in as much detail that they could have been using some sort of refined olive oil instead of extra virgin olive oil. So that was dealing with the endothelial function, which can be considered - it's not a risk factor per se, like high blood pressure, high LDL cholesterol or high blood sugar, but it's considered a risk marker. But then with a lot of these things when we're looking at markers, we're thinking that people with poor endothelial function have a higher risk for disease, but doesn't necessarily mean that that's going to be the case.

Karina Inkster: So let's expand on that a little bit. This reminds me of a conversation I just had with Dr. Matt Nagra, who said as a kind of analogy, it's kind of like saying, well, water is bad for you because the main ingredient in Coca-Cola is water. And looking at a lot of these highly processed foods that happen to have oil in them is kind of the same, right? That might not be the thing that is necessarily causing negative health outcomes. But let's expand on that a little bit. So we're talking about markers and exactly what that means for someone's health, and the fact that endothelial function by itself, I assume from what you're saying, without taking other contexts or other factors into account, might not actually be a good marker of cardiovascular function.

Dr. Scott Lear: When we say a marker, it's because we're not necessarily directly measuring disease, which is far more invasive. But in my field, what we're interested in is preventing heart disease, so plaque, an atherosclerosis plaque buildup, but really preventing heart attacks, preventing compromised function of the heart as a result. And that's a predominant way, but there can be people who have atherosclerosis and never end up having a heart attack. Diabetes is one where the overwhelming majority of people with type two diabetes have obesity, or either overweight or have obesity, but doesn't mean if you're overweight or have obesity, you're automatically going to get diabetes. And so we use these as proxies because we consider them to be robust, but they're not as costly or as invasive as if we're doing an angiogram and putting a catheter in somebody's heart arteries to see whether they have atherosclerosis.

So it's kind of what I would call an upstream preclinical marker. It's not something that in a clinic that a doctor would measure or treat, not like blood pressure or cholesterol, or blood glucose, like I mentioned. And in the end too, in our field, when we're treating cholesterol, high LDL cholesterol, it's because of its relationship with heart disease. If it didn't have that relationship, if blood pressure, and hypertension didn't have a relationship with stroke or heart disease or other problems in the body, then we wouldn't be treating it. It's because of those outcomes that actually cause problems where people feel pain, where organs are compromised, that's the concern.

Karina Inkster: So are some of these measures or markers kind of like BMI, which is supposed to be a population-wide measure of, or a proxy measure of health, but when you look at an individual, what you really need to do is look at more variables and more context?

Dr. Scott Lear: With the endothelial function, that's more of a research marker. I would say it's providing you better individual assessment if I have to compare it to BMI, but it is done more in a research avenue. So it's not like we can say that. And there might be some clinics that use it, but it's not widely used, and it's not something that we say, "Oh, if your value is X, we're going to treat you with either lifestyle or prescribe some medication." So it's not used in that sense. So it's kind of like a nice to know, but it doesn't add anything. If you're taking somebody's blood pressure, measuring blood tests, taking a measure of their waist, get a sense of their family history, their lifestyle, adding in something like endothelial function isn't really going to make a big difference or any difference in how a healthcare provider would address that individual situation.

Karina Inkster: Right. Okay, that makes sense. But a lot of the research that we see on oil specifically uses endothelial function as a marker or as a proxy of cardiovascular event risk, right?

Dr. Scott Lear: Yeah. And one of the reasons this is at the top of my mind, because yesterday I just talked about it in my lecture to my second-year undergrad students, is that the prevailing belief hypothesis for how atherosclerosis forms in the arteries is that there's an injury to the endothelial layer in the artery. So if you look inside or a cross-section of an artery, it's essentially a hose, and that inner lining area is one cell thick endothelial cells. 

And so that's called the endothelial layer. And the theory of how atherosclerosis starts is an injury occurs to the endothelial layer. So for example, somebody who has excess blood glucose, somebody with uncontrolled diabetes, what the blood sugar does is it makes that inner lining leaky. Now, there are usually small gaps between the endothelial cells. They're not quite put together. So there's no gap between them because certain nutrients like oxygen have to flow through as well. But with uncontrolled like glucose, makes it leaky. So big things like cholesterol-containing particles can then go through that inner lining of the artery and go below it, and that can start the process of atherosclerosis.

Another thing is hypertension. So when your blood's going through the artery, just like water going through a hose, the blood that's closest to the wall of the artery goes slower because it's got that friction against the inner wall. And this creates what we call a sheer of stress. So if you just picture yourself in a lazy river that's going around, and you stand in up against the wall of the pool, you'll feel that rush of water passing you. So that's like a sheer stress. So with high blood pressure over time, that can cause an injury. And so this endothelial function measure can get a sense if there's perhaps an injury or something like a dysfunction going on that maybe the person smokes and that's created irritation in the endothelial and the arteries, or as I mentioned, high blood pressure or something. So that's how it's tied into heart disease and atherosclerosis.

Karina Inkster: Got it. That makes sense. It's tied into heart disease and atherosclerosis, but not the only piece of the puzzle.

Dr. Scott Lear: Oh yeah, not the only, for sure. There's so many factors in atherosclerosis, as there are in a lot of diseases. It's rarely that somebody has a chronic disease like heart disease, and there's one attributable factor to that disease. It's usually a cascade and a whole bunch of different factors going on there.

Karina Inkster: Of course. Yep. So is there anything else specific to this Forks Over Knives article, things that might have been not a hundred percent, that can tie into some of our other talking points?

Dr. Scott Lear: Yeah, for sure. The one that I was kind of dismayed about was the Mediterranean diet study. So Mediterranean diet is really the only dietary pattern that's being studied in a randomized trial to look at managing or preventing heart disease. So when it first came out in the nineties, there was a study called the Leon Heart Study. It was a small study, but it looked at the Mediterranean diet and showed that people randomized to that Mediterranean diet, who already had heart disease, had less chance of having another heart attack compared to those on a typical Western diet. And then there's a subsequent one which is referenced in the Fork Over Knives one that it's called PREDIMED. And so this one is looking at a larger sample of people and in whom there is no heart disease to see if there's prevention. And so there were three groups in this.

There was one that had extra virgin olive oil, and another group, instead of that, had a half pound of nuts per week, and a third control. In the Forks Over Knives blog post, it says that there is no difference, but there was a difference. In both the Mediterranean diet groups, whether they had the extra virgin olive oil, or whether they had the nuts, there was a lower chance of getting heart disease over the study period or getting a heart attack, compared to what the typical Western diet. So that honestly was categorically wrong to say there was no difference because there was. It was a small difference, but it was still a difference there, for sure.

Karina Inkster: Interesting. What about research like Caldwell Esselstyn and Dean Ornish, and there's all these folks who have looked at the plant-based diet related to heart disease. Is that on your radar at all?

Dr. Scott Lear: It is. So my blog post today, I call it Nutritional Wars: Is There Such a Thing as the Best Diet? And so, okay, full disclosure, hopefully, you won't kick me off the podcast, but I'm not a vegan, but I'm not a paleo or carnivore advocate either. And I was listening to all this stuff, especially on the paleo-carnivore type. This is how cave people ate, and so this is how we're going to eat. So I actually started looking into this because I'm like, wait a minute. Back then, we lived to 25, 30 years of age. I don't want to do a diet that's going to - that would mean I would've died like 17 years ago. So I'm familiar with the Dean Ornish diet and that program that demonstrated reversal atherosclerosis, along with, there's meditation, and exercise.

So it was a whole lifestyle base. So it was great to show that these things work. Only probably a select group of people would find this lifestyle something that they would want to adhere to, but it shows that if people did X, Y and Z lifestyle, then yeah, you can prevent heart disease. So that was really good. And so I started looking into what did our ancestors rarely eat? So a lot of this stuff doesn't come so much from the research literature as much as kind of anthropology, like National Geographic types of things. It doesn't seem feasible that we ate - as one of my colleagues who spent some time in the seventies among Inuit communities in northern Canada, he said hunter-gatherer people were more gatherers than hunters. He says it takes a long time to chase down a caribou with a spear. And there are a few hunter-gatherer communities still around in the world, and meat is part of their diet, but it's still predominantly plants because the seasons change. The hunting seasons change. So they're consuming what's available locally.

And there's one community, one tribe called the Hadza in Tanzania in Africa, and they've adhered to a lot of ways of collecting food. And when they go hunt, they use bow and arrow. And they're not going to always be successful killing something with their bow and arrow, for meat. And so if we think back to compared to how thousands or tens of thousands, hundred of thousands years humans or ancestors being on the planet, the bow and arrow is a pretty modern technology. So if you're going further back, you're throwing rocks or throwing a spear to try and catch. And so most of these communities are on plant-based diets with no more, at high season, no more than maybe 30% of their calories coming from animal meat. And it might go down to below 15% at certain times of the year. One of the communities in Bolivia are believed to have the lowest rates of heart disease of any population in the world.

Karina Inkster: Interesting. Yeah, I think I had an interesting conversation with someone recently about there's not actually a ton of research literature out there pitting the a hundred percent vegan diet as the best option for health. There's equal research showing that an omnivorous diet, which is plant-based but not plant-exclusive, is good for our health. The piece with veganism comes from the ethics side, and the lifestyle piece and the environment and climate change and all of these other things that we can have individual impact on. But when it comes to the nutritional research, vegans like to think that there's a lot that says, well, vegan is clearly the superior diet. And there are some interesting studies coming out now about veganism and athletic performance and less markers of inflammation and all this stuff. But really when it comes down to it, from my understanding anyways, is there's a lot of diet patterns, a lot of dietary patterns that can be seen as health-promoting.

They're not all vegan, but they are mostly plant-based, most of the time anyways. And like you said, if we're looking at what prehistoric humans or humans over the past hundred to 200,000 years were eating, it's not giant chunks of meat at all times, which is kind of what the paleo and the carnivore folks these days assume it was.

Dr. Scott Lear: Yeah. And the other side of it, if those ancient humans are getting their activity chasing down that food, they're not going to the corner store and getting it.

Karina Inkster: Right.

Dr. Scott Lear: So there's other factors. A lot of times when I've seen is what they call popular diets going head to head, the outcome is all usually weight loss. Which diet is the best for weight loss?

Karina Inkster: Oh yeah. Right. Good point.

Dr. Scott Lear: And I personally get tired of that because our food is far more than just calories. If it was just calories, we could get away with lifting just by eating sugar, probably the densest caloric food that we have, but it's not. We need calories, but we need other things to go with it. But when we compare these diets just based on how much they'll lead to weight loss, it's really distilling them down to something far simpler than they are. And most of the studies haven't compared, let's say like a plant-based versus an animal-based, but more like low fat versus low carb types of diet. And most of those studies when it comes to weight loss show, it doesn't matter if it's low fat, low carb, it's that you're eating less that matters if you want to lose weight.

Karina Inkster: Exactly.

Dr. Scott Lear: But those are all in controlled environments. Sometimes people are provided the food, so it's not really real world. But a more recent study by Kevin Hall where he compared a plant-based diet with a more animal-based diet and had people actually live in this clinic where there are beds and stuff for a few weeks, and they tried both diets, but they were given free access to the food. So they weren't told how much to eat, but they were... It could have been a buffet spread of plant-based, and then the next week, it was flipped over to animal products or less plant-based. And that study found that the plant-based - the people, when they ate the plant-based diet - they ate fewer calories, and this is because they're probably full.

Karina Inkster: Right. More fibre, less calorie-dense foods.

Dr. Scott Lear: Yeah. And the other thing too that's common to all of these diets, whether it's paleo, keto, vegan, omnivorous, flexitarian, none of them are telling you eat processed foods.

Karina Inkster: Good point.

Dr. Scott Lear: They're all saying to eat foods as close to their natural state as possible. And so anytime somebody makes a switch from a diet that has highly processed or ultra highly processed foods to one that's less processed, or eating more foods that look like the food that they originally were, is a healthy choice. And that can come through different types of dietary patterns. And so personally, I find this kind of fight between different popular diets from a health perspective to be a bit more tiring, that if we just spent that same energy, getting rid of processed foods, which I think there's probably a climate sustainability argument there as well, if we're getting less packaging...

Karina Inkster: For sure.

Dr. Scott Lear: ... getting food traveling less, we'd all be a bit healthier.

Karina Inkster: That's such a good point. I like your point about weight loss being basically the only thing people ever talk about when they talk about diets. Veganism is a little different, of course, because he got the ethical piece again, but it's touted as a weight loss diet more often than not, and it's basically just because folks eat fewer calories. That's it. It's nothing magical. So I think that's a really good point. When people bring up this oil concept of oil is not bad for you, they always say, "Oh, but look at how many calories are in one tablespoon of oil." But there's other foods that are also high in calories. It's not just about the calories. It's also about micronutrients and how your body processes them. So I think that's a really good point.

Dr. Scott Lear: In recent years, 10, 15 years, we’re realizing that fat has probably got worse of a reputation than it deserved. And that back, there was... In the sixties, and seventies, the sugar lobby was funding research that was showing that in fat hypothesis for heart disease. There are other diseases besides heart disease too, so we don't want to be too heart disease-centric. And so that paved the way for we're creating low-fat but high-sugar foods. So you can have low-fat Oreo cookies, low-fat ice cream, but it's pumped full of sugar. And we are finding more, in the last five-eight years, that if even if you are eating saturated fat, if you reduce that but replace it with refined sugar, that's probably not a healthy choice. Whereas if you replace that saturated fat with some polyunsaturated fat, that's probably a healthy choice. So when it comes to diet, if you're kicking a food out of your diet, you're going to replace it with something, and what you replace it with can be just as important as what you've stopped eating.

Karina Inkster: That's such a good point. There's not a lot of research on this replacing thing. It's usually about limiting and avoiding and not eating things, and it's not really a lot of pressure or talk about what folks are eating instead.

Dr. Scott Lear: Because a lot of nutritional... When we're looking at things like disease outcomes, and this is why we might look at the endothelial function or other things like blood pressure because we can change somebody's diet and see that effect within a few weeks or a few months. Whereas if somebody changes their diet, we might have to wait and have them on that dietary pattern for five, eight years before we see any difference in whether they get cancer, whether they get diabetes, whether they get heart disease or something else. And so we rely in nutritional sciences on the observational study where it's typical we ask somebody what they ate, which right there, we know is unreliable because we want to know what they ate and how much. If somebody just says they had a burger, how many people just actually have a burger? Or if they have a sandwich, what does that mean?

Some people are very detailed. Then follow them for five, 10, 15 years and look at the people that got a disease, and then look back at what they ate when they first started the study. And so a lot of times this doesn't take into account changes in dietary patterns over the years. We assume, over the span of 10, 15 years, what they ate that one week when we started the study is consistent, or we have to get tens of thousands of people into the study to minimize that noise. Some studies will do dietary assessments throughout maybe every couple years, so that provides some more robust data. And then with those studies and some statistical analysis, you can look at, oh, well, if people changed food X to food Y, how much more or less does it change the risk for disease?

And so we're starting to see those kinds of what we call statistically modeled ways of what happens if you change that. And that's where some of the research showing that saturated fat isn't as bad as the rap it’s got. Because when we do those, when nutrition scientists do those studies where okay, if people did replace it with refined sugar, that increases their risk for disease.

Karina Inkster: Right. So what folks are replacing these foods with is just as important as what they're cutting out is the moral of the story?

Dr. Scott Lear: Yeah. Yeah, for sure. For sure. Yeah.

Karina Inkster: Well, are there any other points on this topic? I want to talk about communication and scientists and kind of veer off into a different direction, but any other points on the Forks Over Knives piece, in particular, diets or dietary patterns, kind of that theme?

Dr. Scott Lear: No, I think I'm pretty close to tapped out.

Karina Inkster: Close to tapped out. Well, that's a good sign.

Dr. Scott Lear: Yeah.

Karina Inkster: Awesome. Okay. Well before we started recording, and actually in the last time we chatted, we talked about scientists communicating, or maybe not communicating. And so this is kind of an idea of the folks who are on the ground doing the science and whether or not or how they are then communicating their findings to everyone else who isn't a scientist. So I'll kind of leave the door open for you there. We can talk about... I know you have a lot of projects like a podcast yourself. We can talk about this idea that you had where a lot of research is publicly funded, so maybe there should be an expectation that scientists then communicate in a way that the general population can understand, but it's an interesting topic to me.

Dr. Scott Lear: Yeah. And at the fundamental level... So I'm at Simon Fraser University, and same with pretty much every university, when it comes to advancement, promotion or advancement in salary, strong contributors, how many papers we publish. So right there and then, that's a form of communication.

Karina Inkster: Right.

Dr. Scott Lear: But they're being published in medical journals. And the university system has been around for more than 500 years. And back then, people at universities were talking to other people at universities. So they're talking the same language and there wasn't as much, what we call applied. So the nutrition stuff we're talking about today is applied, what I'd call applied research. It's science, but it's an applied science because it's... Which distinguishes it from, let's say research where they might be testing things in isolated cells or tissue culture, or outside of the human body, which is all valuable. But when you go to a conference or you present that, you're talking to other scientists. But a lot of research now is it could be...

It's just as important to figure out what's the best diet, but it's also important to know how do we get people to have access to that diet, how do we get people to eat that to make it easy for them to do that? Most of my work is focused in physical activity, so how do we get people to be physically active? And you could have the best program in the world, the best medication in the world. If nobody takes it, nobody uses it, it's not the best. So that's where communication comes in. And so for me, I got into it because I can get an article into a prestigious or semi-prestigious medical journal. And at most, maybe a hundred people, maybe a thousand people read it. There's actually an online media outlet for academics to write for the general public called The Conversation. And I can write an article, a blog-type article on that medium, and I can get anywhere from 50 to a hundred thousand reads on it.

Karina Inkster: Wow.

Dr. Scott Lear: But the key thing is you are writing for maybe a somewhat educated population. Most of the people that are probably reading it have some university degree. We're supposed to write it in a way that's mid-level high school and stay away from jargon. I think that's really important. As you pointed out, a lot of research that scientists do is what we call publicly funded. So that's funded, could be the provincial or the national government agency, or if it's a foundation, like the Canadian Cancer Society, American Heart Association, which they raise their money through donations from the public. I know some of my colleagues would probably push against this, but I think that we should also be learning, because of that, how that we can distill our research to communicate to the people who are generating the funds or have generated the funds. And as one of my former supervisors said during my Ph.D., try to describe your research to your mom.

Karina Inkster: That's a good one.

Dr. Scott Lear: If you can get your mom to understand what you're doing, then you've communicated properly. And it takes skill. It takes skill to do that, and it's a skill that needs to be taught. And I've found that my ability to be concise has improved since being on Twitter, because if I say something wrong or get it wrong, then I get the online community jumping on me and stuff. So yeah, so that's kind of like a baptism by fire there.

Karina Inkster: Right. So do you see this as something that should be taught to professionals and researchers, like, I don't know, some kind of expert who's coming out with a program that folks can take for verbal and written communication, because it's not really part of your official training?

Dr. Scott Lear: Yeah. And it's something that universities within undergrad are actually dealing with a bit more, not so much in what we call science communication, but just trying to improve writing and communication skills. And I'm kind of pushing this more, because before, education was about retaining knowledge, right? Now I can give a lecture, and my students can fact check what I'm saying on their phones while I'm giving that lecture. So it's not necessarily about giving them the knowledge. It's about them learning how to understand the knowledge, criticize it, and then communicate it.

And I think the more accessible information comes to us, I think the more important communication is. And we can see that working both ways. The people who are great at communicating misinformation have huge followings, just as well as people who are great at communicating truthful in information. So it's no longer that knowledge, per se. Knowledge has a role. But even a physician now with electronic medical records isn't memorizing things like a physician had to 40 years ago.

Karina Inkster: That's a really good point. Do you feel like your podcast and kind of that realm is part of this, so communicating to a more general public some health information?

Dr. Scott Lear: Well, I do it because I enjoy it. And I actually started doing it after I was first on your show.

Karina Inkster: Oh, awesome.

Dr. Scott Lear: I was like, oh, this was pretty fun. Let's try it.

Karina Inkster: Very cool.

Dr. Scott Lear: So I've actually revised the podcast, so it's co-hosted one, because one of my former undergrad students reached out to me and said, "Do you want to co-host a podcast?" So now we have one where it's the two of us going back and having a conversation. It's called How to Health. So a little plug there. It's on Spotify, Google, and Apple as well. And yeah, it's all about trying to take that science and give it to people so that they can understand. And we've just been through a huge real-world experiment in communication with the pandemic.

Karina Inkster: Right. Of course.

Dr. Scott Lear: As the science is coming out, how do we communicate that? And if we bring it back to nutrition, the WHO, the World Health Organization, recommends that each person should have no more than 10% of their calories from free sugar. So that's the guideline. So what does that mean to you, to me, to people hearing about that? First, I had to look up what free sugar is.

Karina Inkster: Good point.

Dr. Scott Lear: Yeah, because it sounds like, oh, table sugar. Well, people aren't downing spoons of table sugar. And so it's sugar in table sugar, but it’s also sugar in things like pops, juices, any types of processed foods, basically that free sugar, not sugar in apples or oranges or broccoli and starches like that. And okay, so now I got that, but then 10% of how many calories you eat per day. How many of us know how many calories we eat per day?

Karina Inkster: I have no idea If I'm not tracking it in an app, which is not something I want to do for very long, to be honest.

Dr. Scott Lear: Yeah. And I would say most people are probably eating somewhere between 1,520 and 2,200 calories per day, but that's still a wide range, and then you’ve got to calculate 10% of that, and then you got to figure out how that translates to what you're putting in your shopping cart.

Karina Inkster: Right.

Dr. Scott Lear: So to be kind, it's not a very user-friendly recommendation.

Karina Inkster: So actually, that's a good point. Some of this communication piece might be, well, what does that mean to the end user? It's not just the fact that we need to be communicating at all. It's also how that communication is happening, and what it means to the folks to whom we're communicating these pieces of info. So this is a good example because the average person, including myself, would have no idea where to start if the guideline was, yeah, 10% max free sugar out of all your calories. I would just be like, "Well, that's too hard to calculate, moving on," and it wouldn't really mean anything.

Dr. Scott Lear: And another one that's just been out by Health Canada is the one saying that no amount of alcohol is safe for you...

Karina Inkster: Oh, right.

Dr. Scott Lear: ... and suggesting that people have no more than one to two drinks per week. So I looked into this. I wrote a blog post about this. I have a TikTok account, so I talked about that as well as. And it was very... There was a lot of clickbait headlines and it was very much like, if you have any amount of alcohol, it's deadly for you. The science behind that recommendation isn't totally solid, but it's, again, like you said, people are just going to give up and say, "I don't even want to listen to this. I'll still be drinking whatever I'm drinking." But we communicate risk. What does it mean? Okay, well there's a 30% increased risk of going from no alcohol to five drinks per week or five to 10 drinks per week, 30% increased risk for certain cancers. Now, 30% sounds like a lot. If food was 30% cheaper, we'd all be quite happy. It's what we call a relative risk. And so if one out of a thousand people will get this type of cancer in their lifetime, that 30% goes from one out of 1000 to 1.3 out of 1000.

Karina Inkster: Good point.

Dr. Scott Lear: And then you can start to think a bit more, is, okay, is that a too big of an increase for me, or is it too small to change, right? But we make these decisions all the time, right? There's a risk to crossing the street. The lowest risk for driving is not driving.

Karina Inkster: Right.

Dr. Scott Lear: But we all make that decision to get in our car and drive. So that's the problem I had with that type of recommendation. And it got a lot of press because it was something new and was very much... And sure, yeah, if you're going to from a purely physiological point of view, yeah, having no alcohol is going to be better than one. But if we give people more of the information about it, what it means, then they can balance that off and make it a bit easier than trying to maybe... Okay, well, maybe they can cut down from let's say eight drinks a week to four. Maybe that's realistic, and that's still something. But the way these guidelines were mentioned said no amount is safe. So then the person who might have reduced their alcohol per week is just like, "Well, I'm not going to go to zero, so I'm not going to do anything."

Karina Inkster: Good point. It was kind of like the dark chocolate info that came out recently about lead and cadmium levels in dark chocolate. People are freaking out about this. I'm someone who eats dark chocolate literally every day. Now, am I eating a whole bar of chocolate? No, but still, I looked into it, and there's so many grey areas. There's different brands of chocolate that have differing levels of these things. And also when we're looking at so-called appropriate amounts, we're looking at a large amount of chocolate eaten every single day over a long period of time, which most folks, including me, aren't doing. So again, it's about context. And a lot of people who are just reading headlines don't actually have the information they need to make those decisions for themselves.

Dr. Scott Lear: And some of this actually happens at the university level. There are some studies that have looked into how news releases are developed at the university level. And sometimes the news release that the institution puts out isn't always true to the actual research article because it's going out to different mediums, and they've got whatever, if we're thinking about an old school, like a TV newscast or a print mainstream media, they're flooded with different information every day. So whichever catches their eye first. So sometimes there's that kind of urge to make it sound a bit more, “be careful how much chalk you eat because you may be eating lead.”

Karina Inkster: Yeah, exactly.

Dr. Scott Lear: It’s a lot different than saying, if you ate 10 pounds of dark chocolate a day, you're going to be increasing your exposure to lead.

Karina Inkster: Exactly.

Dr. Scott Lear: I'm just making those numbers up.

Karina Inkster: Of course.

Dr. Scott Lear: The 10 pounds is just... Yeah, so...

Karina Inkster Well, I could eat 10 pounds of dark chocolate a day, but I don't, I could though, just saying. But it is a good point though. So there's the communication piece, and then there's also, how is it being received? And what does it mean for the person who is consuming this information? How can they take action on it? Can they take action on it? Because in a lot of cases, they can't.

Dr. Scott Lear: Yeah, and nutrition is super hard. Comparatively, physical activity, it's easy. The worst amount of physical activity that you can get is zero.

Karina Inkster: Right.

Dr. Scott Lear: The benefits start from the first step and the more steps you do, the better you are doing for your health, whereas the net amount of food we need is not zero. We need to eat. It's not a simple message. And for pretty much all of us, that we don't have control over our food. Unless we're growing in the backyard, somebody else has control over it. And I'm not just talking about processed foods, which obviously we can see that there's an industry that has control, but just even how it's grown in greenhouses and stuff. And it's not saying that that's a bad thing, but it's just a fact that pretty much everything we put into our mouth, other people have made decisions on how that is generated to become that food item.

And then there's like price, convenience, taste that goes into it. And then if it's to processed food, going back to that don't eat more than 10% of your calories from sugar, well, that guideline would work if let's say with processed foods, it said okay, right on the front of it, had some sort of information that could say that. If you're a 70-kilogram or 150-pound person, the amount of sugar in this is 8% of your daily, of that 10%.

Karina Inkster: Right.

Dr. Scott Lear: So don't eat anything else type of thing. If there was something simple that could make it easier. So that's why with nutrition, it's so hard because there's so many factors that go into deciding what we eat.

Karina Inkster: Absolutely. That's a good point. Well Scott, I've got to let you go, but thank you so much for coming back on the show. We will have show notes, and we'll link to your podcast as well, so folks can check that out. And I appreciate the opportunity to speak with you again.

Dr. Scott Lear: Yeah, thanks. This has been wonderful Karina, and anytime. Maybe another hundred episodes down the line, I'll be back again.

Karina Inkster: Who knows? Never say never. Scott, thanks again for joining me on the podcast. You can access our show notes at nobullshitvegan.com/148 to connect with Scott. And don't forget to grab your free copy of the brand-new No-Bullsh!t Vegan ebook at nobullshitvegan.com/ebook. Thanks for tuning in.