 of our planet on the ThinkTech Live Training series. I'm your host Dr. Grace O'Neill. Joining me today is Dr. Neal Barnard, founder of the Physicians Committee for Responsible Medicine. Today we're going to talk about balancing hormones. So Dr. Barnard, can you tell us about how you started PCRM? Sure. Well, Priscilla, thank you for including in your program. It's great to be with you. Back in the 1970s, I started medical school at the George Washington University. Great medical school. But I started to realize that when I got into practice that in, not just in my area, but in just about every area, we didn't really do much to prevent illness. We waited until a person had a heart attack and they came into the emergency room before we talked about the risk factors for that. You know, we started realizing maybe I could have prevented that. The same thing was true for something like breast cancer. We waited until it showed up on a mammogram. So my thought was we need to see what we can do to head off these things in advance. And to my surprise, perhaps, the key thing really was food. That people get heart attacks, not from statin deficiency. They get it from much cheese and meat and those kinds of things. So I started an organization called the Physicians Committee for Responsible Medicine to promote preventative medicine, especially good nutrition, to do research studies and to advocate for what I'm going to call higher standards in research where we're doing good ethical research with integrity. So how did you come about? I know that it seems like you're trained in cardiology. How did you make the transition and then start your own foundation just by the research that you started to do and then you came up with the idea? Actually, I've had a more peculiar journey than that. The only reason I went to medical school was to go into psychiatry. My father, yeah, my father grew up in a cattle business, cattle business originally. He hated it. His whole family was raising cattle. He left and went to medical school and he spent his life treating diabetes in Fargo, North Dakota. So when I moved out to Washington DC to go to medical school, I didn't want to have anything to do with diabetes. I was really interested in how the mind worked and so that meant psychiatry. And so I did a full residency in psychiatry and started practicing in New York at a big hospital there called St. Vincent's Hospital. As time went on, I was doing some consulting for a research company or research foundation and they were interested in diabetes and they asked my advice and I said, if I were you, I would not study rats and mice. I would study human beings and I would suggest that you focus on diet because that's got to be the driver. And they asked me to help them design trials and we did. And I got drawn down this rabbit hole of discovering that not only is this research really rewarding, but we started seeing something we'd never seen before, which was if you change the diet enough, diabetes sometimes even goes away. No, I was not prepared for that. And it's a major thing. So I got more involved in that. And now I'm my appointment at GW is not in psychiatry, it's in internal medicine and I become a fellow of the American College of Cardiology. That's great. So tell us about the role of fat in diabetes specifically. Yeah, this is a big surprise to a lot of people because they think, you know, diabetes means I have too much sugar in my blood. So the problem has to be sugar that I'm eating. So if I eat an apple or some rice that digestually sugar in the blood, that's got to be the problem. Turns out that's not the case. Normally, if you bite into an apple, the natural sugars that are there will go into your bloodstream and then they'll go into your muscles. Those natural sugars are your muscles favorite fuel, or they'll go into your liver or the other cells of your body to power them. Here's the problem. Let's say you are eating fatty foods, cheese pizza, chicken wings, burgers, pork chops, the fat from those foods end up ends up getting into your cells. And as the particles of fat build up into the cells, they can't accept sugar anymore. The sugar will not get into the cells. This is called insulin resistance, but it really means that that insulin key that's trying to get sugar into the cell can't do it because the cell is filled with fat. So 20 years ago, we started using diets that would get the fat out of the cells. And once you do that, the insulin resistance goes away or improves and the blood sugars come down and then people can tolerate having fruits and carbohydrates in a more normal way and the diabetes can improve and sometimes even go away. So how about people who start on a plant-based diet and they decrease their fat, but they might still be having some carbs, you know, suppose they eat like a banana or something, or other carbohydrates, not obviously highly processed things, but I mean, you know, if they're having some carbs and they find that their sugar goes up at first, does that resolve itself later? Yeah, absolutely. Carbs are your natural fuel. And so if you have a banana or something like that, that's what you're designed to eat. Fruits, whole grains, vegetables, beans, those are natural foods. So normally, after you eat a meal, your blood sugar will go up a little bit. Those are the carbs streaming into your blood. And then your body says, great, this is my fuel, and your body will pull that into your muscle cells or your liver cells and other cells in the body. If for some reason that's not happening, that's usually because the cells are filled with fat. So when a person goes on a vegan diet, there is no animal fat left. That's good. But they also have to keep the oily foods low, too. So for example, let's say I get up in the morning and I have avocado toast, you know, and fatty stuff. You know, don't get me wrong, these are delicious things. But if I'm putting a lot of fat into my system, regardless of the source, it's going to end up in the cells and it's going to cause a problem. So if you want to cure your diabetes, get the animal products out of your diet 100%. And keep the oils really low, too, and oily foods, nuts, avocados, and the products that are made from them. And then you'll discover your insulin sensitivity starts to return. How about white rice or, say, like white potatoes versus sweet potatoes? Do you recommend people stay away from those things because they're, you know, more high, especially the white rice that's more highly processed than the brown rice? Will that spike their sugar more or cause a hemoglobin A1C to go up? It's not a big deal. And the reason I emphasize this is if a person is still eating animal products and oily foods, they've got to deal with that. If you're thinking about white rice versus brown rice, that's extra credit. Okay, so once a person has gotten the animal products and the added oils out of their diet, what will happen is that the fat comes out of the cells. And we have demonstrated this with our partners at Yale University. We have changed people's diets, sent them up to New Haven where they go into an MR, Magnetic Resonance Imaging, and went through a technique called MR Spectroscopy, Magnetic Resonance Spectroscopy. I can look into yourselves and I can see that fat going away. You can quantify it and it happens quickly. But if you're still eating a lot of fatty stuff, because you thought maybe fish is good for me or I should have skinless chicken breast once in a while or whatever, you're not going to see the same result. Now, once a person is making those changes, brown rice is better than white rice. It's got the flavor in it. But if you're at a restaurant and the only rice they have is white rice, dig in. It's not going to hurt you. Yeah. So how about in terms of needing omega-3s? A lot of people, they want to get their omega-3s. So they're eating fish, for instance. And in Japan, people live very, they were at least more longer living before the advent of Western foods. And they had some fish in their diet. So what do you think about getting adequate omega-3s and the vegan diet? Yeah. It's easy to do. Now, I should say that omega-3s are healthy fats and you need some for tiny amounts for lots of things. But the amount you need is very small. It's maybe between 1 and 3 percent of your calories. And the natural source may sound a little funny. You take a sprig of broccoli, send it to a laboratory. They'll do an analysis of it and they'll tell you that it's about 7 or 8 percent fat. You thought, broccoli, there's no fat in it at all. Is there? There are traces of natural oils. And proportionately, they're rather high in omega-3. So if your diet is pork chops and gravy and things and a tiny little bit of vegetables, you're never going to know that there's any omega-3 there at all. But on the other hand, if they're a bigger part of your diet, you're getting it. The next step, though, is don't eat a lot of competing fats. So if you're using a lot of other kinds of oils, that's not so good. So lots of green vegetables, my favorite source. If you want to, you can supplement omega-3s. Some people do that. In the same way as people will supplement with fish oil, there are, and you'll see them at health food stores, you'll see them online, there are vegan omega-3s, exactly like the fish oil. They've got DHA, EPA, the same stuff as in fish minus the pollutants and all the other parts of the fish that you don't want. So I'm not necessarily recommending supplementation, but if you are, get a supplement. There's no reason to have fish oil. You should get the plant-derived oil. It's healthier, it's cleaner. Yeah, I know some people recently because there's been a lot of news coverage on ApoE4 gene and how there was a Hollywood store start saying that he has the gene and people are concerned about having fish for that reason. Is the algae supplement equivalent to the fish, the stuff that you would get in the fish? I'm assuming it is because it's from the same source that the fish would get it from. Right, the fish get it from algae, and you're getting it directly from algae if you get it in the vegan source. Now, keep in mind when a person is eating fish, the mercury in the fish isn't what's helping you. The pesticides that are in the fish are not what's helping you. Neither is the cholesterol or the saturated fat, all of which are in fish. Most of the fat in salmon in any kind of fish is not omega-3. That's just a fraction of it. So if you decide I want omega-3, I'm going to eat fish. Sure, you're going to get some omega-3, but you're going to get a lot of other fats that your body doesn't want at all. If you want a supplement with omega-3, I would do a vegan. Yeah, so let's kind of turn around and let's talk about fat and estrogen production because your book, Hormones in Balance, you can show the picture now. Yeah, your body in balance. Your body in balance talks about estrogen and how fat produces estrogen and how it's a risk factor for breast cancer. So I guess just kind of want to touch on that a little bit. Yeah, it's an amazing story really. Back in the 1990s, researchers were realizing, to researchers that took to university in particular, but other places too, they were trying to find ways to reduce the risk of breast cancer. We'd already known that if you have more estrogen as the female sex hormone in your blood, you're at higher risk for developing breast cancer. And the researchers at Tufts brought in 48 women, put them into a metabolic ward where they just lived basically in the hospital and they were testing different diets. Each diet would last eight or 10 weeks and some of the diets would reduce fat. Some of the diets would increase fiber. Some of the diets did both and what they discovered was astounding. You could dial down the amount of estrogen in your blood just by reducing the fat content of your diet. You could also do it by increasing fiber and fiber is just the rough in plant. So what does a vegan diet do? Well, it doesn't have any animal fat at all, so it's low fat, assuming you're not adding a lot of oils. And every bite you eat is from a plant, so it's really high in fiber. Now, those researchers were trying to use low fat, high fiber diets to reduce estradiol in particular so that breast cancer would be less likely. But they went further than that or well, when they published these findings, our team realized that we could exploit this for other purposes. Back in 2000, we published a study where we used exactly this kind of diet for menstrual cramps. Many women have menstrual cramps and for maybe one in 10, they're kind of off the scale. I can't go to work today type cramps. And we discovered that when women avoid animal products and keep the oily foods to an absolute minimum, the cramps often go away or improve a lot. And then I got to tell you what really happened with regard to the other end of the reproductive window with menopause. I had written this book, Your Body in Balance. And I said, we believe that when women follow this kind of diet leading up to menopause, and probably if they have soybeans as well, they may well not have hot flashes are not so bad. So I wrote a chapter on menopause in this book and a woman named Betty called me up. She said, I read that book. I did what you said and my hot flashes were gone within what four or five days. And frankly, I thought that's more than I promised. I was really amazed. And so I asked her, how did you actually interpret what I had written? And she said, totally be an extremely low fat. And I had a half a cup of quick soybeans every day. So I thought, all right, we need to actually do a better clinical trial ourselves. So we brought in 84 women. A half of them went on Betty's diet, vegan, low fat, half a cup of soy beans. You just put them in your Instant Pot and cook them up for 40 minutes. And what we found is it's true that hot flashes dropped by 88. I'm talking about the moderate to severe ones, the ones that wake you up at night, they dropped by 88%. The average woman lost about eight pounds. They loved it. They felt it was life changing. And what the point is your hormones affect everything in your body. Foods determine your hormones and you've got fabulous power that you can use for a whole lot of things. So how about, because you touched on soy a little bit, how about women who are afraid to consume soy because they had breast cancer before? What would you say to them? I would say that unfortunately they've been misled by an urban myth. And it's completely understandable. Many decades ago, researchers discovered that soy beans have what are called isoflavones, genistine, datezine, glycotein. These isoflavones attach to estrogen receptors. And so people kind of naturally assume that if it attaches to an estrogen receptor, maybe it'll cause cancer or cause cancer to progress. And so that led a lot of women to avoid soy. And to this day, many have this idea. However, researchers started to look at women who eat a lot of soy and women who tend to avoid soy and to compare them. And the results were crystal clear. The women consuming the most soy, soy milk, tempeh, tofu, the women consuming the most soy had about 30% less risk of developing breast cancer compared to the women who avoided it. So in other words, having soy didn't cause cancer, it helped prevent cancer. And in 2008, a meta analysis was published of eight prior studies, and the results were absolutely clear that soy helps reduce the risk of cancer by about a third. And then subsequent studies showed that for women who have had cancer in the past, having a high soy diet reduces the risk of the cancer coming back. It reduces the risk of mortality. So by about 25 or 30%. So the point is, well-meaning, ill-informed people would write about soybeans saying it would cause cancer. When the truth is, it does exactly the opposite. So with the soy, because it has some power at the estrogen receptor, do you think that could help women who are going through menopause and they're having less blood flow going to their area? I guess I don't know what to say, but I had some friends and they were talking about these treatments they've been getting, they're very expensive treatments to keep things alive down there. And I don't know if there's any possibility for soy to help out instead of somebody using some kind of hormones which might increase their risk for cancer. Right. The first thing to say is that you have two different kinds of receptors. You have estrogen receptor alpha. That's where estradiol attaches and that's where the cancer concern is focused. Estrogen receptor beta is where the isoflavones preferentially attach. And so you think of it as the alpha is the gas pedal on cancer, whereas the beta is the break and the soy isoflavones favor beta receptors. Now with regard to your question, in the study that I just described, we looked, first of all, at hot flashes because that was the biggest motivator for a lot of women. And as I mentioned, they were dropped by 88 percent, the moderate to severe ones. We also looked at psychosocial symptoms, meaning how do you feel? Are you depressed? That got better for many women. And then physical symptoms like headaches and sexual symptoms improved for many women. Now, I don't think that's necessarily going to be the case for everyone. So if a woman is taking HRT, hormone replacement therapy, and she's reading the label and it says you're at risk for breast cancer and heart problems and dementia and all the potential side effects of hormone replacement therapy, she might take those pills and throw them in the trash. If she wants to use an estrogen cream for sexual functioning or something like that, she can use that. There is some absorption, but that small amount is not associated with breast cancer risk so far as we know. Yeah. And how about, I know the same goes for males where now men are taking testosterone as they get older. What's the consequence of that? Well, unfortunately, people have low T and everything. There's all these commercials on TV, right? Well, Hank might have low T, but the reason he's got that is as a man gains weight, he's eating chicken and velveta and grilled cheese sandwiches and meat and the majority of American adults are overweight. The more body fat you have, fat cells are not just bags of calories. A fat cell is a living, metabolizing factory. So Hank's testosterone in his blood goes into the fat cell. Inside the fat cell are enzymes that convert it into estradiol. Let me be clear. His male hormone, testosterone goes into his fat. A female hormone, estradiol comes out and then it's so, yes, that's right. He is producing his own. So he goes to the doctor and he says, man, there's something wrong with me. I've got breast enhancement. Gee, did I get that from eating soy? I read online that you get man boobs from eating soy. And of course, the doctor takes a look at him and says, how much tofu have you eaten this past week? Of course, the patient has to say, well, I didn't eat any. The reason he has been feminized, so to speak, is because as he's gained weight, he is now producing female hormones. What is the answer? The answer is, if he eats a plant-based diet, no animal products at all. And you might convince him that both are vegan. Elephants are vegan. The biggest, strongest animals eat plant-based diets. Once he does that, he will start losing weight progressively. As his fat layer diminishes, he will stop turning his testosterone off. His natural testosterone will work. And he can take that prescription for testosterone that the doctor gave him along with the low T diagnosis. He can throw that in the trash too. So let's go to, because we don't have that much time left, I want to touch on the thyroid and how you've seen vegan diets help for thyroid function. Well, I think we're still really on the frontier when it comes to the thyroid. Now your thyroid is really important, but unassuming. It's at the base of your neck and it makes thyroid hormone, which gives you energy. And the biggest reason for low thyroid, worldwide, is a lack of iodine. If you were on the coast of Japan, this would not be an issue, because seaweed is loaded with iodine. And that's true in many parts of the world. But if you're in Omaha, Nebraska, you might not have had a seaweed salad in a while, so you might be low. Iodized salt has lots of iodine in it. But if you are a modern person who doesn't have iodized salt because you're having Himalayan salt and sea salt and kosher salt, you might be low in iodine. It's easy to fix. The other reason though, researchers at the Adventist Health Study tracked a large group of people. They tracked Adventists because Seventh-day Adventists are every researcher's dream population. They're non-smokers, teatoblers, health-conscious. They'll tell you what they mean. And so what they found was something remarkable, that when you looked at different diet groups, the people who had the least risk of hypothyroidism were vegan. The people who had the least risk of hyperthyroidism, grave disease, were vegans also. And the people who were really in trouble, the highest risk were the people eating meat and dairy. Once that result came out, the light bulb went off in everybody's head because we knew that even more common than low iodine, the biggest driver of hypothyroidism and hyperthyroidism is antibodies. Your white blood cells are making antibodies, the proteins that are normally there to knock out a virus. They're knocking out your thyroid gland. Why? What we believe are hypothesis is that the dairy protein or meat proteins are recognized as a foreign protein by the body. The body makes antibodies to destroy them and inadvertently, those antibodies attack your thyroid gland. They either attack the gland itself so it can't make thyroid hormone or they attack its control mechanism so it can't turn off and you end up with too much. So either way, try a vegan diet. Don't throw your synthroid in the trash. Let's see how it works for you because we don't really have good double-blind trials yet to see if a vegan diet will help very much. We do have anecdotal cases, a lot of them, so it's worth trying, but let your doctor know. The doctor can monitor. So how about vegans that are people who are already vegan and they have hypothyroidism? Is there any other suggestions? Do they avoid soy? Do they avoid gluten? Do you know anything about that? We don't really have an answer to that because people haven't done those studies. However, whenever there is an autoimmune reaction and hypo and hypothyroidism are autoimmune reactions, our first step is just what we've described. Get away from the animal products because those are the worst antigens, especially dairy. But if somebody still has symptoms, thyroid problems, or the other autoimmune conditions like rheumatoid arthritis or chogrin's disease or asthma, we sometimes look to see if maybe they're sensitive to something else. You mentioned gluten, maybe soy, maybe nuts, maybe potatoes, and there are certain foods that we just take out of the diet for a little while and see if people don't improve. I wrote about this in a book called The Cheese Trap because cheese is a big driver for a lot of these problems. And in the back of that book, I described that elimination diet. Yeah, I think the elimination diet is great if people have the patience. It's sometimes difficult to eliminate everything because it gets so restricted. Sometimes people get discouraged, right? Oh, but you don't do it for a long time. You don't do it for a long time. What you do is for a couple of weeks, you eliminate all the pain-inducing foods, all the animal products, and about a dozen other things. But you'll eat lots of rice and lots of cooked vegetables and things, and you won't be hungry, but it will be a restrictive diet. And then you gradually put one food back in every two days, and if you tolerate it, you keep it. If it causes symptoms, you get rid of it. And people would typically find what their problem is. Yeah. So let's just talk about, we just have a few minutes left. So let's just talk about type 1 diabetes and lowering the fat in your diet. Is that helpful for type 1 diabetes as well? Absolutely, yes. Now with type 1 diabetes, the pancreas does not produce insulin anymore, but where a low-fat vegan diet is helpful for is you have insulin resistance, even if you have type 1 diabetes. Just like type 2, your cells are not responding to the insulin as well as they would if you get the animal products out of your diet. So if you have type 1 diabetes, do a low-fat vegan diet, you'll discover your need for insulin in most cases will diminish quite dramatically. And more importantly, your risk for cardiovascular disease will diminish. That's important because that is the main sequelae of type 1 diabetes. It attacks your arteries. You don't want to drop a cholesterol in your blood. That's great. Well, thank you so much. We're out of time, so we have to wrap it up. I'm Dr. Grace O'Neill. This is Healthy Planet on the ThinkTech Livestreaming Network series. We've been talking with Dr. Neil Barnard of PCRM. Thanks to Michael, our broadcast engineer, and the rest of the crew at ThinkTech for hosting our show. And thanks to you, our listeners for listening. I'll see you on the first Friday of the New Year for more of Healthy Planet on ThinkTech, the show for people who care about their health and the health of our planet. My special guest will be Jane Velez, Ms. Chil Thunder of Unchained TV. If you have ideas for the show or questions for my future show guests, please contact me at Healthy Planet ThinkTech at gmail.com. Check out my website at graceandhawaii.com or Instagram at Graceful Living 365 for more information on my projects, including future show guests. I'm Dr. Grace O'Neill. Aloha everyone.