 Hello, everyone, and welcome! I'm Dr. Michael Greger, coming to you live from my treadmill, from my new place in Seattle, where I'm sheltering in place until the world opens back up. Working on my next book, How Not to Age, on the latest in longevity research. There's tons of research, but I should be able to get out the book by December 2022, and hopefully by then I'll be able to resume my speaking schedule and come to your hometown in 2023. To help keep you satiated until then, my new How Not to Die cookbook, How Not to Diet cookbook, sorry, just came out last month, following how to survive a pandemic, which came out in August and unfortunately continues to be relevant. Check them out at your local public library, and of course all proceeds I receive from all the sales in my books are all donated to charity of course. All right, before hunkering down to write How Not to Age though, I had to script out more than entire years worth of videos for NutritionFacts.org, so I could truly immerse myself into the entirety of the longevity research for the book, and it is from that large batch of cued videos that I pulled out the videos for this webinar, the role of diet in racial health disparities. All these sneak preview videos I'm going to show you are going to be going up on NutritionFacts.org in the next few months, but you're going to be able to see them right here right now, but first some housekeeping logistics. If you can't hear me right now, there are instructions in an email that was sent out last week to tweak your audio settings if at any time you run into technical difficulties. There are live chat room staff standing by, and in fact, let me paste that link in the chat box. You will see I will paste stuff throughout the webinar. If they are unable to help, then we do have NutritionFacts.org staff standing by as well, but presumably if Zoom people can't help you, I don't know what we're going to be able to do, but let me paste that into the box as well. We want to give you as many resources as possible. Please reserve the Q&A button that you will see in the Zoom webinar there to ask content questions as opposed to technical difficulty kind of questions. The webinar will go for an hour, super quick, way too fast hour. This is I think the shortest webinar we've ever done, typically like three hours, but I have reserved some time for Q&A at the end, so feel free to add your questions in the Q&A by clicking the Q&A button throughout the webinar and our NutritionFacts.org staff will be compiling your questions to be answered at the end, and now you may want to wait to see if I cover a topic before asking your question, just in case it comes up later, but feel free to ask anytime. You don't have to worry about taking notes or anything because after this webinar is over, we are not only going to send you a full recording of it, but also a free link to download all the videos that I'm showing you in high definition, so you can see them in all their full resolution glory and you can pause. The videos go so quickly. You can pause, you can see what the papers, you can look up the papers, you can rewind, you can watch them again. All right, but let's get started here. I'm going to start with a video entitled, Spoiler Alert, How a Plant-Based Diet Can Help Reduce Black, White Health Disparities. Let's check it out. During the COVID-19 pandemic, the death rate for African Americans was as much as six times higher than White America. The higher Black pandemic deaths placed a harsh spotlight on their long-standing higher mortality and diminished longevity in general. Unfortunately, diminished African American life expectancy predates the COVID-19 pandemic by decades. The black-white death gap for women is about three years and for men closer to five years. The COVID-19 death disparities may have to do with limited access to healthy food and predominantly Black communities, the housing density that need to work or else, the inability to practice social distancing, but also the underlying burden of ill health. Increased COVID-19 mortality and complications occur more often in individuals with pre-existing conditions like hypertension, obesity, diabetes, and cardiovascular disease, comorbidities that are more prevalent in African Americans. More high blood pressure, more diabetes, more strokes, and more likely to die at early ages from all causes put together. The question is why? Why do Black Americans live sicker and die younger than their white counterparts? Well, one big factor is socioeconomic status. In the United States, race is closely tied to class, with African Americans about twice as likely to be living in poverty. On average, education levels are lower as well. However, even among African Americans whose socioeconomic status is comparable to that of whites, despite the higher education and more socioeconomic resources, health outcomes are still poorer. Part of that has to do with lifestyle behaviors. For example, fewer than 5% of African American adults met physical activity guidelines. Smoking rates are actually comparable, though African Americans tend to be exposed to more secondhand smoke and have lower quit rates. This may be because they're more likely to use menthol cigarettes which enhance the addictive potential of nicotine. Why menthols? Because tobacco companies target the marketing of mentholated products to African Americans. Black lives? Black lungs. Similarly, if you look at food messages on African American television shows, not only does Black prime time contain a greater number of food commercials, African American audiences may be receiving nearly three times as many advertisements for low nutrient junk such as candy and soda. That may be one reason why African Americans tend to consume fewer fresh fruits and vegetables and are more likely to eat junkier foods. Of course, where are you going to get those fresh fruits and vegetables? There are fewer supermarkets located in Black neighborhoods compared with white neighborhoods, as in four times fewer supermarkets. What Black neighborhoods do excel in, though, is fast food. Predominantly Black neighborhoods have 60% more fast food restaurants per square mile compared to predominantly white neighborhoods. Now, of course, dietary behaviors alone do not fully explain these significant differences in diet-related disease patterns between racial groups. There are differences in employment and poverty and home ownership and health care access, all of which can affect outcomes. But while there are certainly many social and economic factors such as racism and income inequality that contribute to health disparities, there is good evidence that simply eating a more plant-based diet could help eliminate disparities in cardiovascular disease and diabetes. Here's the diabetes data. Even after controlling for education, income, physical activity, and even BMI, non-Blacks eating strictly plant-based diets had 57% lower odds of diabetes, and among Black vegans it was even more striking 70% lower odds. And that was after taking BMI into account. So even at the same weight, Black vegans had 70% lower odds of diabetes than Black omnivores. And the racial disparity is only about half that, 36%. So the increased risk of diabetes among Black participants was on the order of one-third, while the protection afforded by vegan diets in this subgroup was about 70%. Even just a vegetarian diet that includes still eating dairy and eggs may more than counteract the racial disparity in diabetes risk. And they're not the same weight. African Americans have higher obesity rates cutting their lifespans by six years, but Black vegetarians and vegans have less than half the risk of obesity compared to those who eat meat. And this is after adjusting for differences in physical activity, so even at the same exercise levels, those eating more plant-based had about a fraction of the obesity risk. High blood pressure. In African Americans, hypertension is the most significant contributor to their increased cardiovascular disease burden and mortality, but Black vegetarians and vegans combined had 44% lower odds of hypertension, an important finding for Black individuals where hypertension is so prevalent, with no benefit found for those who cut out all other meat but continued to eat fish. And the same thing found for total cholesterol and LDL cholesterol cutting odds in half among Black vegetarians and vegans. As with non-Blacks, the researchers conclude these results suggest that there are sizable advantages to a vegetarian diet in Black individuals. What about vegetarians versus vegans? The title gives it all away. Cardiovascular disease risk factors are even lower in African American vegans. This is something we've known about when Caucasian vegans have been compared to vegetarians. However, it was not known whether African American vegans exhibit a more favorable cholesterol profile until now. Significantly lower LDL cholesterol in vegans. Now, of course, the vegans were also significantly slimmer on average in normal weight as opposed to the overweight vegetarians, but even after taking that into account, those eating more plant-based had significantly lower cholesterol. So there's a tremendous potential for plant-based diets to promote health among Blacks living in the United States. In fact, they may have an even greater benefit. For example, African Americans have an excess burden of chronic kidney disease, not only because they have more high blood pressure and diabetes, but there are genetic factors. 8% to 12% of African Americans are carriers of the sickle cell trait, which places them at significantly higher risk of kidney disease. So while Blacks represent relatively small fraction of the U.S. population, they account for more than a third of all patients on dialysis due to chronic kidney disease. And that's where plant-based diets can come in, shown to protect against both chronic kidney disease development as well as progression. Three-quarters of Blacks are lactose intolerant, too, so would again stand to benefit even more from eating plant-based. It is unacceptable that for decades the American healthcare system has failed African Americans and other minority communities in terms of helping to prevent some of our leading killers. But that just makes it all the more important for them to take the reins of their own health destiny. So just like diet can trump genetic factors, regardless of what lifestyle diseases run in our families, but diet can also trump societal factors as well. Next up, I'm going to review some of the issues that have plagued African American food culture in a video entitled The Harms Associated with a more Southern-style diet. And as you'll see, you don't have to live in the South to eat a Southern-style diet. African Americans have a higher burden of cardiovascular disease and diabetes in other American ethnic groups, but recent evidence indicates that eating a plant-based diet may help eliminate such health disparities, as I explored previously. African Americans as a group tend to have the highest reported meat consumption and the lowest vegetable consumption and part of this is access. But this article detailing the experience of a more house lifestyle medical clinic noted that there also appears to be an issue with aspects of the African American food culture. Enter the regards study, the reasons for geographic and racial differences in stroke study. The study found that regardless of where African Americans live in the United States, they are much more likely to consume what the researchers called a Southern diet, which is a dietary pattern characterized by added fats, fried foods, eggs, organ meats, processed meats, and sugar-sweetened beverages. They found that this type of dietary pattern mediates the majority of the racial disparity. Adherence to the Southern dietary pattern increased stroke risk by 39% in Black Americans. In contrast, the greatest benefit was seen among participants who followed a more plant-based dietary pattern which conferred a 29% lower stroke risk. Same thing with heart failure. Eating more plant-based was associated with a 41% lower risk of heart failure, while the Southern dietary pattern was associated with a 72% higher risk. And this is after controlling for things like education and income, death from kidney disease. Same thing, more plant-based linked to lower risk of mortality, whereas eating closer to the Southern diet associated with a greater risk of kidney disease, mortality. Those eating more Southern-style diets likewise had a 56% higher hazard of acute heart disease. This finding was particularly interesting. Dietary patterns and the risk of sepsis. Sepsis is the syndrome of body-wide inflammation triggered by infection, and is a major public health problem. That's how an infection can kill you. Now, we know diet plays a vital role in immune health, but its association with sepsis was unclear. But a Southern dietary pattern of eating was associated with a higher risk of sepsis as well, particularly among Black participants. What about cognitive function? Once again, greater consumption of the Southern dietary pattern was associated with worse outcomes, lower scores on the assessments of each of the cognitive domains, like learning and memory, whereas greater consumption of the plant-based pattern was associated with higher scores. Here's the data on learning. The more plant-based people ate, the better they were at a learning task. Meanwhile, the more Southern-style people ate, the worse they were at learning. Same thing with memory. Better, the more plant-based, worse, the more Southern-style. Is therefore possible that the increased prevalence of Alzheimer's in African Americans could be partially reduced via dietary modification? Easy for a privileged me to tell people to eat healthier, but isn't it expensive to eat plant-based? Have you seen the price of beans? There's this common misconception that plant-based diets are more costly than animal-based ones, so proper education will be needed. A vegetarian diet could result in approximately $750 per year in savings. So healthier and cheaper, what would you do with an extra $750 in your pocket? Not to mention all the health care cost savings. I mean, a plant-based dinner consisting of red beans, brown rice, collard greens, sweet potato, and cornbread could feed a family of four for under $12 or three bucks per person. Check it out. Some of the healthiest foods on the planet are some of the cheapest foods. Such a meal would not only be cost-effective, but nutritious, providing a mountain of nutrition, plus a host of antioxidants to protect against various diseases like heart disease and cancer. Here's the save $750 a year eating more plant-based study. Why? Because you're cutting out meat-poultry seafood. And when one considers total grocery costs, animal products can be the most expensive food. Animal products can be the most expensive components costing more than double the cost of a serving of vegetables or legumes like beans, but peas, chickpeas, and lentils. That meal is making me hungry. Next time, I got to eat lunch before I do one of these webinars. Note that it may sound like I'm using the terms African-American and black interchangeable. Interchangeably, I know they are not synonymous. I'm just using whichever term was used in the particular study I was referencing. Before taking questions, I'm going to wrap up with a video. I'm calling Soul Food. That's good for the soul. The burden of cardiovascular disease in the African-American community remains high and is a primary cause of disparities in life expectancy between African-Americans and whites. Why is there such an excess burden? Because of an excess burden of risk factors, for example, high blood pressure, diabetes, obesity, and high cholesterol. And what's underlying those risk factors? Much can be traced back to diet. Among the ethnic groups, the proportions of people meeting healthy diet recommendations were generally lowest among blacks. In this national survey, most black Americans were found to be eating a particularly poor diet as defined by the American Heart Association. African-Americans may face unique challenges to adherence to dietary recommendations, and one such challenge is an alignment with a cultural tradition of soul food. Now, some soul food components are fantastic. Can't get much healthier than collard greens and sweet potatoes, tomatoes, legumes, dried peas and beans, the black-eyed peas, watermelon, blackberries, corn, okra. It's all making me hungry. But conversely, soul food can also behind added fats, sugars, and salt with prominent use of high-fat meats, not to mention the use of deep fry. So like fried chicken and chitlins, which are pig intestines, foods that can be high in sodium and saturated fat dietary factors linked to chronic disease. Where did the pig intestines custom come from? You have to trace the roots. Soul food is what the enslaved Africans were forced to come up with in the deep south to survive during slavery. That's in stark contrast to traditional West African diets where they come from, which were predominantly plant-based, centered on a foundation of greens and fruits and legumes and nuts and vegetables and whole grains and even more vegetables. However, these traditions have been westernized, bastardized into a diet high in fried foods, sweetened beverages, and bread and processed meats. But the good news is more and more African Americans are adopting plant-based diets to combat their health problems, helped by a growing movement of vegan soul food restaurants that serve healthier plant-based meals. Soul food scholar Adrian Miller even wrote that after eating his way across the country, it was clear to him that soul foods creative energy burns brightest in restaurants that are targeting upscale vegetarian or vegan clientele. Are they reaching the people who need it most though? Well, they do tend to be located in higher African American higher poverty areas. A significant number of restaurants were classified in food desert zones where there's a dearth of supermarkets implying their potential to provide healthier meals to residents in the surrounding neighborhoods. Therefore, having more vegan soul food restaurants and growing movement centered on Black veganism may provide opportunities to influence the nutrition habits in the African American community, especially since some are even able to offer cooking classes. So establishing public health partnerships with vegan soul food restaurants to get more African American adults to eat plant-based foods could be a promising first step in reducing some of the Black white health disparities. We're not meat shamers, said owners of vegan soul food restaurants promoting healthy eating in the African American community. We're plant pushers trying to tie the best of soul foods origins to a 14th century plant-centric West African diet in hopes of making people feel that being vegan is in fact a legitimate part of Black culture and Black identity, even potentially tying it into the concept of social justice in an attempt to reverse the effects of targeted marketing efforts by fast food companies to children in communities of color. This movement has been helped by a plant-positive who's-who of Black culture, not just luminaries like Coretta Scott King and Cory Booker, but the likes of NBA star Samuel L. Jackson and Beyoncé and, influentially, the late activist Dick Gregory, known in popular culture as a comedian, but was also an outspoken vegan health advocate influenced by Alvinia Fulton, who imagined soul food that was actually good for the soul. Instead of celebrating the fact that slaveholders denied enslaved people access to quality foods, she persuaded Black communities to view food as an agent of health and healing, advocating fresh whole foods as the path to alleviating or reversing the crippling burden of chronic disease. Black vegetarians and vegans are showing a plant-based diet isn't just for white people and never was. In fact, you can go back centuries to The Liberator. Back in the 1800s, the abolitionist publication where William Lloyd Garrison wrote his famous essay, I Will Be as Harsh as Truth than as uncompromising as Justice. Well, in an 1853 issue, it was written that a man whose stomach is crammed with animal abominations can no more appreciate lofty moral and intellectual teachings than a swine can appreciate pearl necklaces. Logic, humor, and eloquence are wasted on such persons. If only the American people took more thought what they should eat and drink, obeying the rules impressed upon them by experience and science, by which they meant a vegetarian diet, America would be half-converted to anti-slavery, peace, temperance, land reform, women's rights, etc. in a single year. Isn't that wild? 1853. Anyways, if you are fascinated by the soul food slave food connection, check out slavefood.org. And for a book that covers the subject, check out Healthy at Last, written by none other than Eric Adams, who may very well be the next mayor of New York City. Imagine that. And Healthy at Last features recipes from all sorts of plant-based luminaries, including my purple sweet potato smoothie, which actually is what I had for breakfast this very morning. And I didn't even plan that. It's just that's what was happening. There are also organizations like doing great work, like the Los Angeles Food Policy Council, that has been working to improve access to produce and healthier options in LA's food deserts. And you can check them out at goodfoodla.org. All right, time for your questions. Let me pull up. The Nutrition Facts staff has been compiling questions. And so let's go read through them. Okay, question number one. Is the reason why this webinar is so much shorter than typical ones is because there's just limited studies slash information regarding the health of African Americans. And that is indeed exactly the case. So in fact, one of the things I normally say, in fact, I should have said it again today, is like by the end of this webinar, you will be an expert on topic X. Because basically I searched every possible study that has ever been done on any particular topic, and that's when I pulled the webinar together. And so basically if you have questions about anything that I didn't cover, the answer is probably I have no idea because it's never been covered. There just aren't studies on this. And so I have covered the swath of the best studies that have ever been done on this. And as you can see, there's not much out there. I wish it was a three-hour webinar. But as more studies are published, I will do more videos. So the number of videos on nutritionfacts.org reflects just what's in the scientific literature. People ask me all the time about some weird mushroom or some weird herbal medicine or something. And I'm like, the reason there's no videos about it, odds are. It's possible I haven't got to it yet, but odds are at this point, we've been around almost... Wait a second, is this our 10th year? I think this is our 10th year, 2021. Nutritionfacts.org I think went live in 2011. By now, if I haven't covered this, probably just because there hasn't been any, there hasn't been any science on it or any good science, any science that is practical, groundbreaking, interesting, et cetera. All right, let's move on to our next question. And guess who it's from? None other than Tracing Me Quarter, which I, who I am going to be doing a live Q&A with. Oh, when is it? Hold on. Oh, I have my calendar app shut down. Let me hold on, let me pull it up. I believe it is, yes, next Thursday. And this is going to be January 28th at... Two o'clock, oh, Pacific time. Sorry, I'm Pacific time now. Five o'clock Eastern time. We're going to be talking all about the wonderful stuff she's doing. Anyway, let's get to our question. She says, can I talk about the role of systemic white supremacies, root cause of the highest rates of chronic disease that African Americans experience, related since a lot of challenges African Americans face in regards to healthy eating like targeted marking, food deserts are systemic. How do we begin to reverse the, how do we begin to reverse those challenges as opposed to expecting them to just eat healthier? Okay. And so you'll note, I did not talk about a lot about racism or white supremacy because they're just, those aren't covered in the medical literature. But as I noted, even if white supremacy, even if racism accounted for 100% of the healthcare disparities, the racial healthcare disparities, meaning socioeconomic class, education, all that didn't account for even a percentage. If it was 100% racism, still eating healthier could not more than eliminate the healthcare disparities. So that is hopefully the kind of good news, the kind of optimistic positive view, but not to detract from the horror of white supremacy. Obviously, I'm so looking forward to having a conversation with you, Tracy, next Thursday. So we can cover some of these topics and you can offer some of your ideas of how we can get ourselves out of this morass. Okay. Next question, are African Americans more at risk of any mineral or vitamin deficiencies that can be corrected with a plant-based diet? Well, in general, national surveys show lower food and vegetable consumption and that's where most of our essential vitamins and minerals come from. They come from the ground. And in fact, even vitamins, minerals, people tend to associate with animal foods like a calcium and dairy products or something. Where does that come from? It all comes from the ground, right? It all comes from plants, all comes from the soil and we can kind of cut out the middle move by going straight to the plants themselves. And so I would assume things like folate deficiency, which can cause birth defects. Folate comes from the same root as foliage. It's found in leaves, first discovered in spinach. And so, but also found in beans. So beans and greens, please get folate. But actually, African American women have the highest dark green leafy vegetable consumption in the country. Which is very exciting. Of course, not saying much. People eat so few greens in this country. But anyway, yeah, any diet, so whether Southern style diet or ketogenic diet, low carb diet, any diet that's cutting down on fruits and vegetables will cut down on the most nutrient rich foods on the planet. And so, yes, one would indeed expect relative vitamin and mineral deficiencies in those eating diets with fewer whole plant foods. All right, next question. Are there similar studies done for South Asians? What about Hispanics and Latinos? I did talk, I do have videos about the Hispanic paradox, so-called Hispanic paradox, which is the term used in the medical literature to describe why Latinos have the longest life expectancy in the country. And so that's actually, so there's a healthcare disparity in which whites live significantly shorter. And so wait a second, why is that? Spoiler alert, who eats beans in this country? Probably beans. So legume consumption, beans, split peas, chickpeas, lentils, single and most important dietary predictor of survival around the world. You want to know how long a society lives, ask how many beans they eat. Indeed, all the blue zones, every single one of them. The areas around the world, which have the greatest longevity, so I'll obviously be doing a lot of research on them for the next book, how not to age. The greatest number of centenarians, people who live over a hundred, they all center their diets around, I'm not just plants in general, but specifically use some form of legume as a primary protein source. And so, but of course, doesn't matter where your family came from, we can all eat healthier. Okay, and in terms of some of the studies done for South Asians, South Asians in the United States, there's not much out there that I certainly ran across. Are there racial differences, next question, in blood types? Oh, interesting. Is blood type O associated with less severe illness while A is associated with more severe COVID infections? When I was writing the book, How to Survive a Pandemic, I actually looked at the blood type data. There was this suggestion that people with different blood types had a different COVID-19 course. I mean, anyway. And at the time I was looking at it, the data was really wishy-washy, so I actually didn't include it in the book. And I haven't looked it up since the book came out to see, oh, well, has the data firmed up at all? Because it doesn't really matter. Like your blood type, you're born with it and there's nothing you do about it. So who cares? I mean, I was interested just kind of theoretically, but when I looked at the last look of the data, there was no difference. And are there racial differences in blood types? Certainly with sickle cell trait there is, but I don't know. That's a good question. It's not something I've ever looked into. And doesn't really matter much other than blood donation and blood recipient, blood receiving. Hopefully we can avoid that by not having to go in for operations and avoiding accidents, etc. All things I've got videos about on nutritionfacts.org. Although you'll note I don't have a lot of videos about accidents. That's actually a leading cause of death. It was not. There was no chapter in how not to die. I'm preventing accidents. I actually do have a video coming up on accidental death. on nutritionfacts.org. That's in the queue. So stay tuned. All right. Do this is a good, this is an interesting question. Do I have research on racism and the release of cortisol that additionally impacts healthcare disparities? And it shows up infant mortality rates and other health conditions. So the question would be are those, so for example, those who experience weight stigma. So obese persons who report that they are discriminated against, whether for a variety of ways that's tested. I don't know if my, no, they're not up yet. So I have a whole series of videos coming out on weight stigma. Those that report higher levels of prejudice against them actually do have higher levels of cortisol, the stress hormone, which actually ironically keeps weight on your body. So the cortisol is an adrenal hormone, which is kind of a long-term sense of your kind of long-term stress and it actually helps accumulate abdominal fat. The most dangerous type of fat. And so based on that data, I would assume that those who are discriminated against for any reason would also likely have higher levels of cortisol. And since that's associated with increased abdominal obesity, then that may indeed play a role in some of the healthcare disparities that we've looked at. Okay. Next up, curious how healthcare providers can take into consideration personalize their recommendations to include cultural and traditional food for different people, so it's not all the Western vegan fad items. Well, first of all, those vegan fad items, no one should be eating, right? It's like no doctor should be plugging vegan donuts and vegan ice cream and all the vegan, you know, fake stuff out there. They should be pushing for some vegetables, but indeed we should be sensitive to the cultural aspects. And there are certain vegetables that some cultures don't eat, certain fruits and vegetables that they love. And so, yeah. And so, you know, giving people recipes that, you know, are similar to the recipes they grew up with is definitely a way to do it. And so we, for example, nutritionfacts.org, you know, we have a Spanish version of our healthy eating guide. Which we've kind of adapted to make it more kind of user friendly for those with that kind of cultural background. So, but certainly I think it's a great idea, particularly if your patient population is a certain, you know, has a certain, you know, cultural, racial, ethnic backgrounds. So for example, I helped start a free clinic at Tufts Medical School when I was in med school. And we served a kind of Southeast Asian community largely and just in that area where Tufts Med School is. And so a lot of our patient materials really had to target, you know, recommendations that, you know, would be more likely to be, to kind of fit into their, you know, to require the fewest changes. So, you know, it's something that is easier to do. Because, I mean, we know the whys, we know all the data on what, you know, tremendous benefits in terms of health and longevity changing that I can have. But it's really how practical ways to make it doable in your day to day grocery store kind of life. And certainly this is the time of year as our New Year's resolutions are crumbling. Right. We know what to do. It's just how do we do it? In fact, I'm going to be part of a webinar series coming up later this month with Dr. Jen Hock and Dr. Douglas, which will cover some of these kind of practical tips as well. And that's in the latest New Year's Infects newsletter. If you didn't get it, make sure you subscribe. Next up, why are people of color more likely to be lactose intolerant than white people? Ah, that's a great question. Well, we all, meaning the human race started out in Africa. And then we had the spread from Africa to every other place in the globe. But that's where the human species started. And so there were benefits from having darker skin to get less sunburn, etc. But then when you go up to the northern climates like Scandinavia, then that could actually, having darker skin can be a disadvantage in terms of vitamin D production. And so as humanity went to different niches around the world, there were different traits that were more or less useful in terms, and the ones that were useful in terms of better survival, better reproduction, obviously became more common. And so those who developed this weird mutation to allow them to digest lactose after weaning, the normal state, think of animals, milk is for babies. No species on the planet drinks milk other than us after weaning milk is for babies. And then, of course, drinking milk in another species, that's a whole other issue. And so the normal state of humanity, in fact, most humans on the planet have lactose intolerance. But that's actually, so that's the normal state. The mutation is this lactase persistence. Having this lactose digesting enzyme persist after infancy was that wacky mutation that allowed some in Scandinavia to outlive the competitors. And why? Because winter. When you're in equatorial Africa, there's food all year round. But winter, what are you going to do on winter, right? You've got some root vegetables that are going to stick with you. But if you are able to milk some cows, churn some butter, and maintain calorie intake during the winter, then you have a survival badge. Of course, if you puke it all up because your lactose intolerant, you're not going to survive as well. And so this mutation was beneficial in those northern climates. And so the whitest among us, the Scandinavian country people, those are the folks that have the highest levels of this weird mutation called lactase persistence, lactose tolerance. That's the weird thing. But most people in the world are lactose intolerant because, of course, most people in the world are people of color. Next up, Owen, I have some videos. I have some more lactose intolerance videos coming up as well. Of course, that's just one of many reasons why there are better things to eat than cow's milk and cow's milk products. Is the rate of, next question, is the rate of higher kidney disease related to the intake of alcohol also? When we think of an organ system being damaged by alcohol, number one on the list is liver. Kidney is more damaged by high blood pressure. It was more a sodium thing. And so I mean, alcohol is a carcinogen. Maybe it may increase the risk of kidney cancer. There's a whole long list of cancers that are increased by alcohol consumption. But that would be one potential connection. I actually don't know if kidney cancer renal cell carcinoma is increased by alcohol. I would not be surprised. But no, the high rates of kidney disease are threefold. One, high rates of hypertension, high rates of diabetes, which can damage the kidneys. And then third is this sickle cell trait. So about one in 10 black Americans have the sickle cell trait. It doesn't mean they have sickle cell anemia. It's just they carry this kind of genetic predisposition that increased the risk of chronic kidney disease, regardless of what they eat. Okay. And the next question is, oh, that's interesting. Speaking of which, has there been a correlation between sickle cell disease and COVID? That is something that I've never heard of. It doesn't mean, so it's not something I've looked at specifically. But I assume since there was a time I was reading every single article on COVID in the medical literature and it never came up. I'm assuming the answer is no, but the book came out months ago. And since then, I've not been staying on top of the science. So it's possible new stuff has come up since then. How would you tell you could go to PubMed? So it's the database of the largest medical library in the world, which your tax payer to always pay for at the NIH in Bethesda, Maryland. And you can look it up. You can type in sickle cell and COVID and you can see if any articles pop up. Okay. And if you're like, wait a second, but there's a paywall. How do I get at those articles? I've got videos about that too. Okay. What can health practitioners do to address health disparities like this? Can you also speak to lack of representation of Black RDS and RDNs? And how the healthcare industry itself can provide more opportunities for clinical and community-based plant-based vegan nutrition support, especially since most GPs, general practitioners, get about seven hours of nutrition training. It's actually a little more than that, but still it's miserable. It's difficult to talk to them about this or get insurance for nutrition advice. Yeah, no. So absolutely, there's people of color in general are underrepresented in many aspects of the healthcare field. I talked about one of the ways, in that last video, how the public health community can work on these issues by forming these partnerships with these kind of vegan soul food restaurants in urban areas for cooking classes, et cetera. And of course, everybody needs more nutrition training. That's unfortunately not limited to any specific group within medicine. So yeah, in general, just informing people about the role, diet may play in preventing, arresting, or reversing. The majority of our leading killer lifestyle diseases would be good for everyone, particularly because, right, so diet is the solution and diet, the solution is the problem. And black Americans have greater rates of the problem, and so we need more dietary intervention across the board, and that will preferentially help communities of color, which are stricken particularly hard by these horrible lifestyle diseases. Next up, oh, I think I addressed this a little bit, do African-Americans have lower vitamin D levels? The answer, absolutely yes. If so, do you recommend higher supplementation? I just heard about an expert opinion that the, that's their quote, it's not mine, that the evidence for vitamin D supplementation are really strong and might pass by like vitamin C supplementation hype years ago. Okay, good questions. Yes, African-Americans have higher rates of vitamin D deficiency, because they have lower rates of vitamin D production in their skin, because the melanin in their skin actually protects against the UV rays in sunlight, but it's the UV rays, the same UV rays in sunlight that give us vitamin D are the same ones that damage our skin, cause skin cancer, particularly melanoma. And so they're protected from certain types of skin cancer, but they need greater exposure to sunlight. So for example, at lower latitudes, just if your skin is light enough, and you're young enough and thin enough, then just five minutes on forearms and face, so it's not like you have to be in a bathing suit, you get all the vitamin D you need for the day of midday sun, so between 10 and two. But for someone with really dark skin, that a few minutes could be 45 minutes if you just have forearms and face exposed. And so you can see how you would have much higher rates of vitamin D deficiency. And then the question is like, well, does it really matter? Because vitamin D has all this hype about it, but it turns out vitamin D may not be as beneficial as we've seen. I've got a bunch of videos on that. I've got a bunch more videos coming up. And indeed vitamin D absolutely flops when it comes to a number of conditions. The reason we thought vitamin D was so amazing is because these cohort studies, these epidemiological population studies, tie high vitamin D levels with lower rates of almost every disease on the planet. But guess who has high vitamin D? Those are running around outside. And so maybe it's the exercise, right? Maybe the, you know, so there's reverse causation, there's confounding factors, right? I mean, so reverse causation meaning maybe instead of low vitamin D levels leading to high rates of disease, maybe high rates of disease lead to low vitamin D levels, right? Because you're sick, you're inside, you're not getting enough sunlight. So anyway, that's why we need randomized double one placebo controlled trials where we give people vitamin D or an inert placebo like a sugar pill. And we actually see if these, there are lower rates of diseases. And in some cases it absolutely flops. In other cases, it significantly improves things. And in fact, I have a fun series of videos coming up where there's like a scorecard. It's like, okay, vitamin D totally bombs on that. But who would have thought it helped with this? Anyway, bottom line, spoiler alert. You need to make sure you get enough vitamin D. And for those at high latitudes, particularly this kind of the year, this time of the year, the sun's raised at such an angle, no matter how long you hear in Seattle, you somebody naked by the Puget Sound on the beach here and in January, February, you're not going to make enough vitamin D. And so that's why you need to take a vitamin D supplements. And so I recommend 2000 international units of vitamin D a day. And that is the same for white and black Americans. And look, you should be taking vitamin D year round if you're getting insufficient sun. It doesn't matter if you live in Phoenix, if you're sitting inside all day, you're not getting your midday sun, you need to get vitamin D either from sufficient sunlight or from supplements. Okay, there is a misconception that meat-based meals are quicker and easier to cook. If you're working long hours, exhausted center, how can you rationalize eating plant-based meals? Do you find that plant-based meals are easier, faster to cook? I think it's a similar kind of preconceived notion to the cost. People just think eating vegetarian is more costing when in fact, the science shows it's absolutely the opposite and sensing with convenience. People are like, oh, I don't have time. That's why I go to fast food, right? Because it's so much more convenient. I don't have time, right? You want fast food? An apple, that about is convenient. It even comes in its own edible wrapper, right? Anyone, in fact, yeah, anyone who doesn't know how to eat convenient lamb, I've never met an apple. I mean, come on, right? Some of the healthiest foods are the easiest foods. In fact, they're already done, right? Many first investors can be raw. And there's, and how not to die, I give a whole bunch of tips. There's now all sorts of, sort of like whole grains, for example, and beans, pre-cooked, like canned beans, right? No salt added canned beans, VPA-free canned beans. They're already cooked. You open up the can, boom, done, right? It's 30 seconds, they open up the can. Now they can be a little mushy, and so I actually cook beans from scratch, from dry beans, super cheap. Save lots of money with electric pressure cooker, like Instant Pot. Takes a half an hour, but it's basically a press of button, and it just shuts off automatically. And so you make a whole bunch of beans, and they're a little firmer bite, and I think taste better, but it's totally up to you. So instead of, you know, 30 cents a can, it's, I forget what the calculation was, but it's even cheaper buying dry beans yourself. And there is pre-cooked, even whole grains. You say, well, I don't have time to like make rice or something. Again, you can make it in a rice cooker, electronic pressure cooker, or some of these other grains, like sorghum, which is my favorite rice substitute. But you can also buy pre-cooked grains, like you can get these pre-cooked quinoa packets from like Trader Joe's and things, where literally you just slice it open, it's done. And you can make a little quinoa salad, whatever. Oh, there's all sorts of easy, easy. So if you just Google quick, healthy, plant-based meals, tons of stuff will come up, right? I mean, so like, you know, toasting a corn tortilla, spreading some, you know, fat-free refried beans from a can on it with some jarred salsa, and some, you know, I mean, that's like, you just had a meal and took no time at all. It's easy, convenient, healthy to eat, plant-based. All right, next up, how we doing on time? Oh, right, we're getting towards the end. All right, okay. Regarding the cost of eating healthier, it doesn't matter if you're eating organic. That's a good question. Eating organic versus non-organic, as long as you're eating a healthy diet. Are we compromising our health by eating cheaper non-organic foods? You know, how not to die? I have a, I talk about a video, kind of a computer modeling study. No, don't talk about a video, I talk about a study in which they estimated that if half of Americans in a single more serving of fruits and vegetables, we would prevent, I believe it was 20,000 cases of cancer every single year. That's how powerful fruits and vegetables are. Just half of Americans, one more serving of fruits and vegetables. Now, but they were taught, because they were talking about conventional fruits and vegetables, pesticide laden fruits and vegetables, the additional pesticide burden on the American public by that extra produce consumption would cause 10 cases of cancer. So overall, we would just prevent 19,990 cases of cancer a year, right? That gives you a sense of the tremendous benefits of fruit and vegetable consumption versus the tiny bump in risk. You say, wait a second, why accept any risk at all? I'm choosing to eat organic, great. But we should never prevent, we should never use concern about pesticides preventing us, prevent us from stuffing our face with as many fruits and vegetables as possible. And so if buying conventional broccoli allows you to get two heads of broccoli for the price of one, then go for the two heads. In fact, broccoli, bugs don't like broccoli very much. Conventional broccoli has about the same pesticide residues as organic broccoli. Now there are other benefits to organic, such as better soil and it's better for the workers in the fields, et cetera, to not use pesticides. But from a strictly personal selfish health point of view, the most important thing is the quantity of fruits and vegetables. And so one could argue with the cheaper, the better. Of course, if you actually buy more fruits and vegetables and actually eat them. Okay, we are, oh, and next question, it kind of ties in a little bit with all the government subsidies that various standard American diet food industries get, how can veggies be cheaper? Yeah, so our taxpayer dollars go not to make kale cheaper or apples cheaper or sweet potatoes cheaper. It goes to make sugar cheaper. It goes to make feed crops cheaper for to make dollar menu meat. And why? Because the most powerful lobbies within the Beltway are, is big ag. And so that's why we subsidize animal agriculture and process food industry to make cheap sugar, cheap corn syrup. And so why? Because they make more money. You make more money selling a snack cake that sits on the shelf for a few weeks than it does making produce. Because produce goes bad, right? It's not a lot of markup. You can't brand it anyway. Lots of reasons why unhealthy foods are more profitable. That's why we need to, we cannot rely on the corporate world or our government. Which in many ways has been ensnared by the corporate world to best feed ourselves and our family. We need to regain, reclaim our health by sticking to the science. But there are ways to get cheaper veggies. If you look at my, oh, I have a fun cooking video coming up. We're actually show what's in my fridge and freezer. And if you look at my freezer, half frozen berries, half frozen greens, and other vegetables. So frozen vegetables, because you can get them year round. Shop of farmers markets, community, community support and agriculture. These are all things that I personally do in my own life to cut down on the cost of veggies. And yeah, eating in season, all sorts of good stuff. Anyway, all right. We are, time is almost up. I hope everyone learned a ton. I know I certainly did. I learned about as much as anybody else doing these videos during my monthly live Q&As. You'll note that just basically I have two questions, two answers to, two kinds of answers to the questions I'm asked, which is check out my video on the subject, or I have no idea, but I'll look into it. Well, that's because I don't know any of this stuff either. I wasn't taught much real nutrition in medical school. So I've got to dive into the primary literature, like anybody else. Dig up the original studies and figure it out myself. I'm just so honored to be able to share this information with you. You will note that this webinar was free, as in not even asking for a suggested donation free, but if you would like to see more webinars like this, please consider making a text-deductible donation to nutritionfacts.org, which is a 501c3 nonprofit charity that supports all this work. Thank you so much, everyone. Stay safe, be kind, and eat your veggies.