66. Progress Note #1: Meat Causes...Cancer?

Hello everyone, I'm Dr. Darsha, and I'm Dr. Altamash Raja, and welcome to Medicine Redefined. A podcast where we will explore the often overlooked but necessary components of health, what we consider to be the fundamentals. We will investigate topics and practices that can give you and your patients the best chance to optimize a healthy lifestyle. It's time to move the needle forward and put the health back in healthcare. Welcome to an episode of the Progress Note. In Medicine, the Progress Note is a medical record that documents a patient's clinical status or achievements during their care. It typically consists of four components. The subject of data, the objective data, the assessment, and lastly the plan. It essentially is a systematic review in a point of time. Our goals with these episodes are to highlight mainstream practices, take a deeper dive, and approach polarized topics with nuance. While advancement is always happening in medicine, rethinking data as well as our beliefs is a rare occurrence. Join us as we continue to make progress, hold ourselves accountable, and redefine medicine. Altamash, do you want to quickly explain to our listeners what our idea is here and what they can be looking forward to? Yeah, man. I don't even know how to start. It's been so long since we've taken a little break and I'm getting rusty. No, I'll just decide. I think maybe it probably makes sense to first define what the term Progress Note means. I think many people, I mean, those in medicine, in itself, you could probably tune out for the next 30 seconds or so, but for those not in medicine, progress note is kind of what it sounds like. It's a daily documentation that's supposed to be succinct for healthcare providers to communicate with each other with respect to the progress of the individual, right? The patient is usually the person in front of us, and so often that'll look at overnight events or most recent events or depending on what setting you are in patient setting versus an outpatient setting. You'll kind of look at the brief history. It's broken out into different components, so there's a subjective component, which the patient usually will give you information, you'll take all that together in the data gathering phase. There's an objective component that's for the physical examples and the labs and a lot of that data, then there's an assessment that everybody makes towards the end, and there's a plan that you come up with, right? And so we'll try to, when applicable, keep it within the realms of that. Our hope was that, you know, over the last couple of years, we've talked about all things in health, right? The mission is to add the health back in healthcare, and we've given its fair share to talking about nutrition. Now, it can be an incredibly polarizing topic, and it can be a really dense and complex topic as well. Unfortunately, what we've noted from time to time again, what's been happening, I wanted to say lately, but I'm sure it's been happening forever, that people are starting to, because the mediums for attention are getting shorter and shorter, the necessity to convey nuance when communicating information in the nutrition realm is getting less and less. And so, we're getting these clickbait things where people are communicating things and almost suggesting that things are definitive, and that's not necessarily the case. And, you know, people who cannot separate the signal from the noise, they tend to be the victims, and both you and I get information from our family members, you know, people in our inner circle, they're all sending us links, and they're not just saying, hey, what do you think? Yeah, what is that? Hey, what are your thoughts or something of that regard? And so, our hope here is that maybe we can kind of take a trending topic, if you will, and kind of try to dissect it a little bit, try to use some data without trying to bore you guys, and kind of help make sense of things. Yeah, absolutely. And I think I'll even expand that a little bit, right, to, I'm sure the listeners will understand what we do in our lives, right, like how do we take what we learn from our guests and apply to our lives. So it could be like nutrition, it could be maybe some of the biohacks going on. It could be like, you know, understanding what zone two cardio is now, right, which is what Peter T is all about, and that's definitely something like I've incorporated a lot more. So like in the future, we're going to be touching on these topics, I mean, what Altamush does, what I do, how do we incorporate it, what kind of progress, you know, we're making in our lives with our own health, and really sharing that with you all, with, you know, as much data as we can, but then again, trying to bring as much nuance to the topic, because we know it's not a one-size-fits-all, and everyone has their own individual approach to become the healthiest version of themselves. So it should be fun, it should be a fun new project that we brought into the show here, so. Cool. So with that, let's set the stage a little bit, right, I think that what's going to spark the discussion here is kind of a few posts that both of us saw maybe on Instagram, was there any other social media platforms that you saw before that you saw me, it was really interesting. Instagram mainly, yeah. Yeah, I think that's where we tend to be most active, and you know, people have posted talking about how meat is the end-all-be-all, the worst thing you could possibly put inside your body, right, and then people definitively claiming that meat causes cancer, and meat causes heart disease, and meat causes erectile dysfunction, and there may be some true to those things which we'll get into, but just definitively making these statements tell us the worst possible thing, which can be very, very confusing, and then of course, you know, depending on how many people share and reshare, it gets more and more confusing. So I think that's the one that we're going to try to address today, I'm not, I'm no freaking idea how we're possibly going to do that, and not be here all night, but we'll do our best. Absolutely. So the topic today is, does meat kill you? And the answer is yes, absolutely. You take one bite and you're drop dead on the ground, no, all jokes aside, so this stemmed from a post that we saw where if you go on Google and you just type in, does meat cause, you get a drop-down list, right, on Google, and obviously Google is looking for key words, but a lot of those key words are going to be related to health. So if you fill in the blank, you choose what to put in there, cancer, diabetes, heart attack, stroke, the list goes on, so when you read as a sentence is meat causes blank, meat causes blank, right, and you see all these harmful things. So that's what we're going to break down, but there's also this other set of posts that many of you may have seen is when it compares cigarettes as a cancer risk to now the new cancer sticks which are bacon, right, and I'm sure a lot of you guys may have seen that post that has been circulating, especially along a lot of the vegan influencers posting that to show that, hey, bacon or the new cancer sticks. So let's go in, let's talk about our kind of biases, right, when we see a post like that, what is your initial reaction, your gut reaction that you take away? You know, okay, so I've made some growth over the last couple of years, right, that's the positive, and so now it's, my thoughts are, let me read the whole thing, right, before I try to, yeah, when you say the whole thing, do you mean the comments, or do you see like the caption, or the caption, right, because usually there's a real or something like that, or a 20 second video or something, and then I want to go read the caption, because hopefully the author has added some context to what they're trying to communicate. But initially, there's a visceral reaction, but I've learned to kind of push that down a little bit more, and not just squirrel past it. And so I think, okay, that's interesting, and then I try to assess where that person's coming from, ideally, and I find this, just my analytical brain, the people who cite something, I'm a fan of that, because then I can actually go look at, okay, where are you extracting this information from, and then does your interpretation make sense to me, because that's another interesting thing, you know, I, sorry, this is going to be a little tangential, but before I also find that, you know, there are some people who choose one route of coming back, or debating on social media, right, when somebody will cite a study, and then another person will say, oh, that study did not show this, they actually showed this, and I always find that to be interesting, because I think even that standpoint is, it's, it's a bit flawed, because there are, sometimes can be more than one way to interpret data. And now, some people are, you know, have malattent, and they actually will misinterpret data to boost their own agenda. But often, that's not the case, and I think that if those, you know, I'm somebody who's involved in research, I like to do research, and even myself and my co-authors, or even you and I, right, I mean, I would say we're co-authors for producing this thing, so I, you know, we have different interpretation of different things often, so a lot of times even that aspect is interesting, but anyway, so I look at that citation, and see if that makes sense to me, and what I took away from that, and so that's kind of my initial process now. Yeah, so, and like what you're referring to is kind of lane, lane Norton, right, in terms of the former approach, where he'll take citations and papers, and try to analyze, hey, this is not actually what the paper is talking about. You're trying to prove X, but actually this paper says Y, right, and like he's not looking at it from a malattent point of view, he's looking at it from an educational point of view, and trying to actually have the viewers understand, right, like the research. And I mean, we're not going to go as deep as lane Norton does, or as Peter Atia does, in terms of the data, and you know, looking at the numbers, but at least we'll try to give you a good perspective. So my bias, at least, coming in when I see a post like that, right, talking about meat, is initially wanting to believe it, right, and coming out with energy, because for the listeners, I'm sure you guys know this, if you've been listening for a while, I don't eat meat, right, so I'm a vegetarian. And I've come to understand, and again, like, ultimately I've grown over the years, to really dissect what it means in terms of propaganda, right, and what type of post vegetarians vegans, and on the flip side, carnivores are putting out there, right, to promote their own beliefs. And the key word is beliefs. So people have to understand that there are beliefs that are rooted in why people choose to do the things they do. Beliefs are different than science, okay. Science is, you know, objective data and applying it and seeing how it can work clinically, and the science can be applied differently to different people. That's where beliefs, you can't have beliefs go and permeate through the world and say, hey, everyone has to believe what I believe, right, I grew up Jane, I grew up vegetarian. If I maybe were, you know, or grew up in the States, born in the States from family who was in the States, my parents were American or something, then maybe I would have grown up eating meat, right, I keep them in the back of my mind. So that's kind of the bias that I come in with, right, is a very one of like, oh, man, I wish this was true, but wait, hold up, that's just my belief because I don't eat meat. And then, you know, the ego can come in the way with kind of a superiority complex or something, right, saying like, huh, the way I live is, quote unquote, better than what everyone else does, right? So that's essentially the bias that I'm coming in with. Yeah, and I think, you know, you address a really important point. I think when people master a, the scariest thing of all is when people masquerade around disguising beliefs as science, right, that's, that's what gets really scary. Like, if you, if it's your belief, you call it out, but like, I don't do this because this is what I believe or this is my faith or whatever, and that's so cool, that's so cool to me. I mean, respect on that, right? And, and that's where we can agree to disagree as fine, but when you, again, to say the science supports this and it doesn't actually do that, that's where it becomes a problem. So, so let's, let's take on, on that for now, right? Okay, so I want to maybe start off with the, maybe the most complex and take a top down approach. I think the, the meat causing cancer thing, which is so ridiculously in depth, and this is something that, that kind of like round home day, it happens every two years, right? And most of the time when people are talking about meat causing cancer, they're really referring to red meat, right? Process meat. And whether it's the media taking a headline, you know, a couple of years ago, 2019, it was like the New York Times and a couple others, I feel like 2014, there was another one, in 2011, there was a big thing, it just keeps happening over and over again. And I think, you know, there, there is some merit to that and, but the most important thing for us to remember is that maybe on a population level, there's an association between red meat and cancer. And specifically, colorectal cancer, remember that cancer is, you can't just use it as an umbrella term, you know, if there's an association between one specific type of cancer, somebody else who might have that cancer or has a family history of a cancer risk, that information is not applicable. What we all really appreciate is when we see a study in high school, female gymnastics, we don't say, oh, okay, this applies to me, if it's like you have a population of senior citizen, you know, Japanese males, like that, that doesn't always apply. So that's easier for us to see, but when it comes with these types of things, it gets really, really scared, right? Because I think that cancer, one, it's scary, two, everybody is a perceived expert on nutrition because we put it in our bodies multiple times a day, so automatically you think you have some, you know, credibility when it comes to that. And so, so that's where it gets really scary. But the most important thing, I think, when it comes to stats and science is correlation does not mean causation, right? So just because something is associated doesn't mean there's a cause and effect. And I'll pause there to see if you have some thoughts, because that is, I think, the most important thing to remember that people who are not scientifically trained, keep in mind. Yeah, no, absolutely. I think that's, you know, that's like the number one statement that I think all researchers are just trying to get across, right? People who analyze is that correlation, right, or associations. That's just like, hey, if age goes up, then so does your telomere, like, shortening, right? Or whatever, like that's right here, or definitely anything, right? Those are related, right? But age necessarily doesn't cause those things, right? It's not a direct X happens to Y. It's just that those are associated. So I think that's the one thing, you know, people who really want to start learning to get into the science have to keep in mind. I mean, even when looking at posts and looking at people who claim things, the first thing you should ask yourself is, wait, is this a cause and effect? Or these things may be just related in some way, right? And I think even just discerning that will give you a lot of space now to think for yourself and really to start thinking like, okay, well, what about this situation or this situation or this situation, right? And what we're starting to learn is not only is the human body complex, but like just the entirety of everything that we have learned as a human species is complex in it of itself. So I'll, yeah. Yeah. And I think, you know, people will say, well, how can that be? Like, why is it not the case? And I think that maybe expanding on that is worth it, right? So when there's an association, right? It's hard to tease out like you alluded to that there's various other factors that could be contributing. In the case of cancer, right? You have genetics. You cannot treat as patients in their family history. We know that's important. You can have environmental factors, right? You can have exposures, you can have mutations that can attribute, and so, et cetera, et cetera, that can attribute to that specific type of cancer. And so putting it on one specific thing, meat, red meat, dye, whatever, you know, insert thing, yeah, that's really, really harder. So these things are called confounders, right? There is a lot of confounding variables that can contribute it to it, right? For instance, like if we look at just something that actually has been documented and shown to have the, quote, strongest evidence, all the still weak in the grand scheme of things is the risk of processed meats and colorectal cancer, right? And again, colorectal cancer specifically, nothing else. But that data still has a lot of confounding factors, right? So smoking, alcohol, they tend to increase that as well, right? Those people who tend to be in those groups who are in, who is in take of processed meats is higher. They also tend to have higher BMI's, they have to have a higher colorect load, right? Their overall consumption of fruits and vegetables is far less, right? In general. And I mean, we can dive so much deeper into how fruits and vegetables are protective, so they can actually negate some of the negative effects of meat consumption. But these people also have a lower socioeconomic status, they have a lower cardiovascular fitness, so which one is it? Right. How can one say that there's no way to know unless we conduct an experiment, which would be incredibly unethical, to do a study, like a law or really a short term study, because cancer takes years and years to develop to improve that, right? So when people come out and definitively say that, yeah, meat's the one that's causing it, and like, how the FDU know? Right. Right. And I think the way you said that is a great way for people to think about it is, okay, you have meat and we're looking at, is it causing this? We'll hold up. Let me take a step back. Other things could potentially be associated with this that could make it worse or make it better, right? So shall we dive into the two research papers here that we found through examinth? Yeah. Let's do it. All right. So the first one, and we're going to link these in the show notes, both of these papers, but the first one is basically looking at association of red meat and heart disease, all right? And so essentially they did a meta analysis of 24 randomized controlled trials, right? So what is a meta analysis? So essentially, let's say you have six papers, papers A, B, C, D, E, F, and you're essentially going to come out with a meta analysis, which is going to be a separate paper, which analyzes all of those other six and tries to come up with some sort of direction with that, right? So some sort of association or data analysis that they can put while looking at six different studies. Now typically they say meta analyses are the goals, you know, the best type of research that you can do because you're analyzing so many different things from a general overview perspective. But if you have six crappy papers, then you probably will come out with a crappy meta analysis, right? So it really depends. Okay. So what do you hear the word meta analysis? Don't think, oh, this is automatically right off the bat going to be amazing. The good part about this study though is that it's 24 randomized controlled trials, right? And now we know randomized controlled trials is kind of with intervention, what we would like to see if we could have a goal standard for every single experiment out there in the world. It would probably be, you know, a double blinded randomized controlled trial. All right. So we have 24 of those and we're going to analyze all of that. So what are they looking at again, red meat and heart disease? And so the question is how are they going to measure the red meat consumption? So essentially they broke it down into servings. So 0.5 servings, less than 0.5 servings of red meat or greater than 0.5 servings of red meat and these 24 studies range from either two weeks to 32 weeks. And what they were measuring was lipid markers, right? So your HDL, LDL, triglycerides, as well as blood pressure. Okay. So we're looking at less than 0.5, greater than 0.5 serving on these two things, lipid markers and blood pressure. And what they found was that there was no difference, no difference at all in any of the lipid markers, whether you were eating less than 0.5 or greater than 0.5 except for your HDL. But your HDL was only higher in greater than three servings of red meat. But now typically you're saying, oh, well, that's bad, right? Well, typically you want your HDL to be higher, right? So here we're actually finding, hey, this might be a positive outcome increasing your HDL with greater than three servings of red meat. But if you look at increased blood pressure, which would be a bad thing, increased LDL, increased triglycerides, they're not finding a difference in that with less than 0.5 servings of greater than 0.5 servings. Yeah. No, I mean, I think that's important. I'm sorry, tell me, did they define what a serving is? How do they quantify that? Did they give that in grams or something? You know what? I think they were talking about ounces. I didn't have to look back and see. Okay, I can't remember. But I think it was some sort of ounces, three or so. Yeah. And when they said red meat in this paper, did they specify what the source of the meat was? I think so. Was it pork? What was it? Yeah, it was all of those combined. So they actually have a pie chart and it was processed, unprocessed, so different types of red meat and different ways of processing it. Yeah. Yeah. So again, so full disclosure, I had read this paper and so I'm learning this information for the first time. And you know, again, my takeaway, as you see, there's a lot of follow up questions, right? How was the meat? What was it? So there are more to that. And so that's exactly my process is like, when you come across this type of information, I think that the first thought should probably be, it's like, oh, tell me more if it's interesting, rather than take the conclusions and run with it, right? Right. As you just mentioned, even the highest, you know, when we look at research for those, there's usually a pyramid that you're looking at. And at the top of the pyramid suggests that you have systematic reviews and meta-analyses. And so even the meta-analyses can be really crap, it's garbage and garbage type of situation. And so this one was a, you know, relative to the decent one and it suggests that maybe hey, it's overall, there isn't that big of a deal. I want to go back to talking about just the meat and its correlation with cancer, because I think that that's the one that probably is the most intimidating and, again, has the most noise. Just like this study where they kind of combined looking at, you know, unprocessed and processed meats, again, it's hard to tease out, which is the culprit. Unfortunately, when it comes to the cancer thing, there is, you know, some of the details have been ironed out a little bit better and really they've been able to point a little bit more towards the processed meats. And the reason for that is, right, these processed meats are in these nitrate-based preservatives, which when they go into the body can be carstogenic, right? And so nitrates, depending on the context, can be really, really good. So for instance, beaks, right, beaks have a high amount of nitrates, they can actually increase athletic performance, they can be cardiovascular protective to your point. But when their nitrates are coming from, you know, these preservatives and the processed meats, then they can be carstogenic. And so, again, context over content, really, really, really important, there are other propositions of how that could potentially happen, right? So, when you're preparing your meats, that's another thing that's really, really important to, right? And so, it's really, could be all about the preparation. So, char broiling your meats or, like, you know, just charring the end of on a grill or can activate some of these compounds that can be, again, pro-carstogenic. So, these are things called heterocyclic amines, polyroamatic hydrocarbons, again, nitrocellamines in particular that can cause an issue. But as I mentioned before, often, these pathways that are going to your body, even after you are ingesting these things, some of the literature supports that if you do a one-to-one, like, taking green vegetables after eating something like that, that can counteract that, because they can find to some of these things and it won't potentially have a negative effect. So, that's another interesting thing as well, is because often, you know, when in these studies, when people are consuming these amounts of meats, they're not, they're not having both usually, right? So, it's one or the other. So, when you're comparing two groups, you're like, okay, I'm going to take a vegetarian quote-unquote group. They're consuming lots of vegetables and we've talked a length about how vegetables are good for you. They're good for your heart. They're good for a lot of different things and unfortunately, as an American diet, doesn't have a lot of that. That's why we keep shattering out ECC and Kowski because she has gamified consuming vegetables and fruits because they have a lot of amazing properties that can help, that can be anti-cancer or, you know, anti-cardiovascular disease really insert any disease and they're probably going to be good for you unless you listen to some people who will tell you that they'll kill you. That's a different story. Right. But, um, which is why we're here. Yeah. And, hey, and listen, I think I'd be remiss if I'd have mentioned that is we don't have to figure it out either, right? Yeah, that's true. But, I think we're educated enough and we've done this for long enough to know that sometimes we see these insane claims or like, let's just take a step back and maybe not freak out because I, quite frankly, man, I used to be in that group where I would see this and it would freak me out, right? Because I'm a pretty health conscious individual. I've openly declared about how that was affecting my sleep situation, right? And so, nutrition, it's no different, right? It's so intertwined in our lives every hour of the day that that anxiety itself, that's going to kill you before like the accident does. The worried well, right? Is that easy? Yeah. And, and to your point, I love how you ask questions right after I kind of presented that data, right? I mean, that should be everyone's initial triggers. Wait, let me take us that back. What other, what other information do I need to know? Because oftentimes in a social media post or a major newspaper, they would probably put it like major HDL changes after eating red meat, right? And right off the bat, you'd be like, oh my god, let me send this to my whole family. This headline is crazy. But then, if you're the smart person, you'd click on that link or you'd click on the link and order to click on the paper, right? Because very rarely do they even cite the data within that article. So go to the original paper, look at it, read it, see what's going on, what are they actually doing with the methods? And then you'll be like, ah, okay. They took one little thing and then even exaggerated that. So that is what is important. Yeah. All right. So let's shift gears. You want to talk about the other paper that you came across? Yeah, absolutely. So this one was also an examine. And again, when you go on Google, the post we saw was meat causes and then it also said autoimmune disease, diabetes. So this one is about effects of total red meat intake on glycemic control and inflammatory biomarkers. This was a paper done by O'Connor and all. So they took adults greater than 19 years old with no cardiometabolic disease and they randomized them to different quantities of red meat over three to 16 weeks. And the things they were measuring were fasting glucose, insulin, HB1AC, how do we even know what the other one was? So C-reactive protein, right, which is an inflammatory marker. And then some other pro-inflammatory cytokines like IL-6 and then TNF alpha, which is something else that gets accreted during an inflammatory state. So what they found through this, right, after eating red meat of different quantities over three to 16 weeks, was no difference for any of the outcomes, even in a dose response manner, right? So even if you're eating more and more meat, they're not finding a difference in any of those biomarkers, inflammatory markers or markers that are associated with diabetes in any way, right? So that's kind of what that paper was talking about. Was, did you mention BMI and were there any differences, and did they control for that? I don't think they control for BMI when I was looking to do the paper. I didn't see anything about looking at weight for BMI. I think it was strictly just looking at these landmarks. Yes. Yeah, so I mean, these types of things are so important. I like that, though. I think that, you know, in preparation for this, that they both you and I took us to a different angle, like you were looking at the cardiovascular stuff and the metabolic stuff and I was kind of focusing on it from the cancer perspective. I don't know why I did that, though, because the cancer thing is so incredibly dense and complicated that I mean, I just, yeah, honestly, I think it's cause, like even Peter Tia talks about this, right? Like, sure, red meat is carcinogenic based off the way you can prepare and things. But if you look at the grading system, right, from like A being, okay, this will definitely absolutely cause cancer like cigarettes to BCD. Red meat is like the lowest on the totem pole. It's like, sure, there's a risk, but that relative risk is not that high, you know, unless, of course, you go beyond and smoke all your meat and charade and then eat that quantity. So that reminds me, I'm glad you're about that up. So I haven't seen this. What's it called? Like cancer sticks or what you said? Yeah, bacon or the new is the new cancer stick cancer stick, okay. So I'm glad that people brought that up and they use smoking as an example, right? So just to give people some context, so, right? So a lot of this, this nutrition stuff, it's, it's based off of what we call epidemiological studies, right? And if you really involved into research, you're not a fan of them, but it's the best we have when it comes to population level stuff, right? Because you can't put millions of people in random, again, the best thing you can do is kind of take a meta analysis or a systematic review where you can pool large amounts of data. So you have to take epidemiological study where you can take large population, large N, right? Which is a number of people that are in study and look at that way. And so to give people an idea, there's one thing that we look at. We look at these things called, there's something called hazard ratios, right? So a hazard ratio, it's like, it has to be above one. And that tells you that there's a certain percentage increase. So for instance, if there's a hazard ratio of two for something, right? So if smoking gave lung cancer and the hazard ratio is two, that means that you essentially doubled your risk. Does that make sense? Right? So if you have a hazard ratio of 1.16, that means that there's like a 16% increase. It's not, you know, it's not the effect size. The magnitude is actually very, very small. And so, you know, people will say, well, you know, we've changed the way we discuss public health messages and smoking and alcohol and stuff like that and that's based on epidemiological studies. I assure you that those studies, the relative risk ratios and the hazard ratios are far far greater. We're talking in the 100%, 1000% like for instance, forget where I read this, but the relative risk for smoking and lung cancer associations was like 111% increase at one point. I'll have to look that up. Whereas when it comes to talking about, right, me being carstogenic, it's like a total of like 3% increase, right? And so that's one thing. And then kind of what you suggested right there is like the dose really makes a poison. Yeah. Right? Kind of ain't using that cliche term. But it's applicable here, right? If you're eating two burgers, grass fed burgers, right, leave a week, it's not the same as consuming massive and massive charred meat three to three to four times a day. That's completely different to how you're going to. And then also if you're eating lots of vegetables and stuff like it's part of a healthy diet, that's going to be, it's just completely different, right? And so again, we have to see where it's applicable. Right. And I think a lot of people here might be thinking, well, what about the carnivore diet? Aren't those people eating like tons and tons of meat? It's like, yeah, absolutely. But hopefully they're doing it quote unquote correctly, right? They're eating the healthy, organic, non-GMO, non-anabiotic meats that are coming. And not all of that is red meat either, right? And I know Paul Saladino and those, and that camp are starting to incorporate more fruits or some veggies at least. And hopefully there might be some, like you said, effects that will take away from the meat. But it's definitely interesting, right? And I think this is the thing that I need to learn more about. I'm sure you do as well as more in terms of the effects. But this carnivore diet is so new that we don't, you know, there's no way we're going to find out the data from that in the last like three, four years, right? I mean, these things take a while for the body to process and clinically show something. Yeah. And I think so the issue, the other issue that becomes is that a lot of these things, so the carnivore diet, it's a classic example, right? It's a hypothesis generator off mechanistic data or animal studies or in vitro studies, right? These are studies that are non-human studies. So in vitro studies, they're in petri dish animal models, they're in mice models. Again, I don't have to explain to people the differences. So you take this and you have mechanistic data and say, hey, this makes sense in my scientific left brain and therefore I should use it, but I should do this and apply it. But again, we have to caveat the way we're communicating this information. That's not the same as, oh, we have, again, large human studies for 20, 25 years that we know something true. And so yeah, only time will tell for somebody who's been at a carnivore diet or really any diet that is extreme, I'll call it on one, either spectrum, really, this is the pendulum that we keep talking about, either spectrum and see what happens on 10, 15, 20 years, right? In that individual, that's the other thing. What you mentioned is everybody's not a little bit different. So how you process that might be completely different than how I process it. Marie Spano, I think you're familiar with her, right? She actually had a really good post today talking about how if you are a vegan or vegetarian, these are the micronutrients that you're going to be missing out on, right? A couple things like if you're going to be missing out on DHA, environment, B12 and that kind of stuff and medicine, really first year medical student you learn about the issues and the specific diseases somebody might present with, but that kind of stuff. If you're a carnivore diet, you might be missing on X, Y and Z, fiber, vitamin C, that kind of stuff. So that's something important to keep in mind as well is if you could be on either end of the spectrum, there's an opportunity cost to that, right? And so unless you're supplementing with that, and then I would ask them all are supplements healthy, right? That's going to be another episode. That's why I'll be an episode. It could go on and on, right? And so, yeah, man, it's all very, very interesting and it's all very polarizing and also scary. Absolutely, absolutely, cool. So take a ways, right? So after you did your research and you learning about this stuff, are you going to stop eating meat? So, you know, I think I didn't answer your question about the biases in the beginning. No, I do. I enjoy my meat, pause. There is a little, we are not going to take that out. That's amazing. Yeah. That's amazing. Yeah. Um, here's what I've started doing, right? Adding more vegetables and food, like again, so this concept of, you know, subtraction by addition, which I'm a fan of, right? So just really making it point to creating more vegetables stuff when you just don't have root to think about chicken and I'm not a big red meat person anyway. And I certainly don't ever eat processed meat and say ever, but almost 99.9% you're not going to see me eating processed meat. So that's less of a concern. But again, I go back to this thing if a dose makes a poison, like that's really really important. I have been more cognizant over the last several years about my preparation strategies for meat. Like, for instance, I love, I used to love grilling, right? And so, and sometimes I'm also a little bit of scatter bayonets and you know multitasking medical school, I would always grill and then, you know, if you're studying, come back and chicken, get burned a little bit up like in whatever it's so good chicken, you know, chicken breast is expensive. I'm going to eat it anyway. And I don't do that as much anymore, right? And so, so that's one thing that I've changed up a little bit, you know, not eating like actually charged stuff, understanding how that actually potentially could have a negative effect. But ultimately in terms of the prevention strategies, it's simple as eating more fruits and vegetables. It's going to confer so many different positive benefits, but it's just, it's understated. Absolutely. Yeah, I think my takeaway here is, you know, of course, you know, I don't eat meat as I stayed in the beginning, but more from a social media perspective now is when I see these posts, even from my vegan and vegetarian colleagues, it's kind of educating them, right? And saying, hey, a belief doesn't equal science, right? And, you know, I respect your beliefs, I'm the same belief, there's a reason why I'm vegetarian still. And, but we don't have to impose through propaganda to get people to switch, right? I think that's what a lot of people are trying to do is make people switch one way or the other to get them on their side with this tri-mentality. And I just don't think that's the proper approach. Now, questions that the audience may have as well, like, okay, well, if you're a vegetarian, what about protein, right? That can be a separate progress note episode in itself. We can always talk about supplementation in a separate episode as well. So as you see, like, nutrition's complex, right? One question, if he raises a whole bunch of other questions, which raises a whole bunch of other questions. And so, this is why we started this project, is to kind of go down the weeds and see where we can end up and cover as much as possible. One thing I will say, though, is that meat can absolutely kill you in this one instance, which is if you get the Lone Star Tick Bite, which is a tick out in the Northeast, and actually, nothing. It's mainly Southeast and East Coast. Yeah, that was the Texas and area. Yeah, yeah. It is. And then I was just googling it. It was said like Southeast and East, mainly. So I don't know if these things are migrating or not, but, yeah, Lone Star, right? It should be Texas, Lone Star State. And they can bite you. And if you end up getting an infection, sometimes you can get this thing called an alpha gal allergy. So this is a type of sugar in red meat that you are now allergic to. So people have actually died from eating red meat without knowing that they had this allergy. So in that case, I don't know. I'd have to look more into it to see, like, does this allergy go away? Are there ways to kind of reduce the response? But I have seen that people got an anaphylaxis from it. So that is one interesting way that meat can kill you. That was actually really neat. Fun fact. The coolest thing we learned today, I just quit Wikipedia search. It seems like it's really all of Eastern United States, or really all the way down from the Eastern part of Texas, all the way up to the New England States. Yeah, that is interesting and it doesn't, it's an ugly looking thing. But yeah, stay away from that. And if you know you have that allergy, then certainly avoid meat at all causes. Absolutely. I think that actually just occurred to me that when you were bringing up to these studies that I forgot to mention, is I remember coming across a paper, again, when I was researching this. And I think this was by Schoenfield, or an Ionidis was on the paper, I know that. And so yeah, it's Jonathan Schoenfield. And this is a paper in 2013 in the American Journal of Political Nutrition. Essentially, the title is, is everything we eat associated with cancer. It's a systematic cookbook review. You might have heard about this, or to talk about this, and basically what they did is they randomly took 50 ingredients in some of the common, common, like, out of a cookbook recipes, 50 random ingredients. And just the, the PubMed surges on that to see if each of the ingredients has an association with cancer. Or if there's a study looking at the associated with cancer, 40 out of the 50, there is at least one study documenting either an increase or a decrease risk with cancer, right? So negative or positively. So I don't know if that kind of helps to bring it all together here, is that, and I think that there was a paper or an article that came out after it said, basically saying, hey, it's everything that we're ever eating causing cancer. And you know, again, context over content, I think that we've said that multiple times here, and I think it's really, really applicable yet again. So hopefully people can remember that. Yeah, absolutely, right? So the opposite can always, always hold true. So you can Google Meet Can Cause, and you can also Google Meet Does Not Cause. And those keywords at the end will stay exactly the same. You can try it at home, because I've tried it, and it's just funny and comical to see that and see how people will only see it in one way. But yeah, so I came across this quote that during my meditation yesterday, and I was like, damn, I've got to say this during our progress now, because this is just so fitting for at least like the first episode. And it's a quote by Alan Watts, and he says, we can never, never describe all features of the total situation, not only because every situation is infinitely complex, but also because the total situation is the universe. Now, it's a little meta, a little philosophical, but essentially what it's saying is, hey, every situation, every single question we ask, everything is related, right? And like you said, you can Google it one way, find something in the other direction. And we're just humans on this earth trying to figure out the truth, which, you know, we'll keep seeking and seeking. So, once that's closer, amen. All right. Well, hopefully you guys all enjoyed that. Leave us some feedback, and we'll see what we'll do for number two. Cool. Everybody. 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