December 21, 2016
[0:00] Introduction/ TryFuel
[2:42] Marc Pro
[5:02] Introduction to this Episode
[6:36] Kamal Pate
[10:14] How Examine Came To Be
[12:31] How Examine Works
[16:30] How To Tell If The Science Is Manipulated
[25:27] Quick Commercial Break/ Organifi Green Juice
[27:09] Kimera Koffee
[29:38] Looking Out For Red Flags in Media Headlines
[48:30] Reading an Abstract
[55:06] Top Three Most Beneficial Supplements According to Examine
[1:00:06] The Most Researched Supplements
[1:01:50] The Surprising Benefits of Daily Creatine Intake
[1:12:15] Supplements That People are Infatuated with but Low Credibility
[1:17:16] Best Supplement Stack According To Kamal
[1:40:48] Why You Should Spread Your Vegetable Intake Throughout the Day to Maximize Nitrate Exposure
[1:31:12] End of Podcast
Ben: Hey, it's Ben Greenfield. Merry Christmas! If you're listening to this podcast during the week that it comes out, it is Christmas week. As a matter of fact, today, the day that I'm recording this episode for you, it's my birthday. So celebration is in the air. I'm 21 years old. No, I'm just kidding. I'm a little lower than that. But you can send me a bottle of your booze of choice if you really are convinced that it's my 21st. I'll take it. I'll take it all. Anyways though, this is also the time of year where we’re stuffing our faces with copious amounts of holiday cookies, and chocolate, and eggnog, and Turkey, and mashed potatoes, and gravy, and green bean casserole, and whatever else it is that floats your boat and makes your waistline expand on Christmas. So what better thing to talk about than biologically appropriate food? No, seriously.
There actually is a company that's bringing you this show today that makes biologically and genetically adapted food, or I suppose I shouldn't say adapted, I should say customized food that's customized to your body. It's really kind of cool 'cause there's all these mail delivery companies out there and they send you pretty good meals, but this stuff is actually designed for your weight loss goals, or your weight gain goals, your DNA, your genetics. What they do is they look at your biomarkers, your genetic data, and your health, and activity levels, and then they deliver individualized, biologically perfect meals to your front door. No prep, no cooking, no cleaning. You just get this perfectly designed meal that you then toss on your, for example in my case, my cast-iron skillet, and cook it up. And it actually tastes good. It doesn't taste like astronaut food as you'd think something like this would, or like the Willy Wonka Thanksgiving turkey meal in a pill meal. It's actually good food. It's no gluten, no preservatives, low glycemic index, they're paleo friendly if that's your thing, there's no antibiotics, it's USDA organic.
The company is called TryFuel. T-R-Y Fuel. Very cool concept. I really do dig this. So it's tryfuel.com, TRYfuel.com, and they're giving everybody who listen in a 20% discount. And the discount code that you use for this is Ben's Gift. Ben's Gift. Like it's coming from me. It actually is coming from TryFuel, but it's from me too. I guess. 20% off tryfuel.com and use code Ben's Gift if you want an alternative to eggnog, or if you get sick of holiday chocolates, or if the new year is approaching and you need some meals that are perhaps a little bit more conducive to slimming your waistline or getting rid of some of that holiday weight gain.
Speaking of slimming your waistline, you may have seen these Made for TV commercials in which the person is lying on the couch, zapping their abs with the electrodes to give themselves six pack abs. Those things actually, they actually do work. Electrical muscle stimulation is something I've talked about before. It does increase localized blood flow to tissue, it does increase heat in tissue. You can spot reduce with it. There are some electrical stimulation devices that will simulate like a 600 pound squat. It sounds like cheating, but a lot of them work. However, the one that I use the most often is not designed for six pack abs, or a six hundred pound squat, it's designed for recovery and blood flow, and it's got a special form of electrical muscle stimulation. It's not the square wave form that a lot of companies use, it's a patented wave form that they use to deliver blood flow to tissue without harnessing your fast twitch muscle fibers too quickly so you don't aggravate an injury. You just take a little electrodes, you surround any area of your body that hurts, like your shoulder, or your knee, or your ankle, or whatever, and then you turn this thing on, and it provides therapy to muscles, allows muscles to recover faster, gets rid of soreness, and it's a really cool way to biohack recovery. It really is a biohack.
It's an electro stimulation device called the Marc Pro, M-A-R-C Pro. And you can go to marcpro.com and get 5% off of this EMS, this electrical muscle stimulation device, which can also be used at cocktail parties to entertain your friends as you make your thighs jiggle with the electrodes on them. No, seriously. You can do that. I've done it. It's dangerous when combined with alcohol, but it can be done. marcpro.com and use promo code Ben for 5% off. They've got the Marc Pro, they've got the Marc Pro Plus which allows you to select like high frequency, low frequency intensity. Really cool stuff. It's a fun thing to own, especially if you're an athlete or somebody who exercises. So check it out. marcpro.com and use code Ben. And now, we're going to talk about how supplement companies and media companies lie to you. Those bastards. They lie to you when it comes to what you're shoveling in your gaping maw in the realm of supplements. So prepare to listen in and be entertained by me and Kamal Patel from examine.com. Let's do this.
In this episode of The Ben Greenfield Fitness Show:
“Research studies are very highly controlled, and in very specific populations at specific doses for a specific duration. So making it into general advice for the general public is always a bad idea.” “If you're a freelance writer, or even if you're on staff, like if you're on staff at the New York Times, you can come up with whatever headline you want because it has to be a certain length and it has to be catchy enough so people click on the article.”
He’s an expert in human performance and nutrition, voted America’s top personal trainer and one of the globe’s most influential people in health and fitness. His show provides you with everything you need to optimize physical and mental performance. He is Ben Greenfield. “Power, speed, mobility, balance – whatever it is for you that’s the natural movement, get out there! When you look at all the studies done… studies that have shown the greatest efficacy…” All the information you need in one place, right here, right now, on the Ben Greenfield Fitness Podcast.
Ben: Hey, folks. It's Ben Greenfield, and it's probably no secret that I am a relatively veracious consumer of knowledge. I always have been. I used to sit in my bedroom when I was a kid and just read for hours and hours, and actually would often get punished by my parents, whether that's good or bad, I won't comment on that, for not even coming out of my room when we would have very important guests over, an old family friends because I had a fantasy novel to finish, or I had some encyclopedia I was shoving my nose into. And still on an average week, I read three to five books. I have a copious number of books on my bookshelf and several Kindles that are completely full, I listen to 15 to 20 podcasts a week, I read several dozen research articles per week, and one of my secrets to this kind of hyper productive digestion of information is that I use services, and websites, and journals, and newsletters, and basically digests that disseminate information into readily accessible bite-size pieces that let me cut through the clutter and get to the summaries, and takeaways, and the actionable items from the content that I'm consuming.
For example, I'm a huge fan of book reviews produced by guys like. Derek Sivers and James Clear. And in addition, I stay up to date with health, and medical, and science news via these newsletters called the Stone Hearth Newsletters. And I follow exercise and nutrition research on this website called SuppVersity. And for general life knowledge, I'm a recent subscriber to this blog called the Farnam Street Blog for staying up to date with the best pretty recently published books and articles from around the web.
And of all these things, there's one really comprehensive exercise, diet, and supplement resource that I access on a weekly basis, and I spend a ton of time on this website, I spend a ton of time with the PDFs that they produce, and even the monthly digest that they put out, and that is the website Examine, over at examine.com. And it is produced, and founded, and directed by my podcast guest today, Kamal Patel. And Kamal is the director of Examine, like I just mentioned, and he's also a nutrition researcher. He has an MPH and an MBA from Johns Hopkins University, he is, I think, currently on hiatus from a PhD in nutrition, in which he's researching the link between diet and chronic pain, he's got a bunch of peer reviewed articles he's published on vitamin D, calcium, and a ton of other clinical research topics.
So we're going to be taking a deep dive today into things like why the media and supplement companies lie to you about diets and supplements, how to find really good unbiased information, how to know whether or not the science that you're reading has been manipulated, and also we're going to delve into really good supplements, really good stacks, what are the most proven things that you can shove into your gaping maw if you want to get a better body or brain. So this will be a fun one. And I will keep notes on everything that we talk about in the show notes for today's episode, which you can find at bengreenfieldfitness.com/examinepodcast. That's bengreenfieldfitness.com/examinepodcast. So Kamal, welcome to the show, dude.
Kamal: It's my pleasure.
Ben: I'm curious how this all came to life. Because of when I go visit examine.com, and there's like reams and reams of information on there, and I'm just wondering if it was just like you sitting there one day wanting to write up a nice article on creatine, or how this whole thing actually happened.
Kamal: Well, I was actually sort of born out of Reddit, and Reddit Fitness, and Reddit Nutrition, and the sub-forums right around five years ago. There's always been websites with a lot of information on nutrition, and fitness, and other health related topics, but there was never really a website that only provided information. So like when I was first getting into lifting weights, I used to read Usenet groups, and then luckily the web started and then there was like Bodybuilding.com, or, I don't know what it's called now, but T Mag, T Nation, I guess. I don't know.
Ben: Yeah. There's T Nation, t-nation.com. Plenty of pictures of vascular men and women on those sites.
Kamal: Yeah. I remember they used to have motivational pictures that just got more crazy vascular every week, and that motivated my 19-year old self. So after a while, I figured out that the studies that were cited on those pages were really helpful. You could go back, read the study. If you could understand stats and stuff, you could figure some things out. But any time that you have a website where you sell stuff, you have to make money, and it's not bad nor good. You just have to make money to run a website. So any website that provided information like bodybuilding.com, it had a ton of good content, but it couldn't be systematic because they didn't have the manpower, or woman power, necessary to do all the research. And then if you sell stuff, then you're always going to have particular interests in things, and possibly an angle for selling things. So again, that's not bad or good. It's just whatever the people are interested in. So Examine started to be a sort of a systematic resource, and my background was in evidence-based medical practice. So, we basically just do kind of what research centers do, but for supplements and nutrients, and we're not affiliated with the government. But other than that, we do a very similar thing that they would do.
Ben: So when you say “we”, how does it work? Do you guys have like an office where people are getting supplements, and trying them, and writing about them? Or do you just have like a team of folks who go to PubMed every day? Like how does it actually work for you guys to put out all the information that's on examine.com?
Kamal: So we're a virtual team like, I guess, many teams nowadays. I live in San Francisco, we have people in Toronto, and Ottawa, and France, and some other places. And basically we've put out hiring calls in the past that have been moderately successful, but nowadays I just look on the internet for people who are really, really curious about things, and who are really analytical, and don't have a set position. And I'll talk to them and I'll see if they're interested, if they have open time, and we contract with people and occasionally hire them full time to, like you said, read through research. So we try to get people from different angles, like people interested in the pharmacokinetics of supplements, or people who have a public health background and know more about epidemiology, or people who have been in clinical practice, or people who haven't been in clinical practice but are just voracious readers, and then we look at research from a bunch of different angles, and then we summarize that stuff on our website.
Ben: Okay. Got it. Now you say that you're like an unbiased source on nutrition and supplements. When I scroll through the typical, like if I were to go to your website, and I were to open up the page for, let's say like, beta-alanine, it tells you, for example, what it interacts with, when you'd want to take it. Basically a complete summary with literally dozens and dozens of research studies behind beta-alanine. But when it comes to this website, I guess like floating itself with that huge team of researchers, there's no links on there for me that I can see at least to actually buy beta-alanine, or to go to some affiliate website like Amazon or something like that and purchase beta-alanine. How are you guys actually kind of floating this site? Or is it just like a labor of love?
Kamal: So we do have products. All the information on the website is free. So 99% of what we do is publicly available, and will always be, and will always be updated. And then in order to make enough money to, I guess, pay the bills and to pay me, we do sell three products. A supplement reference guide which has information collected by different outcomes, like if you have allergies, then you can click on a type of allergic reaction and see what studies have looked at that reaction.
And then we also have a stack guide, a collection of stack guides for different goals like aesthetic, skin and hair, or muscle building, or that kind of thing. Just kind of very concise information on what and what doesn't have evidence. And then we have a research digest that comes out each month with some of the latest research papers that are important in different areas and we tear them apart. So we look at them from every angle possible, and then try to be extremely critical of them. So with those things combined, we can keep the lights on, and have enough staff at least to get through basically all the micronutrients and most important supplements.
Ben: Gotcha. I actually want to delve into those in a little more detail later on 'cause I haven't used all of those. Like the supplement reference guide, it's like a thousand plus pages long, but it lives on my desktop. And whenever people ask me about like some fringe supplement, I'll go see if it's actually proven and efficacious, or whether it's just something that's going to give them explosive diarrhea. So you've got this idea behind being an unbiased source on nutrition supplements, but we're constantly bombarded, as you know, Kamal, by claims that fish oil is are good for you, fish oil is bad for you, or I know you guys do articles on everything from steak, to eggs, to probiotics. Now how do we know if a supplement company, or if the media, is manipulating science for their own benefits. I mean what are some ways that things like that are actually occurring out there?
Kamal: Well, the general way that I like to think about that kind of thing is anybody who's really into reading stuff, like anybody who listens to this podcast, likes the idea of science and the scientific method. And supplement companies, they're not really always trying to pull the wool over our eyes, but they are trying to make money. And then the media also, they don't have perfect information. They're not in the life sciences, they don't have PhDs. So when they write about stuff, there's imperfect information there. So the way I like to think about this stuff is the scientific method is about finding the truth through iteration, and through finding out what's false in data. There are some markers of what's false, like when websites have really crazy fonts, and unbelievable transformations stories, and stuff, then that's obviously false. But then there's been times when there's…
Ben: What do you mean fonts?
Kamal: Oh, so like for better, for worse, websites that look like they were designed in the 1990s usually either have outdated information, the person isn't with it enough to keep up with what's going on in the internet. So there's a lot of kooky websites out there that people forward to us, and then I try to read every message, so I comment back to them in a nice way, “This is what to look out for and this is what to not look out for”. But we get a lot of e-mails from people who are in their 70s, and 80s, and stuff, and eventually I just started saying, “Look at the website. Does it look believable?”
Ben: Like what? Do you have any examples of websites that you've been to recently that are just like, I mean not asking you to shove anybody into the bus…
Kamal: Oh, yeah.
Ben: Heck, I don't care if you give examples either.
Kamal: Yeah. So I'll try to come up with an anonymous one. So there was one where, I'm sure you've done a variety of diets yourself, diet experiments, ketogenic diets, higher carb diets, whatever, cutting out foods. So you know that elimination diets are something that people commonly use to try to address their medical conditions.
Kamal: So there was a website, probably three or four years ago, about somebody who was doing a nightshade elimination diet. So, I was always…
Ben: Like eggplants, and potatoes, and things like that.
Kamal: So tomatoes, potatoes, eggplants, red peppers, and then a couple other things. So I was interested in that stuff because just a year or two prior, I was doing my PhD research on elimination diets for rheumatoid arthritis. And there was this guy, there's actually not a lot of research on nightshades. There is some mechanistic research, and kind of the whole thing got started in like 1982 or so, there was an article about, I think it was cows or something in South America who became lame by eating some nightshade plants, and then they figured out it was arthritis that was induced by a vitamin D-type compound in those nightshades.
Ben: Alright. It wasn't like the glycoalkaloids in nightshade like the solanines in eggplants, and the nicotine in tobacco, stuff like that?
Kamal: Yeah. So all the nightshades have their own glycoalkaliods. Tomatoine, or whatever, and they can have different effects and different effects on different animals. So when that came out, then the sort of anti-nightshade, while very minor, anti-nightshade movement started, I guess. And then it started more in earnest when this guy who was a horticulturalist, who is actually a really smart guy, started doing some survey research saying like, “Oh, have you tried cutting out nightshades? What happened? Did your arthritis get better?” And then his arthritis got better when he cut out nightshades.
So I didn't see much actual research on it, and then I found this website, and it had good stories, but this makes it sound like I'm ageist, but it was by a person who was probably like 70 years old, and then they mentioned all the studies that were done, and they were like, “Oh, these studies show that if you cut out nightshades, then your arthritis will get better, your fibromyalgia will get better.” And I was skeptical because fibromyalgia as not a discrete condition often. It's hard to diagnose, it can be a conglomeration of different things. It's definitely not like the nightshade condition. So I was like, “He's really grouping a lot of things in here.” And then I started going through the website, and it was on, and I think it was transferred from GeoCities. Do you remember that?
Ben: Mhmm. Yeah. Vaguely.
Kamal: So GeoCities was, I don't know, Yahoo's thing or something in the 90's where you could have your own website, and it was one of the…
Kamal: So it was transferred from there, and the studies, when I actually tried to find the data, they weren't studies, there were surveys put out by this company that helped you reduce your nightshade intake. So the thing is I'm not pro or against nightshades. There is a mechanism for nightshade reduction and elimination diet for two, four, six, or eight weeks to see noticeable results, but this guy's website mentioned the vague term studies. And if you don't actually look into what the studies are, you can easily be tricked. So just over time, I got to think that whenever people put up web sites and they didn't care enough to make the information readable, if you're a good writer, or to make the website look somewhat good, you know it doesn't have to be a professional web site, but just a decent website, then be skeptical. So these are just heuristics that I recommend basically to older people who don't have the knowledge necessary to like tease apart if a p-value is important or not.
Ben: I have a couple of thoughts on that. The first is that you don't necessarily think that like there's zero evidence that glycoalkaloids can be implicated with like joint, or joint issues, or arthritis-related diseases, do you?
Kamal: Oh, no. I worked with a rheumatologist in Boston on the PhD research, nightshades were probably like the number four or five association with rheumatoid arthritis.
Kamal: So, yeah. It's a thing. It's just, like I don't have a pro or against stance on almost anything because I just think, for some people, they cut out a lot of things including nightshades, and then they see benefit, and they peg it on nightshades. So that's always…
Ben: Yeah. I gotcha. Okay. That makes sense. And then like my other thought on that is like, I guess just because a website is ugly or has an unattractive font, to me, that doesn't necessarily turn me off right away. Like what I look for is, for example, what's a recent one I was at? SuperMemo. So there's a website called SuperMemo and they've got a section there on sleep, right, and it's honestly kind of ugly. It's not laid out that well and it does look like it was made maybe like kind of the late 90's, ish, or early 2000's. But the number of well-cited research studies and the amount of obvious attention paid to citing claims that are made gives me a great deal of confidence in a website like that. So do you think that a website can be unattractive and ugly, and even made to look like it was created in the 90's and still be a dependable source of information?
Kamal: Yeah. You know what? Now that you mention that, I'm just going to retract my answer as a pretty bad answer. It's just 'cause I mentioned to one person, look at the website, and if the person takes care to write well and if the website looks good, then maybe there's a higher chance that it's credible. But there's a lot of web sites like the one you mention, like VitaminDWiki, it does not look good, but it has 5,000 citations for vitamin D articles that are very useful. So there are a lot of websites that don't make any attempt to look good, but are very useful. So more so than what the web site looks like, if the website provide citations, and then provides both the pro and the cons side, then those are usually pretty good indications that the website is good. So if a web site is all about something, then be a little bit more skeptical. But if web site says “pros and cons of vitamin D supplementation at higher doses”, then that might be an indication that it's useful.
Ben: I'm going to interrupt today's show to tell you about something I've actually been eating a copious amount of lately 'cause I had about 25 gentlemen over to my house for like health mastermind, and we did green juice powders all weekend, which is what healthy people do, healthy men do when they all gather together. We don't do crack cocaine, and hookers, and crazy amounts of burgers and steaks as you would think. We just sit around, stuffing our faces with green juice powder. And in this case, we had tons, and tons, and tons of this stuff called Organifi Green Juice.
It's coconut and ashwagandha-infused green juice, and it's like a superfood powder you can pour into teas, into mugs, into smoothies. It's jam-packed with tons of stuff. Algae, and moringa, and spirulina, mint, beets, green tea, wheatgrass, turmeric, lemon, coconut water. It's like this shotgun of nutrients in this teeny, tiny little pack. And it's good. And grown men can sit around and drink it, and still be grown men, still be masculine, with little green stains around their lips. Women can drink it too, by the way. It's not just for dudes, not just for cool dudes hanging out, drinking green juice. So anyways it's called Organifi Green Juice. Organifi Green Juice. And it's a powder, it's not a juice. So there's no clean-up and there's no mess. And you can get it, not only can you get it, but you can get 20% off on it. Go do this: go to bengreenfieldfitness.com/fitlife, that's bengreenfieldfitness.com/fitlife, and use discount code Ben to get 20% off of this Organifi Green Juice.
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Ben: Now in your guys' Examine Research Digest, which is like your monthly publication that you put out that, actually is it twice a month now that that comes out?
Ben: Once a month?
Kamal: Yeah. Twice once a month.
Ben: Okay. ‘Cause I remember it used to be like really big and once a month, and it always took me a long time to get through. Now that it's twice a month, I can get through it a little bit more quickly, which I like. But the research that you go through, sometimes you tell people like what you need to know, what to look for, and in some cases, you've pointed out studies that seem to appear credible, but that are flawed, for example. So when someone is online and on their Facebook news feed, or even if they've opened up USA Today or something like that, there's a story about a supplement, or a story about a diet, or a story about an exercise program, are there red flags or certain things that people should look for that would allow them to question the legitimacy of the claims being made in, for example, a media headline?
Kamal: Yeah. So there was a study done a couple years ago in the British Medical Journal that looked at how research from the top 10 or 20 highest impact factor journals, like New England Journal of Medicine, and German whatnot, how those were translated in media headlines. And the three things that were present in the media headlines that were in the original research most often were positioning research as advice. So research studies are very highly controlled, and in very specific populations at specific doses for a specific duration. So making it into general advice for the general public is always a bad idea.
There were also a lot of times when studies were not implying causation, either because they were just observational studies or because causation can be employed for statistical reasons or whatnot, but then the media headlines said “Vitamin E causes cancer”, or whatever. And then there's also times when research was done in animals where the animal parts were very briefly mentioned. And animal research is not bad, animal research can be very useful, but because occasionally animal physiology can be different, and then also animals get chow in the lab, they don't have a natural lifestyle like humans do, or rather an unnatural lifestyle.
Ben: Right. So when it says like a high fat diet is producing unfavorable health parameters in, say, like mice, a lot of times that high fat diet is essentially like lard and soy feed, for example.
Kamal: Yeah. Now that you mention that, there's this whole thing about is it bad to eat fat in order to, 'cause if you feed mice a lot of fat, or any rodent, then their intestines will become more permeable, and it's the easiest way to make the intestine permeable through diet. So then there is the question of translation. For people who have gut issues, is it important to watch their fat intake in order to reduce parts of bacterial cells crossing through the intestine. And people don't really, really know the answer yet, and part of the reason is that we don't know a lot about different people's gut linings. But part of the reason is that when you feed mice a diet of high fat, you're feeding them a highly purified diet altogether. Because they either feed mice a natural type diet or they feed them this chow that is soy bean, et cetera, oil, plus sugar, plus whatever stuff.
So they have a very dichotomous diet, whereas humans could eat like a bunch of purified fat, they could have a salad with olive oil salad dressing, they could eat a rotisserie chicken, they could eat grass-fed beef, and then they also eat it in meals, often with fiber. And our guts are also different because we have different bacteria that live in our guts. So any time you try to simplify animal findings for that, which is going to come out a lot in the next few years, there's going to be more and more media headlines about gut stuff, it's very hard to do. And especially in media reports, they never talk about previous research. So any one paper, it's just part of an [0:33:19] ______ process. And if you don't mention the previous research that's done. then you're not really getting the full picture.
Ben: Yeah, exactly. Like for example, I just wrote an article about this on marijuana, about the recent studies that show that marijuana can increase the risk of a heart attack. And then if you delve in and you look at the study, essentially what they did was they had mice stick their nose in this tiny little chamber filled with marijuana smoke and just breathe in the smoke for a full minute. And the researchers noted in the study, like they admitted in the study, well, a huge part of the endothelial dysfunction that they say that this marijuana is causing can be caused by the smoke itself, not anything in like the THC or the CBD from the marijuana.
And furthermore, the other thing is that when they look at this huge cohort of patients, this was the other part of the study. They looked at this huge cohort of patients who came into the hospital with heart attack type of symptoms, there was the marijuana group that had one form of symptoms, like the endothelial dysfunctional. And then non-marijuana users had a different kind of heart attack risk. So the media, you could've just have easily had said, “Oh, marijuana reduces risk of heart attacks”. But in this case, they report marijuana increases risk of endothelial dysfunction or vascular dysfunction. And so, yeah. It's really interesting how you can take the results of scientific research and really spin it one way or the other depending on what kind of message that you want to portray as the media.
Kamal: Yeah. I don't think people understand that the media is not allowed to say “we don't know”. And if you can't say “we don't know” and you have to take a stance…
Ben: What do you mean they're not allowed to say “we don't know”?
Kamal: So like you've written before for websites, right? Like outside of your own?
Kamal: If you're writing an article for major media, then you're not always in charge of the headline. They'll come up with a headline, and if you're a freelance writer, or even if you're on staff, like if you're on staff at the New York Times, you can't come up with whatever headline you want because it has to be a certain length and it has to be catchy enough so people will click on the article. So like really what a headline would be for that marijuana study, or for a vitamin D study, or whatever, should be, at minimum, 10 to 15 words long, which it never is, and it should have some words like “might”, or “could”, or “in some people”. So like there was, you know the guy who wrote the paper about 90% of medical findings are wrong? Whatever, four, five years ago. There was this study came out by John Ioannidis who is methodologist professor in stats and medicine that said 90% of medical findings are wrong. So it was really controversial, and then a lot of people kind of threw it around like, “Oh, I don't believe studies because there's a 90% chance they're wrong”.
So it's an extremely complicated issue, but it's probably the most important issue in all of nutrition research. Like I'm sure you get this because, as I understand it, you're a self-experimenter, and I've always been into self-experimentation, but also into research, and people think that they conflict. Like something works, and then the research shows that it doesn't, so it must not work. Or vice versa even. And it's a lot more intricate than that.
So like that study by John Ioannidis was true because of very statistical reasons and the fact that journals don't really run like you would want them to run. They publish results that are bound to get them attention, for example, and a lot of negative research findings don't get published. Because of a variety of reasons, a lot of medical research is wrong. If you reproduced a trial, there's a good chance that it won't find significant findings anymore. Like for example, the p is less than .05 is defined as significant. So the minimum that somebody would know about stats is you go to PubMed, you see that citrulline, or vitamin D, or vitamin B12 improves blood pressure, p is less than .05. So then you share it on your Facebook. “Hey, vitamin B12 helps blood pressure and this study shows it.”
It's not quite true because if anybody is really into stats who listens to the podcast, there's a bit of an internal war in biostatistics about frequent statistics versus bayesian, and I won't get into it at all 'cause it's kind of boring, but also fun if you like stats. But the end result is that if you take a study that is, let's say, p equals .047, so that means it's less than .05 and it's deemed statistically significant, and you can go to your friends and say, “Hey, this study showed that vitamin B12 does help this.” If you take that study and you reproduce it exactly, there is something like a 50 or 70% chance or something that it won't be significant anymore.
So most people would be surprised because if you reproduce a study, you would think you would probably get close to the same result. But you don't, and the reason is that trials are very rarely large enough to be done again and show the same results. A study will be done on 50 people and show a significant finding of p is less than .05, .047. But if you reproduce the study, then somewhere on the continuum of possible results, you'll get one of those results.
Like let's say you have a sugar pill that you test against another sugar pill, and you do that a hundred times. Well, one out of a hundred times, at least one, 50 out of those hundred times, or not 50. Five out of those hundred times, the sugar pill will be better than the other sugar pill, and it'll be p is less than .05. And all of those results will get published because journals publish positive results. And the other, however, 10, 20, 30, 40 times it was tested won't be published. But if you reproduce that same exact experiment, it won't be significant, and then that result is not likely to be published again. Just a very small slice of the total pie of possible research, and that's what people don't really understand.
Ben: Yeah. It's really interesting. Not to belabor the point too much about like the carbohydrates versus the fat issue, for example, but to be fair to like the high carbohydrate diets, in many cases when they say that like a high carb diet causes issues, they're feeding rodents or mice like a bunch of a cellular carbohydrates, like refined sugars and grains. Whereas somebody eating, whatever, sweet potatoes, and yams, and underground roots, and tubers, and carrots, and maybe quinoa, or amaranth, or millet, or fermented and soaked and sprouted beans, they might have a completely different reaction than what they're reporting in a study on macronutrient. So, yeah. It's one of those things where, that's why I appreciate what you guys do is you kind of cut through that clutter and report accordingly.
So the other one, and I also want to turn to some of the things you found to be most efficacious, but the other one that I think is interesting, I'd love to hear your take on this, is this idea, for example, that athletes need a certain number of carbohydrates to perform well during exercise, like a certain mix of fructose and maltodextrin, for example. And when you look at studies in which they will say that a high fat diet, for example, does not benefit athletes, or athletes need a certain amount of carbohydrates to exercise, they always take a sample group, for example, for a high fat diet, in which they feed them a high fat diet, they take them in off the streets, off a standard American diet, feed 'em a high fat diet for two weeks, and then compare that to a group that's eating a normal recommended carbohydrate-based endurance athlete diet. And they show that the carbohydrate diet is superior, but what they fail to do is actually have the athletes who follow like a high fat diet follow that for a year, or two years, or enough time to actually get the adaptive response to be able to, say, burn a higher number of fats for energy, or oxidize more fats during exercise.
And so in many cases, these research studies, they're short, like they're 6, or they're 12, or they're 18 weeks long, or whatever diet they're feeding the participants is just a few weeks long, rather than looking at something that's more lifetime-based or more one or two year-based just because research has limited time in terms of the scope of research in many cases.
Kamal: Yeah. So the ideal experimental side for that kind of thing would be to have a long lead in period. So, like you said, months, if not a year, where you're adapted to the diet, and then also have it be a crossover trial where you're both under the high fat diet, high fat, low carb, and the high carb diet, and then have a long washout period in between the times that you're doing those two experiments. So very few, if any, of the performance trials are like that. And since they're not like that, the scenario that ends up coming up is you do a small study because you have limited funding of like 10 to 20 people, and then you report that a certain group did better than the other group, and it's usually the higher carb group did better. But you could have it the other way, depending on how you design the study. And it's very hard to have those experiments be reliable because in a very small proportion of the papers is the power calculation done. Meaning the calculation that you would do before the study to show how many participants you need in order to find a result. And then if you don't do it…
Ben: What's that called? The power calculation?
Kamal: Yeah. So if you don't do a power calculation, there is one of maybe like, there's like 10 to 20 basic things trials should do, or at least in the paper. And very rarely are all those things done. And when you don't do those things, like when I was at my old position, the first project we did was of vitamin D guidelines. So in 2008, or nine, we were contracted by the federal government to do the systematic review for the upcoming guidelines. So for the first time in my life, I had to like really, really read deeply into papers and read a lot of papers. And first of all, it's really boring. So I recommend not doing that. But if you do do it, you'll find that papers are not nearly as good as you think they are because, this isn't for vitamin D, but for another project we did on fish oil. So in meta-analyses, they pool results of different studies. So a researcher will say a randomized control trial is the gold standard of research, and then meta-analysis is like even more of a gold standard, like a platinum standard, because it pools together results of a bunch of different rain mice trials.
I don't actually have that view because we said “do a lot of meta-analyses,” and the thing that ends up happening is that because researchers have to publish stuff or else they get fired, meta-analysis is a good way to publish something without doing a study yourself. So it doesn't mean that meta-analyses are bad, but what it does mean is that people who do meta-analyses are often not experts in that area. So we did have experts in vitamin D because we had a bunch of money that the government threw at us. But I used to read some meta-analyses on like fish oil, for example, and they would pool together results on fish oil, but they would pool together results from like Japan, and the US, and like Russia, or something. But people in Japan eat so much more fish and seafood from the time that they're young, in addition to other differences between people from Japan and people from Western countries, that the studies really possibly shouldn't be pooled at all. And once you start pooling studies that are not similar and populations that aren't similar, then you're no longer getting a more accurate result by doing the meta-analysis. You're probably just muddying the waters. And then when a meta-analysis gets reported, then people take it as like a super truth. Like, “Oh, there's 15 studies included in this meta-analysis. It has to be true.” It's not true. So it's very hard to detect those things, unfortunately, and you have to become familiar with the research to do that.
Ben: Yeah. So even these huge studies that come out that are studies of a whole bunch of studies, those are themselves flawed in many cases?
Kamal: Yeah. Now there's this sort of new thing called an “umbrella review”, which is a meta-analysis of meta-analyses. And it's crazy, 'cause on the one hand, there's only been one umbrella review on a nutrition thing, I think, and it was a vitamin D, and coincidentally it was by that guy John Ioannidis who did the study on 90% of medical findings being wrong. But he did this umbrella review of all the vitamin D outcomes because there's been so many different analyses, and his conclusion was that vitamin D is basically overhyped, that there's not as much solid research as you would think for vitamin D helping conditions. So on the one hand, I think it's cool that he did that study, and there are a lot of outcomes that vitamin D may or may not be type two that we just assume it is. But on the other hand the meta-analysis loses so much granularity of the individual studies that once you do a meta-analysis of meta-analyses, you're losing any granularity.
So like if a certain vitamin D study was done on post-menopausal women in Iowa, and then you pooled it together with this study of vitamin D in athletes, then you're already losing some granularity. But when you start pooling together different meta-analyses, then you're losing so much granularity that it's like, “why are you doing it in the first place?” Like should you do a meta-analysis of all micronutrients so that you can say that a multivitamin is either good or bad? No. ‘Cause a multivitamin is important because of the different micronutrients within it, not the fact that it's one pill. So, I don't know. I'm just ranting at this point, but I think it's just very hard to understand research by media headlines. So you have to get in…
Ben: One last quick question before I delve into asking you like some of the most proven supplements and stacks that you've found in this research that you've been doing, and that is like the whole idea behind abstracts. Like a lot of times, people will tweet in the abstract, and I do that sometimes. Like I'll place a post to an abstract, not a full article. Are there any cautionary steps that people should take when they're just reading the basic abstract, the basic summary of a study without actually delving into the details of the study itself. I mean is that dangerous to review an abstract, are there like red flags that you should look for? What do you do when it comes to reviewing an abstract? Or if somebody's listening in, what's the best way for them to get through an abstract that's looking at a supplement, or a diet, or an exercise program, or something like that?
Kamal: So when you look at an abstract, when I look at an abstract, Ben, if it's an issue that's really important to me, either for work, or for my personal health, or family's health, or something, I'll always look at the full text of the paper. If I can't look at the full text and there are certain things in the abstract that are red flags. So…
Ben: Right. ‘Cause a lot of times, you have to click and like pay a bunch of money for…
Kamal: Yeah. Exactly. So if you see an abstract where they conclude that the intervention, let's say vitamin D, helped, but in the abstract they just say that the vitamin D group had better outcomes than that baseline, so like the vitamin D group had improved blood pressure, or the vitamin D group had improved depression, that actually doesn't mean anything because the placebo group also could have had improved depression or improved blood pressure.
So really what it has to say explicitly is that vitamin D had a better improvement in blood pressure than the control group did. And that's the easiest trick in the book for researchers who are trying to get something published and of notoriety. Because the reason you have a control group, a placebo in the first place, is so that you can compare that to the intervention. So once you take the control group out of the equation and you start reporting on the intervention group only, then you're not really following science. ‘Cause I could have a sugar pill and I could say sugar pill XYZ improved bowel movements, and it improved bowel movements by 30%. And then let's say that the placebo group improved bowel movements by 28%. So the difference was not statistically significant, but they don't have to technically report that in the abstract.
So there's actually a lot of leeway in abstract writing and it depends on the journal. Even some high quality journals sometimes miss things. Like when I've written abstracts, I was always the low guy on the totem pole. So I would get vetoed. I would say, “Oh, here's my abstract.” And they'd be like, “Oh, we actually need to change these things.” And sometimes the change is to make the abstract better, but sometimes it's to make the abstract more catchy. So you have to watch out for those things. You never take a conclusion of the abstract as truth. You have to look at the results first.
Ben: Yeah. That's really good advice because a lot of times when I'm, let's say I'm reading like the Journal of Strength Conditioning Research, the abstract will definitely say one thing. And then when you dig into the article itself, the results are far less significant than the abstract may have seemed to imply. Or you find out like methodologies used in this study that they don't even talk about in the actual abstracts. For example, they might say something like “power training results in zero improvement in endurance running economy”. And in the abstract outlines, there was a power training group and a non-power training group and no difference between the two, but then you go in and you actually read the methodology, and the power training group was maybe doing one set of 20 box jumps three days a week, and it was nothing like an actual true plyometric or power program that would be used for improving running economy.
So a lot of times you really have to delve into the details, and I find that the abstracts can be a bit dangerous, especially if it's like that one-two combo of an abstract, and then what we are alluding to earlier, like a media news article that's reporting what the media says about the abstract. That's like the most potent, dangerous one-two combo in my opinion for fooling somebody into thinking that something is or is not true. Like the media report on Time Magazine website, or the Huffington Post, and then they click through to the actual study so it must be legitimate, and then all they get is the abstract, you don't read the full study and you wind up getting fooled.
Kamal: Yeah. You should always think about the motivations of the person giving you information. So if it's a media headline, then it's a media headline. It's something that they're using to sell advertising space or whatever. If it's somebody who's your friend, then they don't have devious schemes trying to trick you, so at least you can get rid of that. But if it's somebody you know who's high carb, or low carb, or whatever carb, and they forward you a study like you mentioned earlier about training and carb levels, then you really have to look at the abstract closely because, technically an abstract, in a perfect world, would say the strengths and weaknesses of the study right there. It would say, “we looked at high carb versus low carb diet for triathlon performance, and this is what we found.”
The strength of the study is that we had highly trained athletes which mimics the population that is reading this article, but the weakness of this is that we looked at 10 different outcomes. We looked at time to completion of the triathlon, we looked at perceived exertion, blah, blah, blah, blah, blah. Those outcomes are all correlated with each other. So if one is significant, there's a high chance that others will be too. So this is actually a flaw of the study. Or we had fifteen people and one dropped out, so we no longer reach the number of people we needed in the power of calculation. Those are all important things, but researchers do not have to put that stuff in the abstract. So you'll never find out what's wrong with the study, you'll only find out what's right with it.
Ben: Yeah. It's a rabbit hole that we could go down for a long time, but I want to delve into some of the fun stuff from your website. So let's start here, because I think that this might be surprising to folks. When it comes to supplements, there's a ton out there, obviously, so I'll cut straight to the chase. What are the top three most proven efficacious supplements in terms of general applicability for just about everyone that you think everyone could benefit from based on the research that you guys have done over there at Examine?
Kamal: So I think there's probably only one that everybody could benefit from, which is vitamin D. And that's because I try not to think of supplements as a category. ‘Cause basically when we research supplements, there's things that you supplement onto your diet because they're missing from your diet or lifestyle, like vitamin D, and then there's things that are like, I don't have a good term for this, at a talk at a conference, I said compliments 'cause I was trying to think back to like algebra, or trigonometry, or whatever in middle school. When you compliment an angle then you're completing it or something. I don't know. But a supplement is something that you're supplementing on to what you already have. A compliment, to me, is sort of like a treatment for something, or prevention, or something you tack on.
So vitamin D is a supplement and it's a common supplement because the sun is just such an important thing. And if you don't get sun, we're designed around the sun. So you have to at least supplement part of the benefit you get from the sun. It's only part of it because you can't take vitamin D and all of a sudden you're happy because being in the sun means you're probably more social, you're getting fresh air, there's nitric oxide synthesis, higher endorphin levels, and whatnot. So you're like outsourcing part of the benefit in the form of a vitamin D pill. But there is nothing else that is really a supplement that everybody could benefit from because other than not being outside, people differ for a lot of reasons. So like vitamin C, or vitamin K-2, or certain minerals can be helpful for large chunks of the population, but not for everybody. And for most things, except for I guess K-2, there is some chance of harm. So that's why there's nothing that I recommend to everybody.
Ben: Okay. Got it. Now here's what comes to mind for me though. When you say like vitamin D, well, two things come to mind. First of all, it seems like you get down a slippery slope because when you say, “Oh, vitamin D would be the most recommended supplement that I would encourage everyone to take,” then you run into the fact that in nature, you very rarely, aside from exposure to sunlight, I suppose, find isolated forms of vitamin D. Usually it's delivered along with, for example in liver, vitamin A, and vitamin E, and vitamin K to prevent calcification from excessive vitamin D intake, or when you look at eggs, or the oils from fish, in many cases, it's accompanied by a host of other fat soluble vitamins. So when you look at all the research behind vitamin D, can you tell us, one, if you were going to take one supplement, just take vitamin D? Or do you get concerned about people getting like calcification or something like that if you were to tell them to just take vitamin D?
Kamal: So, I actually don't recommend any supplements when people ask me personally. So on our website, we never use the word recommend on purpose because, like our stance is that you look at what you eat, you look at your lifestyle, and then you maybe try something as an adjunct, and see if it helps. But when people ask me, or there's been a few times when I've worked in clinical situations, so there is a doctor I worked with in San Francisco who does a quantified self-tracking program for his patients, and around half his patients are former addicts, either of hard drugs or other things, and then half for kind of metabolic disease, former heart attack sort of patients, and we didn't recommend any supplements.
So we always started with a very simple self-tracking of just like how did you feel that day, and like how hard did you try to be healthy. And then we did that kind of stuff for a super, super long time, kind of like people who are really into weight lifting, probably at some point in the past 5, or 10, or 15 years have gone back to the basics with either the bar, or the broomstick, or whatever, and wrote down their squat form until they got it exactly right. And we would do that kind of thing with diet and lifestyle before we ever thought about taking the supplement because, like you said, vitamin D is not something that everybody needs to take, and I don't take vitamin D. I tell my girlfriend she should take vitamin D just because she doesn't get outside much, and we live near the beach in San Francisco and it's always foggy. But for anybody who can get enough time outside in the sun, I would never recommend vitamin D. So…
Ben: But perhaps I should rephrase that question then. When I say the most recommended supplements, let me put it this way: what are the most researched supplements when you look at, for example, examine? Like the supplements that you think have the most references behind them, and then the goals may differ. It might be references for athleticism, it might be references for general health, or cognitive performance, but what would be like the three top most researched supplements that you have reams of data on at Examine that appear to be like the darlings of the supplement industry when it comes to things that actually do have a lot of studies behind them?
Kamal: So, this is easier to answer. So creatine is probably one of them. And the reason is simple. It's just because creatine has a fairly high chance of working, working and “providing some increase and some outcome”. And that's pretty simple because creatine is a very basic molecule that isn't hard to understand why it would have it's effects, and there's been a lot of research on both creatine benefits, and on various forms of creatine that basically never work as well as creatine monohydrate. So creatine, let's say every supplement has between a zero and a 100% chance of helping a given person. Creatine has a higher chance than most supplements. So that's one of the most research supplements.
Ben: And by the way, if I could throw it in there, a lot of people think creatine, I used to be under this impression, is just for like football players, and bodybuilders, and strength, and power athletes, but it actually has a lot of really cool neuroprotective and cardio protective properties. Like I recommend to do just about everybody, and especially vegans and vegetarians, to take around 5 grams of creatine a day.
Kamal: Yeah. So we actually recently, or like a year ago, covered a creatine study for depression, and it was the first study showing that creatine helped major depression. And I won't get into the methodology pros and cons, but those are important, but it was cool because mechanistically, it makes sense. So there's a couple ways that creatine can help the brain, and one is that in neural pathways in the brain, the brain, like all organs, tries to be efficient in its set up. We store energy as fat because it's efficient, it's a lot of calories per gram. That's why we're not like huge bags of glycogen, 'cause then we'd be like extremely voluminous. But the brain also tries to be efficient, so it's mostly short connections and then connections between those connections, but there are some longer connections, wider connections. So if the brain is a bunch of streets, then these connections would be like major freeways or highways, and those are called rich club connections. So creatine could increase the prevalence of those rich club connections. So it makes sense that creatine could help major depression.
So this isn't like I'm feeling sad, or I'm taking an SSRI sometimes, but this is major depression where you're thinking, “Either I get electroconvulsive therapy or I try some crazy thing like a ketamine infusion or something.” Creatine could help that kind of thing, and that's where kind of my faith in supplements is restored. Because there's a lot of crap out there, but if something as simple as creatine could help, or something as simple as a ketogenic diet for epilepsy or whatever, then it's all worth it because that research does do something.
Ben: Yeah. And that's what I like about the site too is I can and go a look at whether or not that fancy expensive brand of creatine that is advertised at bodybuilding.com, for example, or T-Nation has any benefits over and above, say like, a creatine monohydrate or something along those lines. So it's useful in that way. And the other thing, of course, is you have a couple of other supplements I've noticed on your most researched supplements line. It appears to be fish oil and marijuana as the next two most researched supplements.
Kamal: Yeah. So fish oil is interesting because if anybody's ever looked into the history of fish oil, fish oil as a trend is almost brand new. So fish oil used to be a waste product and then it was used as like maybe like fuel for lamps or something. And then fast forward a while, and directly as a product of demonizing fat, and then transitioning to, “Oh, maybe a little bit of polyunsaturated fats, mostly omega-3, is good,” and then some early studies about fish oil possibly being useful for some cholesterol outcomes. Fish oil exploded. Within the span of five years, probably in the late 90's or so, fish oil went from zero to a hundred miles an hour, and then that's right around when Pfizer and some other companies started researching fish oil as a pharmaceutical. So probably most listeners know that that's a scam.
So LOVAZA as a fish oil pill is a scam. There's never going to be a trial of LOVAZA versus the fish oil from Costco because it'll be exactly the same. The difference is that the fish oil from Costco will cost 200 bucks for a year's supply, and LOVAZA is like 1,600 bucks or something. So it's draining money from our health care system to make fish oil into a pharmaceutical. There is a pharmaceutical that's mostly EPA that's coming out, that could be better for certain cardiovascular intermediaries. But the reason people get heart attacks is not because they're missing fish oil in their diet. So fish oil is highly researched because there is money to be made from it and because it's something that easily gotten from fish. But it's not one of the most useful supplements.
Ben: Interesting. So even though there's reams and reams of research behind it, that doesn't necessarily mean that the research has shown it to be extremely efficacious?
Kamal: Yeah. As far as like if you were to make a quotient of a mountain of research over usefulness, then I think fish oil would be close to number one on there.
Ben: Okay. Interesting. I did note that one of the things that seemed to be beneficial for fish oil, in terms of your guys' is kind of like summary of it, is that it appears to be most beneficial for decreasing triglycerides, which I know are an independent risk factor for heart disease. I, for example, work with WellnessFX. Every Thursday, I'm poring over people's blood results with them for four to six hours. That's my block of time to do my WellnessFX consults, and a lot of people have extremely high triglycerides and very low HDL, which is that triglyceride to HDL ratio is a risk factor for heart disease. So in that case, I often make the recommendation for something like fish oil to decrease high triglyceride levels.
Kamal: Yeah. So this is where it starts getting a little bit more subtle. So for things like fish oil and even for statins, so they're not in the same category, but some doctors basically think that statins should be in the water supply. And then some more progressive doctors think that stantins are extremely overused and shouldn't be used by anybody, and have more side effects than benefits. Then the truth is probably somewhere in the middle, and the same is true for fish oil.
So if you have a history of heart disease, if your triglycerides are very high, if you're not eating a great diet and you're not likely to eat a great diet for the foreseeable future, and some other factors, then fish oil is not a bad idea as long as you're not making a ton of it. But fish oil is not something that everybody would take. So it's very similar to statins, because if you're a 70-year old man who's had a heart attack, then the decision to take a statin is very different than a 40-year old man who hasn't had a heart attack, even if your cholesterol numbers aren't very good. So fish oil is neither bad nor good, it's a complex story somewhere in the middle. And unfortunately, that's true with almost every supplement. There's very few that's not the case with and is usually sort of either things extracted from food, or foods themselves. So…
Ben: Right, right. And admittedly, I take a fish oil every day. I've seen some of the other research that shows that it could decrease the risk of diabetes, which I, by the way, have a five times higher than normal risk for based on my genetic testing, and it also significantly decreases risk of a lot of different forms of cancer, and plaque build-up. And so I take it, I suspect that a lot of the research potentially is not all using like good non-oxidized, non-rancid forms of fish oil. So I use fish oil. I really do. I use fish oil, creatine, and a multivitamin. Like those are three things that I take just about every day. And…
Kamal: Yeah. I think that's probably a pretty safe group of supplements to take. And like you said, fish oil quality is important. We don't do specific brand names, but if you do take fish oil, if you're questioning the oxidation, or heavy metals, or whatever, then there is a database, IFOS, International Fish Oil Standards, that does voluntary testing of most of the major brands. So…
Ben: Okay. Gotcha.
Kamal: It's always good, I'm sure you're taking good fish oil 'cause you know a lot about supplements but for some listeners, it's probably good to look at that kind of website.
Ben: Yeah. The fish oil I take, it is, again, admittedly, expensive. But, yeah. What I tell people is taking a bad fish oil is much worse than not taking fish oil at all.
Kamal: The one thing I was going to say about fish oil is that everybody has a complex history, so it's always good to either hire somebody who's really smart and knowledgeable, or have a friend who is, or try to find a primary care doctor that is because, like you said, you've had genetic testing done, you looked into research about fish oil and different outcomes, not everybody does that. So like my family is full of thin diabetics. My mom weighs 105 pounds and she's a type-2 diabetic. My grandma is the same, my uncle. I have a high chance for diabetes, so I look into supplements that somebody else wouldn't look into. My family is also vegetarian. So I grew up not eating a lot of meat, except for the pepperoni on my pizza at school and that kind of thing.
So, as I got more into ancestral health and thinking outside of just studies, and I started thinking like “am I different than the people that are being looked at in that this research” because I'm from a region of the world, northwest India that has probably been vegetarian for longer than almost any other place on Earth, several hundred years. So, is my iron metabolism different? My fatty acid metabolism, is that different?
We covered a study a year ago about how people from northern Africa and southern Asia have different fatty acid metabolism because they ate higher plant diets. So in order to convert smaller chain fats to longer chain fats, you had to have a different mechanism for that in your body. So there was a selective advantage to produce a different longer chain fats from plants. So now that could be a disadvantage, it could be a reason why some regions in India have higher incidence of heart disease because we're making more harmful long chain fats. So I think about these kind of things, and about how some research could inform me and some research couldn't, but I know that not everybody has a job like I do where I have to read papers. So outsource it to somebody. Find reputable people, websites, people who are interested in yourself and become friends with them because it's the best thing you can do for your health.
Ben: Gotcha. Now when it comes to supplements, are there any supplements out there that you think people are very infatuated with, or the media, or researchers are quite infatuated with that have very low credibility? Like is there one supplement that you think a lot of people are taking that has very, very little research behind it? Whether it's something that the athletic population is using, pre-workout, or some kind of recovery supplement, or something that you just know is pretty much across the board, something that has very little research, or is even potentially damaging?
Kamal: So for the general public, drive boosters or testosterone boosters are, there's not a lot of research for most of them, or almost all of them. But I would think that your audience is pretty in tune with that, like not taking a bunch of random supplements because they think they might boost their testosterone…
Ben: Actually, you know what? I think a lot of my audience, they're poppin' a lot of pills. I've seen the e-mails come in. Like some folks are taking like 30 different pills in the morning.
Kamal: So testosterone and then, the two major categories are testosterone boosters and fat loss supplements. So there are things that could help, but there's just so much bad research compared to the good research. But less obvious than that I'd say is probiotic research. So there's a ton of probiotic research, and probiotics have been shown to be helpful for certain things, but I can't count the number of ways that it's been misleading.
So if you take a step back from probiotics, even the way that people throw around the term like, “Oh, try probiotics.” What does that even mean? Because you don't say, “Oh, why don't you try food for your diabetes?” ‘Cause probiotics are different species of bacteria. They're not at all similar to each other. So you don't recommend that, “Oh, hey. Go ahead and eat food for that,” because plants are different than animals, and fruit are different than vegetables, and different fruits are different than other fruits. If you have some gut issues, then some vegetables and some fruits could maybe increase histamine problems and some could help with them. So similarly, some bacteria can help with their issues and some can harm you.
So that's why for probiotics, I think you really have to look into the research, and research is extremely overhyped. Plus, people rarely think about dosages much. They only think of dosages in terms of the more the better, like, “Oh, 10 billion units, or 20 billion is better than 10,” but you already have a complex ecosystem of bacteria and other organisms in your gut, so you don't necessarily want to throw in a ton of stuff in there right away. So if you have a sensitive gut, if you have IBS, especially if you have Crohn's or ulcerative colitis, it's probably smarter to do something like either take the capsule apart and start with a microdose, and then increase it over time, or start with like a little bit of sauerkraut juice or something because you don't necessarily want to interrupt what's going on in your gut.
Like if you got a colonoscopy, sometimes a colonoscopy will help with your symptoms because you're washing out good bacteria. But it's a double-edged sword because once you start eating crappy again, then there's like a vacuum and nature abhors a vacuum. So once there's a vacuum in your gut, then you can get a huge buildup of bad bacteria very quickly. So similarly, you don't want to necessarily interrupt what's already going on in your gut, so I think it's good to think about the probiotics that you're taking and not just start with a ton of them all at once.
Ben: That's really good advice because a lot of people really will think that probiotics, not only more are better, but that using the widest variety and array of probiotics is important. And again, I think it comes down to testing, right? We were talking about genetics, and diabetes, and fish oil. You can also get a gut biome test, or you can get the the three day poop panel. It's my favorite where you poop in a little hot dog tray and send it off with a prepaid FedEx label, and you can find out which specific bacteria you're deficient in, which you're high in, which you're low in, and supplement accordingly rather than just painting with a broad brush.
I also wanted to point out the fact that, for example, at Examine's website, you guys have, you mentioned testosterone boosters, you have, for example, I see one page on here where you do list four things that actually do have decent research behind them for testosterone. You've got DHEA on here, vitamin D, zinc, and fenugreek as four things that actually can help with testosterone. And so, that's actually what I like about the site and some your stat guides is, rather than me like taking some testosterone supplement that's got like 18 different ingredients in it that purportedly assist with testosterone levels, I could just go and pop the few things that actually have research behind them, the things that you guys would call like a “stack” that actually has good research.
That leads me to another question that I wanted to ask you, and that is regarding stacks. Now you have this this enormous stack guide that you guys have produced, and I own it, I'll put a link to it, and all this stuff, again in the show notes, if you go to bengreenfieldfitness.com/examinepodcast. And you list a whole bunch of stacks. Everything from cognitive performance, to enhancing testosterone, to fighting inflammation, et cetera. But for you personally, what would you say, for the folks listening in, when it comes to stacking supplements, putting a bunch of supplements together at once. What would you say is the most beneficial stack that you've come across, or one that you use daily, or the stack that you like the best when it comes to general applicability to folks?
Kamal: So the thing that's probably most applicable to the highest percentage of people is caffeine-related stacks. So, do you drink coffee?
Ben: I do. I have since I was 13 years old. My dad was a gourmet coffee roaster growing up, so I have dumped copious amounts of coffee into my body from a young age.
Kamal: So, I guess I'm the inverse of you 'cause I had one cup when I was 11 or so, and I've never had coffee since then. And I don't know if it's because I'm a super taster, or just, I'm also as a slow caffeine metabolizer, but the thing that I see most often is, supplement-wise, is caffeine. Because people drink coffee a lot, they often don't think twice about it, whether it's benefits or detriments. So caffeine-related things are very important. When people ask me for advice on stuff, I always say look at the things that are most prevalent in your life.
So people drink coffee a lot, people are in bed a lot, people sit at their desk a lot. So because of those things, caffeine-related to stuff is going to be important, the type of bed you sleep on and your light exposure before bed's going to be important, and your posture, or lack thereof, while working at a cubicle or at your desk is important. And if you can take care of those things, that's like 80, 90% of it. So with caffeine, people will drink caffeine, and be jittery, and not think twice about it. They're just like, “Oh, I didn't get a lot of sleep, so I drank an extract of a cup of coffee, and now I can't function at work, and I'm just on Facebook all day because my mind is racing.”
So caffeine and l-theanine is the most basic stack that applies to the most people. L-theanine is found in green tea, but it's also isolated. So you can take it as a supplement. But for a decent chunk of people, l-theanine counteracts that jitteriness. So you still get some focus from caffeine, but you can think logically and you can function basically. So I think that's probably the most useful stack for most people.
Ben: So it's caffeine, theanine, and what?
Kamal: It's just caffeine and l-theanine. There are others that you could add in…
Ben: Okay. So just caffeine and theanine?
Kamal: Yeah. But that's the most basic, I'd say. And then I guess if you're not looking to like what's happening that day, if you're looking for health I guess, this isn't technically a stack, but nitrate containing vegetables, I think it's good to, I guess, stack them together. So if you have history of heart disease, or family history, or high triglycerides, whatever, the most basic thing you can do is to regularly eat vegetables that contain nitrates. And the reason is that nitrates are good for heart health because they increase dilation in blood vessels, and it's also good for performance as well. Nitrates, or beet juice, or whatever before a workout is usually fairly effective, but nitrates have a fairly short half-life.
So in order to get benefits from the nitrates throughout the day, it's good to eat vegetables, like maybe twice or even three times throughout the day, especially if you have some heart health issues. Then you're getting the benefit stretched out for longer. So find vegetables that are higher in nitrates, pick out two or three that taste good to you, and buy them at the grocery store a lot. So that's not really a stack, but if you find two or three that you like, make it a staple.
Ben: That's actually really good advice. I don't think anybody has brought up before on the show to spread your vegetable intake throughout the day, specifically so you get the advantages of nitrate. I like that.
Kamal: Yeah. There's some spread out supplements, or spread out foods that people don't think of. Have you ever megadosed vitamin C?
Ben: I have. Yeah. I actually did that last week when I came back from, you can hear I'm slightly congested. Still I got hypothermic while spearfishing in Costa Rica and came back with a bit of a cold, and so I took quite a bit of vitamin D, echinacea, elderberry, and oregano. That was my stack.
Kamal: Okay. That's a pretty solid cold stack, I'd say. So I guess you must be up on the research, but vitamin C is…
Ben: Well, I have the Examine.com Supplement Stack Guide here on my desktop.
Kamal: I know. Not to humble brag, but you must be looking at a good website. So vitamin C is another thing where, and I'm just going to keep repeating this over and over again until it sinks in with everybody, no supplement is inherently good or bad. So always look at the pros and the cons. And also I try to look into things that I don't know a lot about. So like at the library I used to go to, there was this big painting of some ancient physician, and it was a quote, “Teach thy tongue to say ‘I do not know' and thou shall prosper.” So I try to really take it to heart now and look into things that I don't know about. ‘Cause everybody has their pet issues, but I want to know about things that I don't know. So like with vitamin C, when I first got into nutrition when I was 18 or 19 and I was like, “Vitamin C is so good.” Linus Pauling and all this stuff.
And then I looked into the research and I was like, “Oh. Vitamin C is so overrated.” And then now it's sort of in between. ‘Cause the more I looked into the research and the more I looked into clinical experiences, the more I found that people who are often taking like 5 grams of vitamin C at once, and they're like, “Oh, it's just diarrhea, and I don't feel better, and I hate vitamin C.” But the bioavailability of vitamin C is such that basically after 500 milligrams, every time you double the dose, the bioavailability goes down by more than half. So that means that 1 gram won't produce diarrhea in most people. 2 grams, possibly not as well. 4 grams, yes.
So when physicians used to, there is things like vitamin C, iodine, some other nutrients, were used back in the day, like our great grandparents and such, well not great grandparents 'cause they didn't really even know vitamins existed, but our grandparents. They would say, “Oh, if you're sick then iodine or vitamin C could be the thing that helps,” and that's because a lot of people don't eat a lot of seafood or sea vegetables, and iodine is critical for a lot of things. Vitamin C, you need more vitamin C in times of stress. So if you take vitamin C in a rational protocol, like 1,000 milligrams, and if you can tolerate that, then 2,000. And then if you can tolerate that, 2,000 every two or three hours, then I think taking it in times of stress, or before a high stress event, like if you're doing an ultra-marathon, or I don't know about that 'cause there's the whole like adaptation with antioxidants…
Ben: Right. Blood doing a hormetic response.
Kamal: But it you're going to be stressed out, let's say, what's not physically stressful? A chess tournament. Then megadosing on vitamin C could be a good thing, and it really depends on spreading it out. And then there's other times people don't think about dosages, like there isn't any research right now on optimal times to take vitamin D. Like there used to be this anecdote, “Oh, if I take vitamin D at night, then I can't fall asleep, and it must be because people usually get sun exposure in the daylight hours.” Well, that doesn't really make sense because when you take vitamin D, it's not like it's used right away. It's a different pathway than when it gets synthesized through the skin. So researchers don't really know if there is bad or good times to take vitamin D. Researchers don't really know like if you can wash vitamin D off your skin with soap.
So there's things that people don't know about protocols that could be really important. So just because you take a supplement and it doesn't have an effect doesn't necessarily mean it won't have an effect. Look at different dosing schedules at different doses, like with probiotics, think about what you're taking up with. Like vitamin D, everybody knows that it's fat soluble, but vitamin D isn't actually absorbed that well if you take it with a lot of fat. It's absorbed much better if you take it with a small amount of fat. So if you take it with no fat, it's not absorbed well. If you take it with like half a stick of butter, it's not absorbed well. But if you take it with a little bit of fat, it is absorbed well. So there's just a lot of intricacies that you have to think about before saying a supplement works or doesn't work.
Ben: Yeah. And that's why I appreciate you guys do on the website because I can't tell you how many times during the week I'll simply visit the stack guide, or the supplement goals reference guide on my desktop, and pull up the PDF, go through it. And when somebody asks me a question, I can actually delve into research that is produced by someone who's not selling supplements, which to me is quite valuable.
And for those of you listening in, basically there's three things that I get from Examine that, in full disclosure, I have purchased each of these. Their stack guide which is a whole, I think there's 17 different guides in that stack guide, but it's like step-by-step directions for stacks like Kamal just went into, caffeine and l-theanine, how much to take, how often you'd take that, in which dose, with or without food, et cetera.
Then they have their supplement goals reference guide, it's big, but it's not meant to be read cover to cover. Like when you have a question about a supplement, or when one of your friends says, “Hey, I'm taking the newest form of beta-alanine in some type of extreme lipophylic deliverability system,” you can go into the supplement goals reference guide and see over 5,000 human studies and look at 400, or actually more than 400, different health goals that something like that may or may not be applicable, whether it be testosterone, or power, or strength, or pooping better, or whatever.
And then they've also got their Examiner Research Digest, which, that's how I led into this podcast. One of the things I'm big into are digests, or newsletters, or ways that I can cut through information quickly, ways that I can more or less biohack my digestion of copious amounts of research. And the Examine Research Digest, it's very straightforward. It's six new studies you get into your inbox, they're analyzed every month. They're on audio, so you can listen to 'em, or they're in PDF, so you can read them. And they're also printable. So that's a good way to stay on top of the latest research, and it is something that the lay population can consume. You don't have to be a propeller hat-wearing nerd, or a lab coat-donning researcher to get benefit out of that one.
So I'll put links to each of those in the show notes over at bengreenfieldfitness.com/examinepodcast, where I'll also put links to a lot of the things that Kamal and I talked about, like the IFOS website for testing fish oil, the ugly web site I mentioned that has good research on sleep, caffeine-theanine blends, the gut panel for testing bacterial balance. I'll put as much as I can on there for you guys to access, and then of course leave your comments, leave your questions. And if you really dig this episode, leave a review over in iTunes.
Kamal, thanks for coming on and sharing all this stuff with us. I love what you're doing, and I'm just super-duper stoked that I could get you on the call today and dig into your mind a bit.
Kamal: It's my pleasure. It's always good to talk shop with somebody who knows stuff.
Ben: Awesome. Well, folks, if you're listening in, I'm Ben Greenfield along with Kamal Patel signing out from bengreenfieldfitness.com. And again, bengreenfieldfitness.com/examinepodcast is where the show notes reside. Have a healthy week!
You’ve been listening to the Ben Greenfield Fitness Podcast. Go to bengreenfieldfitness.com for even more cutting edge fitness and performance advice.
I’m a voracious consumer of knowledge.
On an average week, I read 3-5 books, listen to 15-20 podcasts, and read several dozen research articles.
And one of my secrets to this hyperproductive digestion of information is through the use of services, websites, journals, newsletters and, well, “digests” that disseminate information into readily accessible bite-size pieces that allow me to cut through the clutter and quickly get to the main summaries, takeaways and actionable items from all the content.
In addition, I stay up to date with health, medical and science news via the Stone Hearth Newsletters, exercise and nutrition research via the website Suppversity, and, for general life knowledge, I’m a recent subscriber to the Farnham Street blog for staying up-to-date with the best recently published books and articles from around the web.
And – for one of the most comprehensive exercise, diet, supplement resources I have ever accessed – I am a frequent visitor to the website Examine and their monthly publication The Examine Research Digest, which is produced by today’s podcast guest: Kamal Patel.
Kamal is the director of Examine.com, an independent and unbiased encyclopedia on supplementation and nutrition. He is a nutrition researcher with an MPH and MBA from Johns Hopkins University, and is on hiatus from a PhD in nutrition, in which he researched the link between diet and chronic pain. He has published peer-reviewed articles on vitamin D and calcium as well as a variety of clinical research topics, and in today’s episode, you’ll discover:
-How supplement companies and the media manipulate science for their own benefits…[11:38 & 16:30]
-Why Kamal thinks the “elimination diet” for nightshades is a hoax…[18:55]
-The best way to know if a diet or supplement website is delivering you fake information…[29:35]
-The truth about what they really feed lab rats and mice in high-fat diet studies…[31:35]
-Why an extremely high percentage of the research released in medical journals is flawed or biased…[35:00]
-The best way to quickly review an abstract without reading a full article, and red flags to look out for when reading an abstract…[44:50 & 48:30]
-The top three most proven and researched supplements that just about everyone could benefit from…[54:56]
-The surprising benefits of daily creatine intake…[61:50]
-Why Kamal doesn’t take fish oil, but Ben does, and how genetics should influence supplement intake…[65:35 & 68:35]
-The two supplements most people most infatuated with that Kamal thinks have very low credibility…[72:15]
-The most beneficial one-two combo stack you can take for daily mental performance…[77:45]
-Why you should spread your vegetable intake throughout the day to maximize your nitrate exposure…[80:48]
-And much more!
Resources from this episode: