Micronutrient Blood Test Results Explained | Dr. Joel Fuhrman & Mike Haney
In a recent episode of A Whole New Level, Levels editorial director Mike Haney sits down with Dr. Joel Fuhrman, board-certified family physician, seven-time New York Times bestselling author, and one of the most prominent advocates for nutritional medicine in the United States. A former world-class figure skater who went to the University of Pennsylvania School of Medicine with the specific intent of specializing in nutrition, Fuhrman has spent decades studying and teaching how diet can prevent and reverse chronic disease — from heart disease and diabetes to autoimmune conditions and cancer.
The conversation covers the surprising consistency underneath the apparent confusion of nutritional science, why micronutrients — not macronutrients — are the real lever for longevity, how to actually read blood tests for nutrients like vitamin D, Omega-3, B12, homocysteine, and ferritin, which supplements are valuable versus which may be actively harmful, and why body fat percentage may be the most important health marker of all.
"We can push the envelope of human longevity to live 20 years longer than the average American lives, and we can beat out the blue zones by a mile, because modern nutritional science has given us this unprecedented opportunity in human history to eat better and healthier than ever before." — Dr. Joel Fuhrman
A physician who went to medical school to practice nutrition
Mike Haney: I'm going to start by just setting up a little bit what we're doing here. We're doing a series of shows around the idea of blood testing as a way to figure out how healthy you are, and we're looking at a bunch of different sets of markers that you might have. And the focus today is nutrients — blood testing for nutrients.
But we want to talk more broadly about the role that nutrients play in your health, and then a little bit on how blood testing can or cannot, depending on the nutrient, tell you something about how that nutrient is interacting with your health and just how to make sense of, if you find yourself getting a blood test that includes nutrients, how to make sense of the results that you're getting back.
I can't think of anybody better to talk to than you about this, because you're one of the most public advocates for nutrients and nutrient density, and caring about nutrients in what you eat. So I thought maybe we'd just start with a little bit of background. You're a family physician, you're a seven-time bestselling, New York Times-bestselling author. Tell me a little bit about your journey up through medicine and how you came to focus on nutrients, how you came to this specialty or this area of focus that you've spent so much of your life on.
Dr. Joel Fuhrman: Well, believe it or not, I actually went to medical school with a specific intent of being a physician, specialize in nutritional medicine.
Mike Haney: Interesting.
Dr. Joel Fuhrman: Because back in the 1980s, 1970s, I was on the world figure skating team, and I was eating healthfully to improve my stamina so I wouldn't get sick competing internationally, like Novak Djokovic, the tennis player. Improved his diet so he'd have better stamina in the long matches of the tennis courts, long matches that went on and on and on.
And so, a lot of top athletes eat healthfully for better performance and the anti-aging effects to maintain their careers. I was into all this stuff, reading about nutrition and trying to eat an excellent diet when I was young.
Then I became familiar with natural hygiene, a group of physicians, and a group and a thought process that said, you are what you eat, and people don't have to have heart attacks. You don't have to have strokes if you eat an excellent diet. These are not the natural consequence of aging, and heart disease still is the number one cause of death, cardiovascular death, in the country today. And even cancer can be largely prevented.
And the same dietary portfolio that slows aging, prevents cancer, heart disease, and extends human lifespan can be utilized therapeutically to help people reverse disease and get rid of their asthma and get rid of their rheumatoid arthritis and get rid of their multiple sclerosis and get rid of their chronic headaches and get rid of their fatigue.
So I became like a hobby and interest in nutritional science, and I did so much reading and investment in that field that I said, "You know what? I'm going to go back to medical school." And I went to University of Pennsylvania School of Medicine and became a board-certified family physician to get the conventional certification and credentials, and then be able to treat people in that niche, for people who want more nutritional information, education to not just cover up an illness with drugs.
They give people a high blood pressure medication and while they still have high blood pressure, just pushing it down with a drug, but get rid of it so they don't need drugs. Not just give diabetic medications, lower the blood glucose, but have them so they're not diabetic anymore, so they don't need medication. Because you don't get protected against premature death from taking drugs like high blood pressure medications, cholesterol medications, and diabetic medications.
You live longer because you don't need medications, because you're not diabetic, you don't have high blood pressure. You don't need drugs to lower your cholesterol, because your cholesterol's normal from eating right, and because your body fat's low. There's no such thing as a healthy overweight person. The point I'm making right now is that nutritional excellence is a thousand times more powerful than conventional medical care to enable people to live a healthy, happy, and disease-free life.
It really is truly protective and can be used therapeutically to reverse disease. I went to medical school to focus on that as a career. I didn't become a regular doctor and then switched. I had the whole intent from the very beginning to do it this way. And I've been very blessed and lucky to have the opportunities I've had to speak to millions of people, to have years of television shows on public television where I've been on television for thousands of hours.
I've raised over $70 million for public television with my shows on PBS TV.
Mike Haney: Wow.
Dr. Joel Fuhrman: So my shows have been seen by millions and millions of people, and that's how I've had bestselling books on nutrition and longevity because many millions of people have bought my books. I've been very lucky to have the opportunity to have a lot of people change their life for the better because of my work, my dedication to this field.
Mike Haney: Right. It's a really interesting path. I mean, medical schools are sort of famous for not teaching nutrition very well, I think. Even today, we hear that from doctors that we work with and folks just coming out of medical school. So tell me about that intersection of somebody who came in with that nutritional focus and you encounter traditional medical school education. How did you find it? Was there enough there for you or did you have to continue learning on your own and figure out how to marry that traditional perspective with a more nutrition-forward approach?
Dr. Joel Fuhrman: Well, believe it or not, I enjoyed medical school. I felt the foundation of what I learned there, if anything, supported everything I want to do.
Mike Haney: Interesting.
Dr. Joel Fuhrman: Because it wasn't contradictory. It was contradictory with the conventional medicine. Because they taught you the first thing in medical school, the first week they said, "Drugs are toxic and they put poisons into the body that shorten people's lifespan and people should live in a manner to avoid the need for medicinal substances whenever possible."
And they run, this is how the drug works by blocking or interfering with a natural body process. We went all over how the longevity of cells is related to the nutrient concentration and diversity of cells and the level of toxicity in the cell, or metabolic waste products.
Because we have both cells that are exposed to internally created wastes that our own body makes. Those are called endogenous wastes. And then the exogenous waste from the external environment on top of that. And the high nutrient levels in the cells, particularly of phytochemicals, phytonutrients, and antioxidants, enables the cell to keep itself clean, remove toxins, carcinogenic substances, repair the DNA.
I learned the basic biology and biochemistry and physiology of the human body in medical school to enhance my work in the nutritional field, even though it didn't directly talk about nutrition with any training. I, of course, supplemented that with my hours and hours of dedication, reading more than 50,000 scientific journal articles on nutrition and longevity and health.
I spent my life poring through research articles and becoming an expert in this body of knowledge and combining the two, conventional medical education with nutritional science research. I'm also the president of the Nutritional Research Foundation. In medical school, believe it or not, they made me chairperson of the Nutritional Education Committee at University of Pennsylvania School of Medicine.
Mike Haney: Wow.
Dr. Joel Fuhrman: And I was on the admission committee there too. I interviewed people to come to the medical school. I even spoke about nutrition to my medical students.
Mike Haney: Oh wow.
Dr. Joel Fuhrman: The school had very good lecturers. They were entertaining and experienced. So I'd be walking to my chair to sit down and I'd see people who were younger than me taking their chips or cookies and hiding it behind their back, moving their junk food away. And I'd say, "I'm not your mother. You can eat whatever you want. I'm not looking at you or inspecting what you're doing."
But I had a lot of my contemporaries that I went to medical school with who were very grateful and kept in contact with me on how much I affected their career and their personal health and their personal medical careers when they left medical school too, because they knew me as a friend and we talked about this a lot.
Why nutritional science isn't actually as confusing as it seems
Mike Haney: Over this career, focusing on this, what have you learned? What do you know now that you didn't know back then? What's emerged for you or what have you learned through the practice of implementing some of these things that you were thinking about and learning and reading about back then, as you were a student, with now decades of working with actual people?
Dr. Joel Fuhrman: Right. A hundred different things. I mean, I could start anywhere, but there's a lot more science available today that gives us the biological explanation of why it works. You know what I mean? So that's really what we know. We can give a lecture and give so much science, we can show so much research articles. We have a lot more information today than just the empirical evidence of what seemed to work before. We knew mushrooms were really healthy for people.
Mike Haney: Right.
Dr. Joel Fuhrman: We knew they even helped people live longer. We knew that. But now we know, actually, that onions and mushrooms have various connection with the actual, the way the cell works — there's actually a nutrient in mushrooms called ergothioneine that binds to the cell wall, that then connects, that stabilizes the DNA, imprints the DNA of a cell from aging, let's say. So we have this connection with mushrooms. The human body does, that we're built to actually accept the nutrients in mushrooms and utilize them.
And the same thing with green vegetables. Our bodies are, you should say, green vegetable-dependent animals or isothiocyanate-dependent — ITC-dependent. It's really fascinating how these ITCs, or isothiocyanates, are probably the most anti-cancer, longevity-promoting compound in vegetables, and they're found in green cruciferous vegetables.
But how much broccoli and cabbage and Brussels sprouts and arugula and greens you eat doesn't necessarily give you the protection. It's the blood level of isothiocyanate, it's the urinary isothiocyanate that's related to the high degree of protection. And I'll tell you why, it's kind of interesting. Because the ITCs are formed in the mouth. They're not in the vegetable. They're formed in the mouth as you chew open the cell wall.
Mike Haney: Right.
Dr. Joel Fuhrman: And as you chew open the cell wall, there's an enzyme called myrosinase that breaks down and catalyzes the reaction in your mouth and mixes with bacteria in your teeth and forms more nitric oxide. But you produce the ITCs in your mouth, proportional to how well you chew. Now, the myrosinase enzyme is heat sensitive. So if you overcook the broccoli, boil it in a soup, the cabbage, you deactivate the myrosinase enzyme, you won't form much ITCs when you chew the vegetable.
Mike Haney: Yeah.
Dr. Joel Fuhrman: But if you took the broccoli rabe or the collard greens or the turnip greens or the kale or collards, and you cold blended it in a blender, so the cell walls were broken down and the ITCs were formed in the blender, they would then be stable if you poured it into a soup to cook. But if you poured it into the soup to cook and then you blended it, you would've deactivated the enzymes.
But see, the ITCs themselves are relatively heat stable, but not the enzyme that forms the ITCs. Here's my point — for people to get a high level of these protective isothiocyanates, the ITCs in the body, you have to eat a good amount of raw cruciferous vegetables, like arugula on your salad, and cabbage.
Also, onions have the same corresponding alliinase enzyme that's heat sensitive, like the myrosinase enzyme in green vegetables, that forms the anti-cancer organosulfate compounds in onions. People know when they cut an onion, it makes their eyes tear, because you're forming a chemical reaction on your kitchen table, because you cut the cell wall.
The point I'm making is the better you chew these things to a complete liquid in your mouth, you could change the amount of ITC formation by 10 to 40 fold, increasing absorption and production by how you're preparing the food, how you're chewing the food, whether you're eating some nuts and seeds with the meal to facilitate the absorption of the fat-soluble compounds.
We know so much now, not just of what to eat, but how to prepare the food and how to eat the food to maintain the level of nutrients in our body to get maximum protection against cancer, slow aging, and promote longevity. We didn't know this stuff years ago. We knew it was good to eat green vegetables, we knew it was good to eat mushrooms, but now we have more data to fine tune things, to tweak things, to give people who are really nutritional enthusiasts the knowledge to really get the full benefits of what they're trying to do.
And what we're trying to do is to tell people, "You don't have to get cancer, you don't have to have a heart attack, you don't have to have a stroke, you don't have to be demented. We can push the envelope of human longevity. We could live 20 years longer than the average American lives, and we can beat out the blue zones by a mile, because modern nutritional science has given us this unprecedented opportunity in human history to eat better and healthier than ever before, and we also can make it taste great."
It's been very fulfilling to watch people have transformational effects on their health, their health recoveries, and to see the outcomes. Even people who have cancer are now living 15, 20, 25 years later with no further cancer recurrences, because they've embraced this type of nutritional excellence.
Mike Haney: Right. Let's stay on that topic of nutritional research for a moment. Because I'm coming at this from the perspective of a health journalist. I'm reading studies, I'm trying to figure out what to write about, I'm trying to figure out how to educate the public, and nutritional science is just famously very hard to do, right? And when you talk to the public, the average person, they're confused. They'll say, "Well, one day you're supposed to eat this. The next day you're supposed to eat this. This is better for you. This isn't." And they'll cite headlines that my colleagues will often overstate, conclusions will often be a little too hyperbolic, extrapolating a particular study to some larger point.
But I think for the average person, making sense of nutritional science is hard. My sense, talking to researchers and doctors, nutritional science is hard to do, right? It's hard to get massive randomized control trials on things, it's hard to get long-term data. It's hard to go from the cellular effects that we might be able to study in the lab or in animals or in small populations to the real world.
How do you think about making sense of nutritional science and helping the lay person? Because I know you still work a lot with folks who are trying to improve their diet, trying to help them get more nutrients. How do you translate the nutritional science into the real world and combat this sort of confusion that I'm sure you encounter with the folks that you work with as well?
Dr. Joel Fuhrman: No, I don't.
Mike Haney: Okay, good.
Dr. Joel Fuhrman: The nutritional confusion is due to internet marketers and people who have some kind of position, because they're funded by the meat industry or the dairy industry or the sugar industry. You can take some science to defend any position, but if you look in a comprehensive fashion and you spend time reading thousands of articles — so I'm saying I've read 30 to 50,000 articles.
In my book, Eat For Life, my most recent book, I picked out the thousand most important nutritional references for people to be aware of. And I truly had each chapter go over what each chapter represents, maybe 300 to 500 nutritional research articles — what those articles cumulatively, how will they corroborate each other?
And rather than seeing all these articles contradicting each other, that's not true. It's that if you look at the full mass of nutritional science out there, the corroborative evidence is unbelievably consistent. The message is not contradictory, it's pretty straightforward.
You have all these groups trying to take one small study and that are done incorrectly — the same thing, the drug industry too.
Mike Haney: Right.
Dr. Joel Fuhrman: But if you look at all the studies in a comprehensive manner, without a predetermined bias, then we see a general trend that is hard to deny by people who are very intellectually sane and emotionally sane.
Mike Haney: Right.
Dr. Joel Fuhrman: For example, a study on nuts and seeds, and prevention of cardiovascular death and cancer deaths. We're saying the American diet gets its fat intake from animal fats and oils. Yet, every study — no studies contradict this — when you reduce animal fats and oils and instead get your fats from whole food, nuts and seeds and avocados, you get about a 30% reduction in all-cause mortality and about 40% reduction in cardiovascular mortality. That's incredible.
You can't reduce mortality by 30, 40% with any intervention. But this hasn't… compared to eating oils and animal fats to nuts and seeds. For example, do you have a salad every day? And on that salad, do you put a dressing made with nuts and seeds, like a walnut balsamic or an orange sesame dressing? Or do you put oil and vinegar, like olive oil and vinegar?
So the question is, this science never got filtered down to the population, because of marketers and people who want to eat the way they want to eat. But the science isn't confusing. It's absolutely stunningly corroborative and consistent, showing that if you use the fat from whole nuts and seeds, then you would dramatically have a longer lifespan.
Plus the fact that oils have caused a lipemic rush in the blood. Animal fats cause this lipemic rush, which means you get a whole bunch of fat in the blood at one time, like sugar and white flour. White flour is sugar, and it gives you a glycemic rush in the blood.
So you have this huge amount of calories going through the bloodstream, that then stimulate the dopamine centers in the brain, same as if you had eaten, as if you snorted cocaine or shot up with heroin, and you become dopamine insensitive and you develop cravings for higher caloric intake and for a high calories in the blood at one time, right?
So people become habituated to, and addicted to, overeating. And now we have Americans eating generally about double the amount of calories humans need for good health, because their diet is low in nutrients and they've habituated to the addictive nature of food. And of course, everybody in America is overweight and cancer-prone.
But what I'm saying right now is that when you eat a diet that's really healthy, you don't feel like overeating. You're satisfied with the right amount of calories. If you're not addicted to cocaine, you don't want cocaine. If you're not addicted to the caloric rush, you don't have to get all those calories in to be satisfied.
I'm using the example of nuts and seeds as how consistent the nutritional science literature is in demonstrating that eating walnuts and flax seeds and sesame seeds extend lifespan. We could do the same thing looking at the consistency of the scientific literature.
And the most stunning information of the last decade in nutritional science is that as you dial up more animal protein into a person's diet — you go from 5% to 10% to 20%, 25%, 30% to 35% — as you dial up more animal protein, you dial down lifespan accordingly, and you increase risk of cancer and cardiovascular deaths proportionally to the increase in animal protein intake.
That doesn't stop the keto or the carnivore people from saying, "You have no randomized controlled trials. Where's this? Where's that? I feel better. I'm doing better." But we have to go with, when we look at the impact of hundreds of studies that corroborate each other, we also see that, as we dial up more plant protein in the diet, we get longer lifespan.
It's not even controversial anymore. We know that people on these diets that are richer in animal products have shorter lifespans. They're promoting growth hormones. We understand the mechanisms via which the bacteria in the gut now produce a different type of toxins from eating those type of foods, like TMAO, trimethylamine oxide, which increases risk of kidney failure, cancer deaths, and cardiovascular deaths. We know about these things, what's going on.
We're understanding how the body works. But as we dial up more plant protein in the diet, we prevent these hormones from promoting cancer cell replication and we extend lifespan accordingly. And the question is, what are the foods that are highest in plant protein that people are eating that are extending human lifespan? And it's pretty simple — it's the same foods that are extending lifespan — it's green vegetables, nuts and seeds, and beans. Green vegetables, nuts and seeds, and beans have the most scientific evidence to be linked to longer lifespan in humans.
So what I'm saying, to answer your question — contrary to what people get on the internet and the media, us nutritional scientists reviewing thousands of articles are stunned by how consistent the nutritional science literature is in pointing to this opportunity of what would be the proper diet to extend human lifespan? Which, by the way, being a plant-based or being a plant-strong diet like that is also best for the planet, for climate change, planet pollution, and the planet as well. So those things come together.
That's where the American College of Lifestyle Medicine — the only board certification authority of physicians who are using lifestyle and diet to help their patients — are behind what I'm saying, because that's where the science is. This is evidence-based.
Mike Haney: Right. What I'm hearing you say is it's a challenge of perspective, not of knowledge. It's not that we don't know, it's that, often, whether that's the media, the average person consuming it, maybe even some folks in the medical profession, are just narrowcasting a little bit too much. And if we take a broader view, we'll see some of these truths emerge.
Dr. Joel Fuhrman: Yes, we have a lot of evidence for the type of advice we give people, and that evidence — people should understand the evidence is not scanty, it's overwhelming.
Micronutrients versus macronutrients: the key distinction
Mike Haney: Right. Let's move on to maybe digging into nutrients as a topic a little bit more, and then we'll talk about the notion of blood testing. I'm just going to start really dumb, high level — what is a nutrient? We toss that word around, but what is a nutrient? How should we think about what it is and what role it plays in our body?
Dr. Joel Fuhrman: Well, we're talking, really, here about micronutrients. Because macronutrients are fat, carbohydrate and protein, and water. There are four macronutrients. And I'm saying right now that Americans eat too much fat, they eat too much protein, and too much carbohydrates. Those are the three sources of calories. Americans overeat calories, which shortens their lifespan.
Mike Haney: Mm-hmm.
Dr. Joel Fuhrman: And the reason they overeat calories is because they're not getting enough micronutrients and fiber. Because when you don't get enough micronutrients and fiber — and by the way, Americans are ubiquitously, nutritionally deficient, because they're eating processed foods and animal products which don't contain… Their diet is 60% processed foods and 35% animal products, which neither one contains phytochemicals and antioxidants. And it's the diversity of phytochemicals and actually the diversity of fibers that gives us the best bacteria in the gut to prevent disease.
But getting back to your question here — yes, the micronutrients are vitamins, minerals, phytochemicals, and phytonutrients found in plants, and the vitamins, minerals, phytonutrients, phytochemicals, and antioxidants that do not contain calories.
And because we're not eating enough of those rich phytochemical and antioxidant-rich plants, Americans are nutritionally deficient. They're not deficient in macronutrients, they're deficient in micronutrients. And I'm saying getting more micronutrient bang per caloric buck, getting more micronutrient bang per macronutrient buck, is the secret to a longer lifespan.
Mike Haney: Right.
Dr. Joel Fuhrman: We have to eat more foods with a high micronutrient density and diversity. And when you do that, your cells are less toxic, less inflammation, and you also become instinctually satisfied with the right amount of calories, and you feel comfortable eating whatever your caloric requirement may be.
Mike Haney: Mm-hmm.
Dr. Joel Fuhrman: But when you — and I'm saying here that a piece of chicken is like a bagel.
Mike Haney: Mm-hmm.
Dr. Joel Fuhrman: Now why am I saying a piece of chicken's like a bagel? Because they're both sources of macronutrients without having a significant micronutrient load. The bagel is rich in carbohydrate, but where's all the phytochemical and antioxidants that would've come along if you had a mango or a strawberry —
Mike Haney: Right.
Dr. Joel Fuhrman: — instead of the bagel? Chicken is rich in protein, but where's all the phytochemicals and fibers and antioxidants and protective isothiocyanates, if you had got your protein from sesame seeds or pumpkin seeds or something, right?
So we're talking here that the idea that the American diet is high in animal products and processed foods makes people dangerously deficient, which sparks an epidemic of cancer across the modern world, because we are a vegetable-dependent animal like the other primates are. And I always tell people, if you don't like green vegetables, you better live close to a hospital, because you can't expect to have a normal life without a high green-vegetable intake.
Mike Haney: I like that perspective, because I feel like we do focus so much on the macronutrient side, right? We're always telling people, "Get more protein." We do talk —
Dr. Joel Fuhrman: Cut back on fat, eat more protein.
Mike Haney: Well, when we —
Dr. Joel Fuhrman: Watch your —
Mike Haney: — talk about healthy fats, healthy carbohydrates, but I think this focus on micronutrients is going a level deeper and really saying, "No, no, it matters what the sources of these are." So how do you think then about the — you say folks eat too much protein, too many carbs, and too much fat — how do you think then about macronutrient balance? Or do you not even focus on that and say, "Let's just talk about getting the right foods in." Do you counsel people to get 30% protein, 40% fat, et cetera?
Dr. Joel Fuhrman: No way. That's just ridiculous.
Mike Haney: Okay.
Dr. Joel Fuhrman: That's no — you don't have to focus on that. In other words, people are focused on the macronutrients and missing the whole point. Green vegetables are critically important and they're rich in protein. Beans are rich in inositol pentakisphosphate. They're slowly digestible carbohydrates. They're rich in protein. They have a lot of resistant starch.
These foods already have the right protein, fat, and carbohydrate ratio, right? Even whole grains have plenty of protein. The nuts and seeds are a source of good, healthy fat. We have people know that flax seeds, chia seeds, hemp seeds, walnuts are rich in short-chain Omega-3 fatty acids that protect, stabilize the heart against cardiac arrhythmias.
But they're also full of lignans that are digested by bacteria in the gut, that have anti-estrogenic effects to prevent breast and prostate cancer. So the same foods that protect the heart against arrhythmia. And when you're eating foods that are natural, you're getting the right ratio of fat, carbohydrate, and protein.
And the ratio could be somewhat different. It's not some white carbohydrate and fat balance. It's the type of fat people are eating that are addictive and make people get overweight and overeat calories. When you eat enough healthy food and your nutrient levels are high, then you instinctually desire the right amount of calories. And we don't overdo the fat, the carbohydrate, or the protein.
Keep in mind, I'm saying that people in America are eating too much fat, too much carbohydrate, and too much protein. That means they're eating too many calories.
Mike Haney: Mm-hmm.
Dr. Joel Fuhrman: And how are overweight people thinking they're going to lose weight successfully without focusing on micronutrients and trying to adjust some right idea of this macronutrient basis? And that's where people are coming to a keto diet or an Atkins diet or a carnivore diet.
The reason they're advocating that is because they're radically restricting carbohydrate, that puts the body into an emergency state where the brain can accept ketones as an alternative fuel, to break down fat, to make ketones for the brain, which helps people able to eat their meat and not be overweight.
Mike Haney: Right.
Dr. Joel Fuhrman: But that causes the chronic acidosis and the lack of protective nutrients that radically shortens human lifespan. So we're saying that all the long-term studies of people following those type of diets show they have the most early-life mortality, which means the most deaths before the age of 70. You can't trick mother nature by some gimmick to lose weight. You can smoke cigarettes to lose weight too, or snort cocaine and smoke cigarettes to lose weight.
Mike Haney: Right.
Dr. Joel Fuhrman: But the truth is, we're a primate, and the right way to do it is to eat right.
Mike Haney: Right. Right.
Dr. Joel Fuhrman: And when you do eat right, you're not deficient in protein. For example, there are five plant foods. Let's say you're a complete vegan, not eating any animal products at all. The five plant foods are fruits, vegetables, beans, nuts and seeds, and intact whole grains. The only one marginally low in protein is fruit. So the only way you can get your diet excessively low in protein is if you ate too much fruit and not enough vegetables, beans and nuts, right?
Or you pour oil on your food. Do what most Americans do — they get 500 calories of oil a day poured over their food. They just took 15 grams of protein out of their diet, because they got that same calorie content from sunflower seeds and sesame seeds and hemp seeds. If they were eating nuts and seeds in place of that oil, they would've got the fat with protein, with fiber, with anti-cancer nutrients in.
Plus, you'd absorb the full — you don't absorb the full phytochemicals from the salad you're eating if there's not some fat with the meal.
Mike Haney: Right.
Dr. Joel Fuhrman: But when the fat from the nuts and seeds comes with the meal, the fat is absorbed slowly into the bloodstream, at one or two calories a minute, which the body can then preferentially burn for energy and keep you controlled your whole afternoon, as opposed to putting oil on the food, which is absorbed almost instantaneously at about 40 calories a minute, which creates a spike of calories in the blood that drives overeating behavior.
So now this person says, "Oh, I had a bowl of vegetable bean soup, and I had a big salad with nuts on it, and I had two pieces of fruit for dessert and I'm still feeling empty. I got to have a pizza, got to have a burger, I got to have some cheesecake. I got to have an ice cream cone." They'll never be satisfied with normal food, because it doesn't spike their brain with enough caloric concentration that the oil would've done.
Mike Haney: Right.
Dr. Joel Fuhrman: But I'm saying, if you're eating a normal amount of calories — and by the way, Americans eat about 3,200 calories a day on the average, where most primitive societies ate about 1,600. So I always say, "Half of what we eat feeds our needs and the other half meets the needs of our doctors."
And fat on the body makes chronic inflammation and makes you insulin-resistant, and activates aromatase to produce extra estrogen and has a whole series of cascading effects that increase risk of cardiac disease, cancer, and accelerates aging of the body. We're saying here that unless you achieve fiber and micronutrient adequacy, you are going to desire excess calories.
"Half of what we eat feeds our needs and the other half meets the needs of our doctors." — Dr. Joel Fuhrman
Blood testing for nutrients: what it can and can't tell you
Mike Haney: Well, I think that's a really good lead into the idea of testing nutrients. So we've arrived at the point that micronutrients are what is really important here. So I think that leads to: how do I know how my levels of micronutrients are, and what role in your mind does blood testing play in understanding that picture?
Dr. Joel Fuhrman: Well, the blood testing can be a motivational factor to help a person make change, just like a blood pressure measurement can say, your blood pressure's high, you got to cut the salt out of your diet. They said, "I don't even know I had high blood pressure." Well, you're eating salt all these years, eventually it flips.
So maybe the high cholesterol, high homocysteine, whatever the things we're testing, can be utilized to help target — but help people motivate them to make the changes and to give them the confidence they're doing the right thing. But let me give you a couple of examples. I mentioned that the nutritional concentration in the cell and the lack of toxicity in the cell is the key to longevity.
But also, we're talking about the cell membrane, having cell membrane fluidity and the Omega-3 index being favorable — to have the right ratio of Omega-3 versus Omega-6 on the outside of the membrane. And gaining weight and overeating oils is going to have your Omega-6 levels be too high and your Omega-3 index is going to be too low, because you have extra body fat and you're eating all these seed and grain oils in your diet, right?
When I advise a person to eat healthfully, I want them to lose body fat while they're consuming adequate Omega-3 sources, like flax seeds and walnuts, and take an Omega-3 supplement while losing weight, so we can start to see the Omega-3 index come into the favorable range.
The studies over the last decade have shown that the Omega-3 index being higher is protective against brain-shrinkage with aging, and cognitive impairment. But also, we're finding in the last five years that a higher Omega-3 index is linked to longer lifespan and lower risk of all-cause mortality as well. It's not just brain shrinkage.
Mike Haney: Right.
Dr. Joel Fuhrman: If your Omega-3 index is somewhat low, maybe three or four, maybe he says, "Okay, take a little more of that supplement, then, to bring you up to five or six." So it can help with people directing their supplemental regimens. And, of course, I'm saying, too, that there are some benefits to eating animal products, such as B-12, Omega-3 from seafood and fish, and zinc, that you don't get optimized with plant foods as easily as you can optimize those nutrients with animal products.
So by looking at the Omega-3 index, it assures us that this person on a plant diet, who doesn't want to take in the toxins from fish or the plastics from fish — because we know that, at this point, the dumping of plastic and garbage in the oceans, particularly the bottom feeders, like clams and oysters and mussels and scallops and crabs, and the lobster, those are called bivalves.
They filter a lot of water through them, and when there's overgrowth of algae and cyanobacteria, and the BMAA filters down through the water and gets concentrated in these foods, there's a link now to people eating lake fish with algae overgrowth or fish caught off a continental shelf, particularly bivalves and shellfish, with clusters of ALS and PDS, Parkinson's, dementia syndrome.
So a lot of people into plant-based eating are also keeping their body clean by reducing seafood as well. But then, you're reducing Omega-3 food and zinc, so it pays to supplement smartly and conservatively with a few elements as we move our diet more plant-based and more plant-heavy. And as we cut back animal products, we're lowering some protective nutrients that are in animal products, like B-12, zinc and Omega-3 fatty acids.
So then, looking at the B-12 level, we're taking those supplements appropriately, and now people have some confidence that they're taking the right amount, because their blood levels confirm they're in the optimal range.
Mike Haney: Right.
Dr. Joel Fuhrman: Now, one thing to consider here though is that B-12 in the blood is not a great indicator of where you are. Let me explain for a minute. Because the normal range for B-12 in the blood is like 250 to a thousand, let's say.
Mike Haney: Okay.
Dr. Joel Fuhrman: Right? So if your level is 600, 700, 800, your level's fine and you're not going to have to do any more testing. But what if your level is 200 or 300? It's still in the normal range, but it's the lower end of the normal range. The blood test doesn't really tell you if more would be better for you once you're in that normal range. But that's where homocysteine is effective.
Mike Haney: Interesting.
Dr. Joel Fuhrman: Because homocysteine elevates in the blood if you're B-12 deficient or if you're B-6 or folate deficient. Now this person eating a nutritarian diet, like I recommend — all these green vegetables and beans — is not folate deficient. They're getting tons of folate in their diet, they're getting tons of B-6. So now, if the B-12 is on the lower side of normal and the homocysteine's a little elevated, it's most likely elevated because the person needs more B-12. So that's an indicator the person could need more B-12, right?
There is a very genetic defect called a methylenetetrahydrofolate reductase deficiency that can cause homocysteine to rise too. That would mean that the folate's normal, the B-12 is normal, but they still have a high level of homocysteine, and then they may need a certain supplement to deal with that.
Mike Haney: Right.
Dr. Joel Fuhrman: But this is something that the blood test can help us evaluate.
Mike Haney: Right.
Dr. Joel Fuhrman: Is it something common? Is it something unusual? But good to check that once in a while to make sure that you're having adequate levels, and good to check your Omega-3 index. Because we all convert the short-chain Omega-3 from walnuts and flax seeds, and we convert that into the longer-chain EPA and then DHA at different genetic capacities. Some people make more, some people make less. And to know your number, with how much you have to supplement, is probably a good idea.
Mike Haney: Right.
Dr. Joel Fuhrman: Right? Vitamin D is also very unique, could be very uniquely dependent on that individual, and we're usually not recommending people take huge amounts of vitamin D, but take enough so you're not deficient in the blood.
And you can get enough from sunshine or get enough from… But we usually — most people are supplementing conservatively to protect against deficiency, but like with any other nutrient, we're talking about a region of homeostasis where too little could be bad and too much could be bad as well. We don't want to just take large amounts of nutrients we don't need. Right?
Mike Haney: Right.
Dr. Joel Fuhrman: So I'm saying right now that vitamin D's interesting — there was a study on Caucasian surfers in Hawaii and they found that the majority of them were vitamin D deficient. How do they spend an hour out in the sun every day in a bathing suit and then not get enough sunshine to make vitamin D?
And they found out. The answer was when they came out of the sun, they went into the showers and they use soap and wash their skin. And when you wash the oils off your skin with soap, vitamin D takes time to penetrate into the tissues once you have sun exposure. So you have to leave the oil on your skin and not wash with soap for hours after exposure to get the vitamin D to penetrate the body. So that's why I shower once a month, whether I need it or not.
Mike Haney: Well, you've just answered a question for me, because I got a set of blood testing recently and was low in vitamin D. I had said to my wife beforehand, "I don't even need to look at vitamin D. I live in San Diego."
Dr. Joel Fuhrman: Yeah.
Mike Haney: "I'm surrounded by sun constantly," and I was vitamin D deficient. And maybe that's why.
Dr. Joel Fuhrman: It could be also that you need to — vitamin D is a fat-soluble nutrient —
Mike Haney: Mm-hmm.
Dr. Joel Fuhrman: — and you need to take your vitamin D supplement with a meal that has fat in it.
Mike Haney: Yeah.
Dr. Joel Fuhrman: So if you get vitamin D with a piece of fruit, there's no fat in it, you're not going to absorb it well.
Mike Haney: Right.
Dr. Joel Fuhrman: You have to eat the vitamin D with some nuts in the meal.
Mike Haney: Right.
Dr. Joel Fuhrman: Or you have to have the fat on your skin sit there after your exposure and not come in and take a shower. After you're exercising outdoors and going for a run or going for a swim, don't take a shower that quickly.
Mike Haney: Right. So you mentioned vitamin D, the Omega-3 index, the homocysteine, which I want to come back to, because it's such an interesting one. Are there other nutrients you find particularly valuable to test in the blood?
Dr. Joel Fuhrman: Well, it depends. Because I prefer that people change their diet and eat healthfully. Because if you test a person on a conventional diet, I would expect all their blood to be messed up and all their blood to be deficient in a lot of different nutrients, unless using it to motivate them to eat better.
But I'm assuming — most of my clients and people who follow my advice are eating relatively healthy diets, so they're not going to be grossly deficient in all these nutrients. We can just target those nutrients that are most likely deficient on a healthy diet.
Mike Haney: Mm-hmm.
Dr. Joel Fuhrman: You follow me?
Mike Haney: Got it.
Dr. Joel Fuhrman: Because the average American is just going to be deficient across the board. You can test for everything. Clean your act up, eat healthy. You can't escape from the biological laws of cause and effect. If you don't eat — we're talking about eating fruit, eating a wide variety of natural plants as a method, as a technique to live longer.
I have this acronym that I call G-BOMBS that delineates these six foods that have been shown to have a huge amount of science showing they extend human lifespan and prevent cancer. And the G-BOMBS stand for Greens, Beans, Onions, Mushrooms, Berries and Seeds, right? And if you're eating a lot of these foods, then your skin carotenoid score, your beta-carotene, your blood is going to be good.
Mike Haney: Mm-hmm.
Dr. Joel Fuhrman: Now, beta-carotene that you're eating as a supplement doesn't make you live longer, but if your levels of lutein, lycopene, beta-carotene are good in your blood because you eat a lot of vegetables, then they're linked to longer lifespan. In other words, it's marking a high vegetable eater, because there are hundreds of different carotenoids.
You can't just take the one pill and expect to get the full benefit — you can't pill yourself or supplement yourself into good health. You need this wide assortment of natural compounds. And the foods that are high in beta-carotene have other compounds, other phytonutrients, many of which haven't been discovered yet or even named yet.
We can tag these, flag these nutrients in the blood to indicate people have poor diets. But I would just say, well, I can look at your diet and tell you you're going to be low on these things too. You know what I mean? Fix up your diet first and then we could look at your blood more selectively.
Mike Haney: Right. We talked a little bit about homocysteine and its relationship to the B vitamins. What I take from that, what you were describing there, is that if you are looking at blood test results, particularly in the nutrient space, it's all about the context. It's the context of what you're eating, it's the context of your lifestyle —
Dr. Joel Fuhrman: Yes.
Mike Haney: — and it's the context of some of these other markers.
Dr. Joel Fuhrman: Right.
Mike Haney: Are there other sets of markers that have that kind of relationship? I'm thinking particularly of the one that comes to mind anyway, is vitamin D and calcium, which I know have a relationship. Are there other particular markers that you say, "Look, if you're going to look at the result of this, also look at this or think about these other sets"?
Dr. Joel Fuhrman: Well, certainly. I mean, we're talking here about the fact that you could be eating inadequate calcium and taking in all the extra salt and animal protein and acids that drive the loss of calcium in the urine. So you could be developing osteoporosis and losing calcium, but the blood calcium will be normal.
Because the body — you could be taking in extra salt in your body all the time, but your body's excreting all the salt in your sweat and your urine trying to get rid of it, and your sodium in your blood is going to be normal. Or you could be marginally deficient in zinc, but the zinc in the blood is still normal. So sometimes we have to look outside the blood.
What I'm saying right now is by the time the calcium in the blood starts to go down, that probably means calcium binding protein is going down. Because even when people are losing calcium, calcium of the blood doesn't go down. So that means calcium binding protein is going down and albumin's probably down if calcium's down, and that means the person is malnourished.
Mike Haney: Mm-hmm.
Dr. Joel Fuhrman: Lower calcium in the blood accompanied with lower albumin, lower total protein, means the person has poor assimilation of protein, poor digestion, and they may have something that's interfering with assimilation and absorption, like cancer.
Mike Haney: Mm-hmm.
Dr. Joel Fuhrman: Or they could be severely sick, malnourished, cancer, something like that. We usually don't see that. So yes, we have to look at other indicators to know what the cause is sometimes.
"You can't pill yourself or supplement yourself into good health. You need this wide assortment of natural compounds — and the foods that are high in beta-carotene have other compounds, other phytonutrients, many of which haven't been discovered yet or even named yet." — Dr. Joel Fuhrman
Reading your Omega-3 panel, ferritin, and iron
Mike Haney: Let's go back to Omega-3s for a minute, because within a typical blood test — I know within the one we're offering, there's a bunch of Omega markers you're going to get back. There's a couple of Omega-6 ones and then there's the individual Omega-3s, and then you're going to get ratios. How would you read that set of blood tests from somebody? What kinds of things are you looking at there?
Dr. Joel Fuhrman: I don't think it's important to know all the different index. I mostly read the Omega-3 index.
Mike Haney: Okay.
Dr. Joel Fuhrman: Because that's the most heavily studied there.
Mike Haney: Right.
Dr. Joel Fuhrman: And the Omega-3 index, we're looking to have a number ideally above six. Let's say between six and nine.
Mike Haney: And this is effectively your total of the three Omega —
Dr. Joel Fuhrman: It's the amount —
Mike Haney: Omega —
Dr. Joel Fuhrman: — percent of Omega-3 fatty acids as a percent of total fat on the cell membrane.
Mike Haney: Got it.
Dr. Joel Fuhrman: Now, to keep in mind that the red blood cell membrane, which measures the Omega-3 index, we have a red blood cell turnover about 90 days. So if you're taking a certain amount of Omega-3 supplement on a certain diet, with a certain body fat, your body fat, your weight, the supplements and what your diet is, all affect your Omega-3 index.
Mike Haney: Mm-hmm.
Dr. Joel Fuhrman: But it has to be at steady state for about four months, because of the red blood cell turnover. If you've started to lose weight and eat healthy and take the right supplements right now, and take the blood two weeks later, the red blood cells are going to be the red blood cells that were circulating two and three months ago.
Mike Haney: Right.
Dr. Joel Fuhrman: So you got to wait four months to take the blood test for it to be accurate.
Mike Haney: Right.
Dr. Joel Fuhrman: I often tell people, "Well, lose some weight first and eat the right diet and take the right supplements, and then we'll test your blood maybe six months from now." You know what I mean? Because your body weight's going to affect it negatively too. Just like body fat affects triglycerides and cholesterol.
The saturated fat you've stored in your own body affects your cholesterol level and your triglycerides. So until you got your body fat and visceral fat low, your cholesterol and your triglycerides are not going to be optimized.
Mike Haney: Right.
Dr. Joel Fuhrman: It's a moving target as a person is getting healthier. But yeah, I mean, the most important thing is the Omega-3 index. And those other ratios kind of fix themselves. The arachidonic acid gets better, the excess Omega-6 goes down with weight loss. So the Omega-3 index is the main thing, because that's where we adjust the supplements.
Mike Haney: Right.
Dr. Joel Fuhrman: Just like with iron. With iron — iron sat and total iron binding capacity can be an indicator of iron overload in rare diseases, like with hemochromatosis or some things. But mostly with iron deficiency, we see ferritin go down.
Mike Haney: Mm-hmm.
Dr. Joel Fuhrman: Ferritin is iron storage protein that goes down when you're deficient in iron. It's the most sensitive to iron deficiency —
Mike Haney: Right.
Dr. Joel Fuhrman: — except when a person has an autoimmune disease and they have a lot of inflammation. Because the activated — like the rheumatoid arthritis being activated or an infection or a cancer — could make the ferritin falsely go up. But for most people who are not sick, ferritin becomes the most sensitive indicator of iron deficiency.
Mike Haney: Interesting.
Dr. Joel Fuhrman: So we don't need to look at… There are certain tests that are more sensitive and that we look at most, we consider to put more weight on. So if your ferritin's below 40, you should be taking some iron.
Mike Haney: Mm-hmm.
Dr. Joel Fuhrman: But, if your ferritin is above 60, it's better not to take iron. Because iron is an oxidant, and extra iron is not good for you to have extra. But if you're deficient, then it's better you take it.
Mike Haney: Right.
Dr. Joel Fuhrman: It's good to know your ferritin level, particularly for a woman, because us males aren't bleeding each month and our iron absorption is relatively pretty good. Most males have normal ferritin all the time. We could check it. But for females, either they're losing blood with menstruation — should they supplement with iron or not? And you really got to know your ferritin to know whether you should supplement with iron or not.
Mike Haney: Mm-hmm.
Dr. Joel Fuhrman: And even postmenopausal women absorb iron at such different rates that some could need iron supplements because of low ability to absorb iron and other women don't.
Mike Haney: Right.
Dr. Joel Fuhrman: So the only way to know that was the blood test, check the ferritin level.
Supplementation: what to take, what to avoid, and why folic acid concerns him
Mike Haney: Interesting. Well, that brings up an interesting point. You mentioned the idea of Omega-3 supplements. How do you generally think about supplementation?
I would guess that, generally, we want to get everything we can get from whole foods and from our diet, but how do you think about which particular nutrients are most useful to supplement versus which are not? Which are you just not going to get what you need from a supplement?
Dr. Joel Fuhrman: Great question, because it's really important people are aware that certain supplemental ingredients are potentially dangerous and cancer promoting. And traditional multivitamins have those cancer promoting ingredients in them.
I do make my own line of supplements, so people aren't taking those things in supplemental form. And my line is designed for people who are eating relatively healthy diets. I'm not giving them stuff that they need just because they're not eating any vegetables and fruits. You know what I mean?
Mike Haney: Right.
Dr. Joel Fuhrman: But, in general, the answer to your question is that folic acid is not the same compound as folate found in vegetables and beans. And when you eat a diet with lots of beans and vegetables in it, you get tons of folate so that your blood level is even up above the normal range, in many cases. Right? And the conventional authorities are telling women of childbearing age to take folic acid to prevent neural tube defects.
Mike Haney: Mm-hmm.
Dr. Joel Fuhrman: And I'm saying there's an overwhelming amount of evidence on the side of the literature that folic acid supplementation increases risk of breast and prostate cancer. It's a synthetic compound. It doesn't exist in nature. It's not the same thing as folate in real food. And the cells can't keep it outside the cell when it doesn't need it. And it leads to excessive cellular replication, and it's a cancer promoter.
Mike Haney: Mm-hmm.
Dr. Joel Fuhrman: And we have people taking folic acid, driving increased risk of cancer. You should be getting your folate from vegetables and beans and not from taking folic acid, even if you're of childbearing age. It's completely — and I'm making this radical claim, and nobody's talking about this except me — I'm saying this viewpoint of conventional medical and health authorities is driving an epidemic of childhood cancer as well.
Because women, instead of eating vegetables to get folate, are taking folic acid and not eating vegetables. And the lack of vegetables in the diet, not only during pregnancy but even years prior to conception, is linked to increased risk of acute blastocytic leukemia, the leading cause of cancer death in children.
So the cancer in children is affected by the mother's poor diet, including, by the way, brain tumors in children. When you have a child with a brain tumor at age 12, it's affected by what you ate before you conceived the baby even. And those are linked to not just the lack of green vegetables in the diet, but also the consumption of luncheon meats and processed meats — that affect the woman having a baby, whose child at age two or three gets cancer.
Mike Haney: Right.
Dr. Joel Fuhrman: You're not only causing yourself to get cancer with processed meats, like baloney and salami and pastrami and hot dogs and bacon — you're not just increasing your risk of cancer, but if you are — eggs in your body as a woman, and maybe even to a certain degree, the sperm as well for a male — you're damaging your genes that you can pass on to the future generations. That's how dangerous these foods are.
Mike Haney: Right.
Dr. Joel Fuhrman: So instead, what does our population do? Instead of advising people to eat vegetables for folate and watch the consumption of luncheon meats, instead, we tell them to take folic acid, the synthetic supplement, because people are low in folate in their diet.
Mike Haney: Right.
Dr. Joel Fuhrman: A lost opportunity. Right? Okay, likewise, to finish that question — vitamin A, meaning acetyl palmitate and retinol palmitate, has been shown to be linked to osteoporosis and to increase all-cause mortality and increase cancer deaths as well.
It's better to get your vitamin A elevated because you're eating a lot of different carotenoids, and the body can make the amount of vitamin A it needs from the wide spectrum of carotenoids you eat in colorful plants.
The minute you start taking vitamin A in excess, a synthetic supplement for it, you could be taking too much of that compound. Instead of your body making enough, you get excessive amounts. That doesn't mean vitamin A and folic acid might not be good in a person who's starving or gets no nutrients, who's eating just junk food. You know what I mean?
Mike Haney: Right.
Dr. Joel Fuhrman: But generally speaking, they are major factors driving cancer and people should not be supplementing with vitamin A, and they shouldn't be supplementing with vitamin E either, for that matter.
Mike Haney: Mm-hmm.
Dr. Joel Fuhrman: Because vitamin E has too many different fragments. And by supplementing with just one fragment, you could be blocking the absorption of another fragment. The same reason we saw beta-carotene supplements increase risk of lung cancer and heart disease risk. Because when people were taking beta-carotene as opposed to eating vegetables for carotenoids, you don't get the absorption of the full symphony, the full spectrum of all the carotenoids.
When you take a lot of just one type, it can interfere with absorption of the other types, and it's exposure to the wide variety of these phytonutrients that extends human lifespan, not taking one isolated nutrient in a high amount.
So yes — we're talking about getting our nutrients predominantly from food, with the full biological spectrum present. Because there are multiple vitamin E fragments, there are multiple carotenoid fragments, there's lutein and lycopene and cryptoxanthin… We want to get our nutrients from food.
And then, the question is, okay, once you're on this diet where you're getting a wide amount of these nutrient levels from food, are there any individual nutrients that can be added to that to extend human lifespan and prevent shrinkage of the brain, shrinkage of the immune system, shrinkage of the bones — things that happen as we age? It's natural to weaken your bones, weaken your muscles, weaken your brain, weaken your immune system. People die. They don't live forever.
And yes, getting a little extra zinc as we age can prevent weakening the immune system and weakening of the brain, and a little extra DHA can prevent that, and paying attention to plant protein to make sure we don't get too many hormones promoting growth — but too little can also be a problem too. We want to be in that sweet spot.
So then, yes, paying a little more attention to these things to make sure we're in the beneficial range, supplementing conservatively. We know, for example, that certain compounds, like the EGCG in green tea and extracts from multiple mushrooms, and the curcumins found in turmeric and black turmeric.
And we know that there are certain compounds in plants that we don't generally eat all the time, and supplementing with some of those has powerful anti-cancer effects to extend human lifespan. So we've taken nutritional science to a higher level of kind of perfectionism to instruct people how they could really use the scientific information for their own body's protection and to extend human lifespan.
Mike Haney: How do you recommend the average person navigate these kinds of questions? One of the things I'm hearing from you is, again, sort of context matters when you're thinking about your diet, where some of that supplementation might be helpful, what kinds of things you should be increasing.
If I get back a set of blood test results and I've got my nutrients, and they're the various things, and I'm committed to cleaning up my diet in some way, what do folks do? Do they go read a book? Do they go try to work with a nutritionist? Do they take it to their GP and say, "Here, give me some advice"?
Dr. Joel Fuhrman: I don't know. I mean, really, most people — most doctors and nutritionists are inadequate to answer these questions. I write books and people can read my books. They can come to my website and ask me questions.
But there are, like I mentioned earlier, a board certification for doctors specializing in nutrition and lifestyle medicine, called the American College of Lifestyle Medicine, ACLM, and they can look up doctors who have at least certified or board certified in ACLM to help advise them. Because you get all kinds of people with opinions and crazy opinions out there. I would say at least stick with somebody who's ACLM-associated physician, and there are 8,000 of those doctors across the country, you know?
Mike Haney: Right. Yeah, that's really helpful. It's a question we get a lot — "How do I find somebody who's going to put forward this sort of lifestyle focus?" at the front end.
Dr. Joel Fuhrman: Right. Life — good life. Which includes not just food, includes having good emotions and sleeping and exercising and not being exposed to pollution. And as we're doing this, we're trying to live as healthily as we possibly can.
How long it actually takes to move the needle on nutrients
Mike Haney: Yeah. Well, maybe that's a good place to start wrapping up. One of the other things I wanted to get to on this idea of nutrient levels, testing them, moving them, improving them, is how movable these are. And again, I'm sure this will vary by nutrient that we're talking about here.
And I know that lifestyle, exercise, stress, et cetera, plays a role in all of this, as it does for all of our health. If we think about somebody who is committed to improving their diet, who's going to try to exercise, who's going to do the things — how movable and over what timeframe should we expect to see improvements if we need to work on some of these?
Dr. Joel Fuhrman: That's a good question. People aren't going to like the answer either. Because the answer is when we follow people's antioxidants and carotenoid levels in their tissues, we find that it takes nine to 12 months of eating healthfully to see the levels go from 10, 20, 30,000 to where they should be at 80, 90 or a hundred thousand.
Mike Haney: Mm-hmm.
Dr. Joel Fuhrman: So you don't just suddenly eat healthy for a week or two and your levels of nutrients in your tissues are at ideal levels. You got to eat healthfully for a year and you got to drop a lot of body fat in the process if you want to see a nutrient concentration of your tissues.
Just imagine if you lost a hundred pounds of body fat — you just doubled the concentration of antioxidants in the remaining mass in your body. You just took away… So if you were 50% body fat and now you're 15% body fat, your level of nutrient concentration in your tissues just went up by 60%.
Mike Haney: Mm-hmm.
Dr. Joel Fuhrman: You know what I'm saying? So yes, it takes time to fix some of these things and people have to be patient with it. But even while they're fixing it, we see incredible progress in how people are feeling. Their diabetes goes away, their blood pressure normalizes, their headaches go away. They don't have to achieve measured perfection to start to feel better and be healthier, even though it might take longer to get to that level of really being in the ideal range.
Mike Haney: Right.
Dr. Joel Fuhrman: You know what I mean? But good question.
Mike Haney: To that point about something like if you're trying to bring a prediabetes or a type 2 diabetes down, you're going to be looking at insulin, you're going to be looking at A1C. Are there other proxy markers related to nutrients, as we think about a large blood test of some kind, that you would watch, that would be moving as your health is improving, as your diet is improving?
Dr. Joel Fuhrman: Believe it or not, the most important one is body fat percent. Because as the body fat percent goes down, and it's the direction of travel of the body fat percent —
Mike Haney: Mm-hmm.
Dr. Joel Fuhrman: Let me explain this. A person is 80 pounds overweight and they're losing three pounds a week, and they just lost 25 pounds. Their diabetes is gone. They're still 60 pounds overweight now. They lost the first 20 pounds of the 80 they were overweight. They're still 60 pounds overweight, but their diabetes is gone.
Mike Haney: Mm-hmm.
Dr. Joel Fuhrman: If they keep losing weight, it'll never come back. But if they start to gain weight and they gain a little, their diabetes will come back again.
Mike Haney: Mm-hmm.
Dr. Joel Fuhrman: Let's say they lost 40 pounds. Great, they lost 40 pounds. That's phenomenal. Go to Las Vegas and pig out at the buffets and gain back 10, and you're still 30 pounds down — but if you gain back 10, your diabetes is back, even though you're 30 pounds down.
Mike Haney: Mm-hmm.
Dr. Joel Fuhrman: Because you just gained back 10. And you know what, your cholesterol went back up, your inflammatory insulin resistance went back up, your inflammatory markers, your HsCRP went back up. The markers of cardiovascular death, myeloperoxidase and oxidized LDL just went up.
What I'm saying is that losing weight is a tremendous benefit in improving markers and lowering risk, but if you start gaining weight, you're going to be pushing your numbers in the other direction pretty quickly.
Mike Haney: Mm-hmm.
Dr. Joel Fuhrman: So weight becomes a primary direction of travel. I say you're a nutritarian — the diet — when you're eating healthfully and at your ideal weight, or you're eating healthfully and you're moving in the direction of your ideal weight.
But if you start traveling in the wrong direction, or you're overweight and not losing, then there's something you're doing wrong and you can't expect the blood markers to fix themselves. The blood markers fix themselves when you're traveling in the right direction and you're eating the right foods and the right amount of those foods.
So people have to eat a lot of the right foods and they have to try to figure out — being a scientist artist in their own body — the art of knowing their perfect caloric window that meets their metabolism, their exercise capacity, and their genetics that tells them, "How many calories do I need to keep my body fat under 15% as a 70-year-old male?" You know what I mean?
Mike Haney: Mm-hmm.
Dr. Joel Fuhrman: "To do the amount of exercise I'm doing, I figured out, yeah, actually, I eat about this. I feel like eating about this much of food. It's working. I'm not gaining weight." So people have to figure this out and keep going in the right direction.
Mike Haney: How do you recommend people figure that out? How much of it comes down to feeling? I've heard you talk about the idea of — I don't want to misconstrue this, but I think it's basically learning to eat when you're hungry, not just because you have cravings or because it's lunchtime.
Dr. Joel Fuhrman: Yeah, absolutely. But if you don't eat enough healthy food, you never can get the instinctual connection with hunger. So I tell people, "Well, let's have you eat a giant salad every day, at least a half a cup to a cup of beans every day, at least one to two ounces of nuts and seeds every day, at least three to five servings of fresh fruit a day. At least, we're giving people at least a half a cup of onion and mushroom a day."
"Let's see, are you eating… So let's, at least give you the basic prescription of what you should be eating every day of healthy food. And then, once we get nutrients in your body, we can start to deal with your cravings and why you're overeating. Because until you supply some nutrients and some fiber into your tissues, you're not going to be instinctually connected with the body's signals about how much food you should eat. You're going to want to overeat all the time, because you're nutritionally deficient."
So first, let's get — so it's more a question of, at the beginning at least, getting enough healthy food into the body and that'll crowd out more of the unhealthy stuff too, and you start to feel more satisfied.
But you're right — I'm saying eventually, when a person gets healthy enough, that takes time. Then they can eat what they feel like eating, because the amount of food they feel like eating will be the right amount of food, but that's because they've achieved the nutrient adequacy we're talking about here.
"Until you supply some nutrients and some fiber into your tissues, you're not going to be instinctually connected with the body's signals about how much food you should eat. You're going to want to overeat all the time, because you're nutritionally deficient." — Dr. Joel Fuhrman
Body fat percentage, DXA, and learning to like healthy food
Mike Haney: Right. Right. One more question on the body fat, because you brought that up, and I think that's such an interesting idea that we've got all the blood markers, but we've also got body fat percentage. And one of the things we've written about and talked about is DXA scans as a way to know about your body fat percentage.
I'm curious how you think about DXA or other measures of body fat, and what particularly should you be looking at? How you think about different kinds of fat on the body, and how should people go a little bit deeper into that question of body fat percentage and what you should be looking at?
Dr. Joel Fuhrman: Yeah, DXA scans are the most accurate, of course, but I'm okay with all the electrical impedance — we use the InBody, those other machines. Because it doesn't have to be so perfect, so accurate. People know they're overweight and we take care of… We have a retreat here in San Diego where people come who are overweight and stay with us for months to get well.
But not just to lose weight and to get off their medications for diabetes and high blood pressure, but to learn the intellectual knowledge and the emotional and wisdom teachings that help them feel comfortable, satisfied both physically and intellectually, and at peace and change their taste muscle to enjoy eating this way, and learn the recipes to make it taste great. They learn the skills they need to stick with it long term.
But what I'm saying, to your question right here, is that, yeah, it could take time for a person to change, but unless you stop drinking alcohol, you have to have time away from it. Well, you keep lighting the fire under your desire by eating addictive fast food and commercial baked goods and sweets and candy and salt — you're never going to get your body connected with the natural signals. You're always going to want those things.
Mike Haney: Right.
Dr. Joel Fuhrman: So it does take a period at home, in your own home, of getting the junk and dumping it into a construction garbage bag, and eating the healthy food every day — have a big serving of cooked green vegetables every day at night, maybe a wok vegetable dish. Have a salad every day for lunch with the beans on top and the onions on top, and the tomatoes cut in, and the scallion or onion on there, and chew it up really well and eat it, and try to start to eat right.
And don't decide how much you like it right now. That takes time to re-change your taste preferences and re-change your taste muscle. And that comes from getting rid of the extra salty, extra sweets, the extra fried foods. You have to be off those things that are hyperpalatable to get yourself to like this stuff more.
The initial start, you just got to start doing it and not judge whether you like it so much. But we'll make people like it and their body will adjust. They'll learn the recipes, their tastes will change, and they'll learn to like this stuff if they start doing it, learning the recipes and doing it. But they got to do it at the beginning, even if it temporarily makes them feel a little worse.
Because they're going to feel better smoking cigarettes, not stopping. They're going to feel better drinking coffee, not stopping. They're going to feel worse, a little weaker, when they stop the salt. When they switch to a healthy diet, they're not going to feel better right away. It temporarily is going to make them feel a little bit fatigued out and weak from the over-stimulation stopping — the detox process of the body.
Mike Haney: Right.
Dr. Joel Fuhrman: We can talk about this forever, but the point I'm making is, when people make a change for the better, as strong as I'm recommending, they have to understand that that could enhance so-called withdrawal symptoms, detox symptoms, and they can temporarily, for a week or so, even feel a little worse. Plus, their taste buds are still not converted over. So try just to do it without judging it so much.
Mike Haney: Right.
Dr. Joel Fuhrman: When people come to me with a severe medical problem, I'll say, "Look, if you want to test whether this works, you have to let me decide what you eat. Not you make these decisions, because your decisions up to this point got you into this problem."
Mike Haney: Right.
Dr. Joel Fuhrman: "If you want to test scientifically whether you can get rid of the problem, then really test what I'm telling you to do and do it — eat this way whether you like it or not. But I'll promise you in month two or three that you're going to love eating this way, if we work on the recipes and you give your taste buds a chance to change over."
Mike Haney: Right. That's where, I imagine, given that that can be challenging — things like watching your body fat percentage or watching some of your blood markers, or whether it's your glucose or whatever, those kinds of markers can ideally be, as you mentioned earlier, inspirational in some way to say, "Well, look, this is still hard. Maybe I don't love everything, but boy, I can't argue with the fact that these things are —"
Dr. Joel Fuhrman: "My cholesterol dropped." Of course, keep in mind the hemoglobin A1C is on the red blood cell membrane. That takes three months. Even though the person's diabetes is gone, the hemoglobin A1C at the first month is still not great yet. We got to wait till three months later and recheck it, then you'll see how good it got.
Mike Haney: Right.
Dr. Joel Fuhrman: So some of these things lag behind. Even cholesterol could lag to a degree, because while you're burning up fat on your body, you're still living off a high saturated fat exposure that was stored in your own tissues, which can artificially pump the cholesterol up. So until the person gets closer to their ideal weight, you don't see the drop in cholesterol and triglycerides that's possible for them to achieve from eating this way.