Episode 105: The Real ‘Nutty’ Professor: Dr. Joan Sabaté on the Science of Nuts, Plant Power, and Sustainable Eating

Welcome to the Plant-Based Canada Podcast! In today’s episode, we’re joined by Dr. Joan Sabaté, a renowned physician and nutrition researcher, best known for his work on environmental and sustainable nutrition, and the health benefits of nuts and plant-based diets.

Dr. Joan Sabaté MD, PhD is a Professor of Nutrition and Epidemiology. He directs the Environmental Nutrition research program at Loma Linda University School of Public Health and he is also a board-certified physician in Internal Medicine. He was the principal investigator of a nutrition intervention trial that directly linked the consumption of walnuts to significant reductions in serum cholesterol, published in the New England Journal of Medicine in 1993. He is a co-investigator of the Adventist Health Studies, the largest cohort of individuals following a vegetarian diet relating dietary intake with health outcomes. For the past 25 years, he has been the principal investigator of many human nutrition intervention trials investigating the health effects of nuts, avocados, and other plant foods. Dr. Sabaté has authored more than 200 high-impact research articles (with an h-index of 82 and >40,000 citations). Additionally, he was a member of the US 2020 Dietary Guidelines Advisory Committee.

Resources:

Adventist Health Study 2 Studies: https://pubmed.ncbi.nlm.nih.gov/23836264/; https://pubmed.ncbi.nlm.nih.gov/30487555/

Whole-food, plant-based lifestyle intervention trial: https://pubmed.ncbi.nlm.nih.gov/39305340/

Review of Plant-Based Milks: https://pubmed.ncbi.nlm.nih.gov/36083996/ 

2020 Dietary Guidelines for Americans: https://www.dietaryguidelines.gov/resources/2020-2025-dietary-guidelines-online-materials

Nuts & Health: https://pubmed.ncbi.nlm.nih.gov/8357360/

https://pubmed.ncbi.nlm.nih.gov/8269904/ 

https://pubmed.ncbi.nlm.nih.gov/15559025/

https://pubmed.ncbi.nlm.nih.gov/10479222/

Dr. Joan Sabaté’s Socials:
Faculty profile

International Congress of Vegetarian Nutrition

Environmental Nutrition

LLU Nutrition Center

Plant-Based Canada’s Socials:

Instagram

Facebook

Website

Bonus Promotion

Check out University of Guelph's online Plant-Based Nutrition Certificate. Each 4-week course will guide you through plant-based topics including nutritional benefits, disease prevention, and environmental impacts. Use our exclusive discount code PBC2025 to save 10% on all Plant-Based Nutrition Certificate courses. uoguel.ph/pbn.

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Transcript

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SPEAKER_00 0:05

Welcome to the Plant-Based Canada Podcast. Join us as we talk to experts to explore plant-based practices and how our food choices impact our health and the environment. We sit down with doctors, dietitians, athletes and various fields to break down the evidence behind a whole foods plant-based diet and discuss the practical steps we can take in the effort to shift towards a healthier lifestyle. My name is Stephanie Nishi, and today I am joined by Dr. Juan Zabate, a renowned physician and nutrition researcher, best known for his work on the health benefits of plant-based diets as well as environmental and sustainable nutrition. Dr. Juan Zabate has an MD and PhD and is a professor of nutrition in epidemiology and directs the environmental nutrition research program at Loma Linda University School of Public Health. He is also a board-certified physician in internal medicine. He was the principal investigator of a nutrition intervention trial that directly linked the consumption of walnuts to significant reductions in serum cholesterol, published in the New England Journal of Medicine in 1993. He is a co-investigator of the Adventist Health Studies, the largest cohort of individuals following a vegetarian diet relating dietary intake with health outcomes. And for the past 25 years, he has been the principal investigator of many human nutrition intervention trials, investigating the health effects of nuts, avocados, and other plant foods. Dr. Sabate has authored more than 200 high-impact research articles with an age index of 82, where an age index is a metric used to measure both the productivity and citation impact of a researcher's published work. And his work has over 40,000 citations. Additionally, he has been a member of the United States 2020 Dietary Guidelines Advisory Committee. Before we get into the discussion, we have something that may be of interest to you from the University of Guelph. Do you want to take your plant-based knowledge to the next level? Stay tuned for a special promo code. The online plant-based nutrition certificate through open learning and educational support at the University of Guelph has everything you need to know about implementing a sustainable plant-based diet. Each course is just four weeks long and will guide you through essential topics including nutritional benefits, disease prevention, and environmental impacts. You can also customize your learning with unique courses such as plant-based diets for athletes and implementing a plant-based diet at home. As the first university-level plant-based certificate in Canada, you'll explore current research, learn from leading industry experts, and join a community of like-minded people. Use our exclusive discount code PBC2025 to save 10% on all plant-based nutrition certificate courses. The discount code is valid until December 31st, 2025. Learn more about the certificate program and find the discount code in the show notes of this episode. Dr. Sabate, thank you so much for joining the Plant-Based Canada podcast. I'm so excited to get to speak with you for this.

SPEAKER_01 3:52

Well, it's a pleasure for me to be here, and thanks for the invitation.

SPEAKER_00 3:56

So you've been a pioneer in plant-based nutrition research for decades, and I've been following your research even before we had the I had the pleasure of meeting you. And I've always wondered if you could tell us what first inspired your interest in the field and how did your journey into nutrition science begin?

SPEAKER_01 4:16

Wow. I mean, you are bringing me back a few decades. I would say probably the reason that sparked me my the interest in plant-based nutrition and particularly on vegetarian diets is because when we had our first son, I married a woman that she was vegetarian, was raised vegetarian, and although uh the consumption in my household uh before getting married was not very much on meat, but was not complete vegetarian. So when we had our first son, we had to make the decision is going to be vegetarian or not. And uh the logical thing, since my wife is the one that uh carries most of the lot as far as preparing the meals, we decided, I mean, that was going to be vegetarian, like the two of us at that time. I went to, and that I was uh in a residency program in internal medicine at the University Hospital of São Paulo in Barcelona. And I went to the library of the hospital and started searching for what would be the advantages and the risks of raising uh a child vegetarian. That was in the early 80s, and I can tell you that the literature was not very favorable for that. So I had a kind of an existential crisis. I mean, what should I do? I mean, I should just follow the desires of my wife, or I should uh check more thoroughly uh into this. So that was in a way, I mean, my my first interest in shifting my professional career from wearing a white coat and being a regular uh internist to really try to uh get more into plant-based diets and vegetarian diets. At that time in Spain, where I'm from, and I uh was there, uh there was no way to get trained in nutrition, much less in plant-based nutrition. But so that's again one of the reasons that I end up not uh as the first choice, but I end up doing or pursuing uh academic degree in a doctoral degree in nutrition in the United States. And I choose Loma Linda University because of their spouse and they are unapologetic about vegetarian nutrition. So that I thought this is the place where I can learn more about this. And because on my search years earlier, uh, when I'm saying uh when we had our first son, I found that there was a couple of articles from the faculty here in the Department of Nutrition at the School of Public Health in Loma Linde University that encouraged, or at least they were uh not critical but uh quite open in uh describing the advantage and the disadvantage of the risk of raising kids with vegetarian nutrition and provided guidelines. So this article was central, and I said I want to meet these professors and I want to learn from them.

SPEAKER_00 7:47

It sounds like the real-world practical aspects and coupled with your scientific background and mine really is what brought this together.

SPEAKER_01 7:59

Um yeah, well, I mean, I I grew up also in Spain in uh in an Adventist home. My parents were seven-day Adventists, so I was not foreign to the concept of plant-based nutrition, I mean, by just uh church instruction and by uh encouragement and things of this sort. So it was a fertile uh area in my brain, but when I had to make a decision or at least uh discuss with my wife whether uh because one thing is to be following a plant-based, I'm talking about 45 years ago, okay? Not now, and with the little knowledge that it was in the scientific community, but also in my brain, and uh so now we say, oh, it's obvious. Well, things were not so obvious 45 years ago. So uh the idea was should uh I pursue more research on the growth of vegetarian kids, and that was my doctoral dissertation at Roma Linda, because one thing is to have a plant-based diet for adults, and it's well demonstrated, as probably you are going to ask me, uh, that is good in adults for the prevention of chronic diseases. And another question is is a vegetarian diet adequate? And one of the high tests of testing the adequacy is to see if it provides the nutrients and uh needed on a body that is developing and growing. So that means for a child. So adequacy versus healthiness, uh, which are two aspects of the diets versus sustainability, which now we're into this one. So I judge a diet based on three parameters now. I mean, I'm talking about moving 45 years later, okay, nowadays. A diet or diet pattern has to be judged on three uh axes or three parameters. One is adequacy, does it provide all the nutrients? Two, is healthy? So does it prevent disease? Does it promote longevity? And third, sustainability. Is it feasible not only for me, but also for my grandkids? So I'm saying eating this way will be possible, uh eating this healthy way will be possible not only for me, for my generation, but for subsequent generations. So these three parameters have to be use and judge when you judge any dietary pattern.

SPEAKER_00 10:34

And your research has really contributed to each of these three areas. And you mentioned the Adventist background that you have, and that was actually some of my first introduction to your scientific work, and you've played a key role in both the Adventist Health Study and the Adventist Health Study II, which have followed tens of thousands of participants since the 1970s, I believe. I was wondering if you could share how studying the Seventh-day Adventist population has advanced our understanding of the links between diet, lifestyle, as well as chronic disease. But first, before even answering that, can you tell us a little bit about what does it mean to be Adventist?

SPEAKER_01 11:15

What does it mean to be Adventist? Well, it depends on where you are. Growing up Adventist in Barcelona, Spain, I mean, in the 60s and 70s, uh, was an oddity. And people really uh didn't even know what it meant, uh, didn't know how to relate with that. Sometimes uh, especially in elementary school, uh, people were just for emotional reasons antagonic because I'm saying you are different. I mean, you you go to church on a different day and uh and and you eat uh whole grain bread instead of uh French baguettes and things of this sort. As you grow older and you see that uh the world is full of uh differences, way of seeing life. I mean, I don't see, oh, I don't have this feeling. I mean, I I that's the way I am, the way I understand. And and I think overall there is uh um many advantages because some of the concepts that now people uh appreciate, such as the rest, I mean, when a society uh is something that I do practice regularly in my life uh on Saturdays or Sabbaths. I mean, I totally unwire. I mean, don't give me a call because I'm not going to answer you unless it's an emergency. So this idea that we are in a busy world, very much connected. I mean, uh, it's good to disconnect. And and and so I'm seeing I see many advantages of that. But uh when you are young uh and in expert, and uh there were some challenges. Okay, I can go on and on, but I think I'm here for the plant-based diets, not for talking about my experience of being advent. Um, your question as far as the studies with adventures, studying adventures has many scientific advantages. Uh, but first of all, why to study advents? Because uh, since the advent of nutritional epidemiology, which started here at Loma Linda more than 50 years ago, uh, we know that you can relate a particular diet uh with a health outcome. Before, nutritional science was mainly based on either animal studies, uh, lab research, and very tightly controlled human studies in which they were in a lab. So all of these types of studies, I mean, are good for testing the adequacy of a diet. So does the diet provide all the nutrients needed, I mean, uh, for growth and development. But didn't have the tools to assess chronic diseases, because by definition, if a subject is just in a lab uh 24 hours, you can just keep subjects uh or a rat for a limited time. So you cannot see, I mean, you can see that having a diet versus another or nutrient or the absence of this nutrient has an immediate metabolic effect. But you cannot see if 20 years from that diet or following this diet for 30 years will increase or decrease the likelihood of developing a heart disease or cancer or whatever. So it was not until the advent of nutritional epidemiology that we could apply the epidemiological tools to see the distribution not only of disease but of health parameters. So advanced health studies are good because you have a large number of subjects that are well educated, uh health-oriented, so they do fill out questionnaires, I mean, uh, with a high level of accuracy compared with the general population. So that brings to a more validity. That's one point. Second point, advanced by large, they do not smoke, they do not drink. That doesn't sound like a novelty, but I can tell you 50 years ago that was a novelty. So smoking and drinking are two powerful determinants of disease. So if they are removed in a population, uh you can see more subtle differences or small differences of tomatoes or carrots or meat. Because tobacco has a relative risk of 10 for lung cancer or more. But maybe uh uh eating meat may have a relative risk of two uh for cardiovascular disease. So the absence of these, I mean, reduce the confounding. That's uh that's uh another advantage. And contrary to what people think, administs are not vegetarian, only maybe at the most 50%. But so there are people that are uh, I mean, strict vegetarians, others that are lactop of vegetarians, others that are what nowadays on on today's lexicon will say flexitarians. That was my life probably 50 years ago. I mean, you eat meat occasionally and uh whatever, and then there were people that ate meat on a regular basis. So, but this um, you know, gradient or range of intake is what allows to find results. If everybody is vegetarian, you are not going to find any connection between meat and cardiovascular disease. You need from no meat to medium meat to more meat to high meat. So, but this is not only the parameter that varies in the diet. Uh, adverness, at least when I did my study that probably you are going to ask as far as notch, I mean, about uh on my postdoctoral dissertation. Some ate nuts regularly, others occasionally, and others almost never. So, and this applies to carrots and to tomatoes and to everything. In summary, advanced have a wider range of intake for most of the foods than the general population. Therefore, this gives more likelihood to find results if it exists. What we say in the Herga, it is a statistical power, the ability to find results. So all these characteristics, I mean, make kind of a natural experiment or makes an ideal population where to uh develop uh, you know, different uh propositions as far as to test if different foods or different dietary patterns, in that case, vegetarian dietary pattern, has an effect with health. I'm sorry for the lecture, but I'm a professor and I do teach.

SPEAKER_00 18:17

Very fair. I was wondering if you could tell us a little bit about those findings that you found for those individuals in the Adventist Health Studies that were following the vegetarian diet compared to those that were eating more animal-based products. Did you find what did you find in terms of their health?

SPEAKER_01 18:35

Okay, let me clarify that you said in the previous question that I'm one of the leaders. I mean, I I was one of the, and I am one of the co-investigators on the Adventist Health Study. I'm not the leader and I'm not the director of these studies. But I did participate uh, especially in developing the questionnaire for the Adventist Health Study II. Uh, while we were doing uh research on the Adventist Health Study 1. Uh uh it was clear that the summary of the results that I can tell you is that plant-based diets and its constituents, that means legumes or fruits or vegetables or nuts. You know, I love nuts because that was my anyway, uh, do have a preventive role for many chronic diseases, uh, several cancers. And in particular, uh I did my postdoctoral uh training uh with the Adventist Health study, and we connected uh the foods in the questionnaire uh with um the risk of developing uh uh myocardial infarction, so an incidence of heart disease and mortality in heart disease. And we found that uh meat uh increased the risk, but particularly in males, not so much on females. Whole grains lower the risk. And the major finding that uh was you know changed my life as far as the way to do research was that nuts, frequency of nut consumption was a major powerful determinant in lowering the risk of heart disease. Uh so that's one thing as far as the different uh things. On the other side, if you do as a food pattern, uh we uh know uh and we have seen that those that follow a plant-based diet, uh whether be um a strict vegetarian, a lactovegetarian, or a pesco-vegetarian, I mean, had uh more longevity than those following uh a diet in which includes meat on a regular basis. So it's not only uh postpone the um you know the development of these diseases by lowering the risk, but it really postponed death. That means more longevity. So that's in in a nutshell, I mean the summary of uh of of the adventiscular studies.

SPEAKER_00 21:19

Thanks for sharing that. And we'll actually get into some questions about nuts a little later on because you've done some landmark studies in this area, so I'm curious to hear more about that. But first, along these lines of health, you recently co-authored what has been noted as the largest and longest clinical trial to date comparing a whole food plant based lifestyle intervention with standard medical care and people with type 2 diabetes. So something that affects a large number of individuals, especially in North America. Can you walk us through the design of the study and what some of the key findings were for the study?

SPEAKER_01 22:00

Okay, this study was recently published, but it was conceived and later developed and carried on a few years ago. The one that originated this study on that was one of my residents and later became an assistant professor, Dr. Kelly. And he got a grant to study if a whole food plant-based diet had better results and that the standard medical care. And the issue on this study was not that it was new, because there has already been a few studies before, but that it has it was a large grant to be developed in the Martian Islands. Because of this is a group of islands in the South Pacific, far, far, far away, that somehow had a connection with the United States. And people over there, I mean, they don't have whole food plant-based. I mean, most of the diet that is imported and is uh, you know, I I would say either canned meat and uh and products that are already not whole foods, let's put that way. And uh the prevalence of obesity there is very high. So we thought maybe we can do kind of a almost a community trial. I mean, let's let's let's let's take like segments of of the population. Uh, but we end up uh the because I was part of the designing of this study. So we end up a standard randomized clinical trial uh in which uh the subjects were diabetic, which was not very difficult to identify. And and then we did a quite extensive uh intervention, providing uh not only education, but also providing food to them, that they were whole food plant-based, uh, to the one that were randomized into this arm, and the other ones just follow the standard protocol that they got. And um this study is the longest and the largest, largest by the number of sample size, and the longest because before there were studies of short term, and this was over half a year. So uh the intervention uh produced, I would say, the expected results. Um the hemoglobin A1C went down, I mean the glucose went down, and all of the things, and all the cardiovascular um risk factors such as cholesterol and obesity and all these also uh were different uh than uh the standard uh medical care. What happened is when the intervention was not anymore, because that was for the first three months. I mean, some of these parameters had a tendency to go up. Nevertheless, the hemoglobin A1C still was lower in the intervene group. And what is more important, uh the degree or the percentage of subjects that regress on the subject, I mean, with no diabetes, or on the subjects that uh had to lower the medication because they improve, was much, much higher in one group versus the other. So uh I think uh the study per se was nothing new, but it was new is in the context that it was done, and also the length of the study that shows uh that uh the implications of this. Basically, what are the implications? Biology is the same among human beings. Uh, if we do proper education to our patients and we do change the food environment, that people can have access to whole foods, uh, these are very two determinants that could really end up improving the health of the diabetic patients and decrease or basically have no need for medications.

SPEAKER_00 26:36

That was something that actually really stood out to me because in many trials you see in the short term individuals are able to follow the intervention and you see the decrease in the risk factors. But this one was actually longer term, and you did see that decrease in the need for the diabetes medications and cardiovascular disease medications. So that's something that really stood out to me.

SPEAKER_01 26:59

So and the diet that the diet was provided to them at the beginning. I mean, for examples, because as I said, I mean, the the ability, the ability to find whole foods plant-based uh in in the Martian Islands is difficult. So this could be uh similar to nowadays in Canada and in the United States when there are these uh food deserts where people of low income, I mean, uh that that has prevalence of obesity and diabetes, um sometimes you say, oh, they don't have the willpower or whatever, but I mean they probably don't have the means or the ability to get fresh products and and and and beans and whole grains and all these things. So uh this study shows that when the foods are available and there is a proper education, I mean, changes can happen.

SPEAKER_00 27:56

For sure. And the environment has such a huge impact in that. And I'm gonna ask some questions about the environment, but from a different perspective, particularly because you're one of the earliest researchers to explore the environmental impacts of dietary patterns. And I was wondering if you could tell us how has the field of environmental nutrition, so to speak, has has this evolved since your initial work, especially in terms of the data quality, the relevance, and policy impact that you've been able to have with this work?

SPEAKER_01 28:30

Wow, this is a difficult question. Um first of all, thanks for uh believe that I'm one of the first, but uh uh I I probably was one of the first uh uh nutritionists interested in this in the United States. But I'm saying the issue of the environmental impact of diets uh has been uh started in in European countries and in Canada, probably before United States. Um I really uh fix this discipline and I put the name environmental nutrition uh as the area of research and uh that relates nutrition and diet on this third dimension that I mentioned at the beginning of the study. Uh what's the point in recommending two servings of fish to everyone on the planet if by doing so we're going to deplete the the fish stocks in the oceans? Uh or what is the point in so what I'm saying is we need to be mindful of what we recommend to our patients or in public policy to see is this feasible. I do remember as an anecdote when I made the connection between nuts and particularly walnuts and sedum cholesterol, that the walnut producers in California they said if people have to eat two or three ounces of nuts a day, it's not going to be enough parking lots in California to take the asphalt out and produce because there is no uh so what I'm trying to say is that applies not only to applies to everything. I mean, we need to be mindful. And no wonder that I mean the production in California of almonds and wildnuts and all this has uh multiplied manifolds uh because of the demand, but I'm saying and also has environmental impacts, but I mean we can discuss that later if you ask me the question. Okay, so yeah, uh we showed that again a plant-based diet uh is not only feasible from the health aspects, but also is feasible uh and probably more appropriate than for the sustainable aspects. That I mean, people following a plant-based diet not only live longer, but also, I mean, the impact on the environment is uh overall uh less. Um previously uh people have just compared, for instance, one kilogram of beef versus one kilogram of soy. But you cannot just compare these two things because people, yes, sometimes eat the beef, I mean, just by putting on the grill, but the soy you have to manipulate, and sometimes people eat the soy not as a bean, but uh as a meat analog. So you have to uh test the foods as really eaten by the population and to see what is the environmental impact. So uh we have developed a data set and we have computed the environmental impacts of different diets uh using data from the Adventist Helder study that I mentioned earlier. There are some that eat meat regularly, others that occasionally, and others that never, but not only berries on the meat. I mean, the ones that do not eat meat, they eat more fruits, more vegetables, more legumes, more bread. So we need to account for all of these things into that, and as a pattern, not as an individual food, we uh measure, not model, because many of the studies uh before us and after us, I mean, they model things. I mean, basically it's a dietitian that's or a nutritionist that sits in an office, develops a diet, and then uses a computer and you model the effects. Well, that is good as an introduction, but I mean, uh, we measure the actual food patterns of people that live longer, that are healthier, and compare with those the same uh group that probably don't have as much health, but I'm saying uh with a different dietary pattern. And then we test ask the question besides health outcomes, do also have sustainability outcomes differently. And in summary, we found that uh the plant-based diets not only relate with lower mortality, but also relates with lower greenhouse gas emissions.

SPEAKER_00 33:09

It sounds like it could potentially provide more real-world applicability because it's what people are actually consuming. And you actually mentioned nuts as something that has some questions. And in my mind, nuts and plant-based milks are two of the questions that come up a lot in regards to the environment and sustainability. And my understanding is that you actually co-authored a scoping review on the plant-based-based milk side of things. And I was wondering if you could speak a little bit more to that question of what is the environmental impacts and sustainability of, say, nuts and plant-based milk alternatives in particular, so such as almond milk is one of them that relates back to nuts.

SPEAKER_01 33:53

Okay, let's start with uh plant-based milks first, that for which we we publish uh a paper. Um we wanted to see if uh um the plant-based milk that is okay, as opposed to a cow's milk that is, I mean, um you milk a cow and you get the milk. I mean, you cannot milk an almond or a soy and get the milk. So it there is some process involved. So there is what we say food processing. So we wanted to see uh what was published on the um environmental uh um effects of producing uh these plant-based milks. Of course, producing almonds or producing uh oats or soy is much less than the milk. But I mean, this is not the way to do that because this soy has to be uh you know, grounded and has to be soaked and has to be added, uh, and there are other vitamins that are added or whatever it is, then has to be packet. Uh, if it's fresh, it has to be refrigerated, as the cow's milk does. But I'm saying, so we look for studies that have checked all the life cycle assessment of this. And we found, first of all, because that was a scoping review, that means this is an exploratory review, that there were very few studies that have addressed that. There are many promotions of these milks, but I mean very few studies that have done, and some of them were basically commercially funded, which is nothing wrong, but I'm saying we we did that. In summary, what we found is that despite all the processing and all these uh plant-based milks, whether it's soy or almond or oats or peas, uh, you know, have a much lower greenhouse gas emissions than cow's milk. That's the first point. The second point on this review paper is that we compare the um nutrition uh composition, I would say adequacy. And it was clear that except for soy milk, I mean, the rest, although we can use for the word now milk, I mean, we're not very compatible uh with the nutrient profile of the cow's milk. So if someone wants to follow a plant-based diet for their children uh after breastfeeding stops, uh do not use all these meals except for soy milk. Soy milk is the one that mimics more, I mean, the cow's milk, and for which we have studies, not on this review but in others, that has been kids has been raised with soy milk. But uh all the other milks are good for adults, are good because, I mean, for those that want to follow a plant-based diet, uh, but nutritionally, I mean, are not adequate, I mean, for children. That's my recommendation. I didn't have any study on that, but I mean, that's uh what we say. Uh, because one thing is um, you know, a replacement, but you when when you replace something doesn't mean that it it is exactly the same as what you are trying to replace. So this is the summary of uh our study. Uh, regarding the nuts, we have to study nuts and sustainability uh from different perspectives. Uh nuts are very high in protein and very high in fat. So many people eat nuts instead of uh um similar sources of these nutrients from the animal kingdom. Uh given that the production of nuts uh has been concentrated uh in California. Uh and California is a Mediterranean weather, so I mean there is not much uh water like in Canada. In order to increase production, I mean, you need irrigation and this commercial production. So the production of nuts uses uh quite a lot of water. I can tell you that the word nuts in my um mother tongue, Catalan, is uh fruita seca, so dry fruit. That means that they were growing without much irrigation. So you were there for a year or two of your life and you realized that I mean you can produce hazelnuts and you can produce almonds uh with very little water. It's a dry fruit. However, here in California, I mean, to like any modern agriculture, I mean, to increase productivity, I mean, if you water heavily, I mean, you do the production. That happens not only for nuts, that happens to everything. If if you water your your grass, it will grow uh more. So there is a conjunction of two things here that people uh uh don't uh clarify in their uh in their mind. I mean, if you produce nuts for, I would say, the whole United States and half of the universe in a very small concentration with modern uh agriculture, that means quite a lot of irrigation, it's normal that they use a lot of water. But if we were to produce all the beef in California for all the United States and for half of the universe, I mean the amount of water that will be used would be tremendously higher. So we have to put things in perspective. No question that cultivating nuts, a kilogram of nuts versus a kilogram of lettuce, I mean, produce more water. But a kilogram of nuts has 20% of protein, 50% of fat, and a kilogram of lettuce is basically water. So I'm saying we cannot just compare orange with apples or lettuce with nuts. So we have to see things from another perspective. It's not by the weight, but also by the on protein basis or on fat basis that delivers. So from the protein basis, protein coming from beef versus protein coming from nuts, the amount of water needed is dramatically less.

SPEAKER_00 40:22

The context makes such a huge difference, especially when you're thinking about what you're comparing it with and what aspects you're comparing. And on the topic of nuts, I really want to get into this a little bit because your 1993 paper in the New England Journal of Medicine was the first to show that walnut consumption can improve heart health, as you mentioned earlier. And I was wondering how did this groundbreaking research shift science, the understanding, as well as public dietary guidance on nuts and lead to all this other wealth of research that you have conducted as well as others?

SPEAKER_01 41:01

Well, as Stephanie, you have done your homework. I mean, you you bring me back to a few decades. Okay. I did this study uh because uh, as I mentioned earlier, we uh as in my postdoctoral work, I found that nuts lower the risk of cardiovascular disease. So, as a good scientist, I wanted to know why. And so the idea occurs to me that doing a small randomized dietary intervention trial with NOTs, I mean, could help me to know if indeed NOTS changes the risk of cardiovascular disease. In this particular study that you mentioned, that was the first one, was for cholesterol and blood pressure. And we found that on this particular study have were no changes in blood pressure, but a dramatic decrease in serum cholesterol, particularly the LDL cholesterol, which was at that time considered, and is still now the bat cholesterol, with no changes in HDL cholesterol. So the ratio of LDL to HDL was in a favorable direction. We didn't uh test walnuts against butter, that we already knew probably the results before starting. I tested walnuts against a cholesterol-lowering diet, the step one diet at that time. So it was irrefutable, the results, because in addition, it was uh crossover design. So the same genetic pool, the same subjects. I mean, there was no confounding factors by other aspects. And it was a metabolic study in which subjects came to the metabolic kitchen seven days a week, three times a day, I mean, to eat the meals. Uh they had to lick the plate, I mean, uh, to finish everything under the uh direct um observation of the researchers. And I was at that time very young, so I spent half of my day in the metabolic kitchen. Okay, so that's what happened as far as the nuts. Why this had so much interest and what this changed my life? Because after that, given not only the media but also the scientific interest, I have spent 20 years of my life, I mean, just doing uh other studies with wildnuts as well, but with other nuts, I mean, and different cardiovascular disease, diabetes, and many other aspects. Because, and that was not my idea, but is because then it was the first time that people could incorporate something into the diet that has good results. Until then, the message by the dietitians or by the physicians was remove fat, remove butter, remove this, remove that. So this is not something that people like, but the message incorporate nuts, a crunchy, tasty food. I mean, this is. It's you don't need much health education for that. I mean, that people automatically get it and can practice. So, this is one of the aspects. The second aspect is that notch uh are full of fat, therefore the satiety level is high and are tasty, so on and so forth. So the American Heart Association, that is the one that gave me the uh the postdoctoral fellowship, recommended not to give not or not to prescribe, recommended to the physicians not to prescribe nuts to uh um hard patients because they are high in fat. I'm talking about 40 years ago. Now they have changed completely thanks to our research. Uh but my point is the idea that you can eat fat because the fat is tasty, it's good. I mean, uh it changed the paradigm as far as research. Um and that's we know that really unsaturated fats and the importance is not the fat. What is important as far as the health uh is the type of fat and the sources of fat. So these are the two aspects that I think uh made the this process you know relevant and getting much more interested in what probably should deserve a smaller study. But I mean, being first and and and and really changing the paradigm as far as uh what is good for you uh as far as preventing heart disease.

SPEAKER_00 45:38

I also just want to highlight the design of the study that you did. It's one that researchers can say, oh, that's showing cause and effect. Not all research is able to show that. And this paradigm shift that you had, especially it's a positive. It's something people can do or add instead of putting restrictions on people, that changes mindsets quite a bit. And along these lines, you've served on dietary guidelines advisory committees, specifically in 2020 in the US. I was wondering if briefly, because I know we're getting close to time and I feel like I could just keep speaking with you, but could you tell us about your experiences on being on this committee, especially with your previous research background, and how did you advocate for integrating plant-based and sustainability perspectives into national dietary guidelines? Or what was your experience with that?

SPEAKER_01 46:34

Well, um I think it was overall a very good experience. Well, it it is a privilege to be part of these dietary guidelines. There were only 18 or 20 of us, I mean, selected. So when I received the invitation, I took as a privilege and an opportunity. The second point is that I think I was there not because I'm a great scientist, it's because I mean I uh in a way spouse I mean uh plant-based diets. So uh as there is now in the committee for 2025, there is one member at least of the committee that clearly and unapologetically espoused this diet. So uh I think I was there because to uh present uh the uh be aware, uh make aware the rest of the of the group of of the plant-based diets. So uh on all of this was positive, and I think uh my influence uh or my advocacy or whatever you want to say, I mean, probably uh had uh some effects. Uh what I was not necessarily happy uh is that it was from day one, it was clear that I mean, this uh even though there was a need and a push in the society and in some of us in the committee, we were told very clearly that uh contrary to the previous year, that we were not going to spend any time on the sustainability aspect, and that this uh we were going to only base our uh you know conclusions on the health aspect. Uh, I was a little bit disappointed because uh by then I had already published the environmental nutrition book. I thought that I was there, I mean, uh also to bring these ideas, so I could not um have any influence on that because it was clearly off the table. So that that that was in a way the disappointment. Nevertheless, I mean the the committee carried on on the previous ideas of the 15, in which there are three dietary patterns that are recommended for health, because now we have to move beyond uh foods or beyond nutrients. We have to go for diet patterns. And the dietary patterns that uh were previously proposed was the healthy American diet, whatever that means, uh the Mediterranean diet and the vegetarian diet. And as you know, because you have been in the Mediterranean uh for a few years, I mean Mediterranean and vegetarian are both plant-based. I I'm I'm happy for that, and I still it it continues to be in this way.

SPEAKER_00 49:27

Thank you for that. And we'll link um the details for your book as well as some of your papers in the show notes so that listeners can peruse those if they're interested. But I want to hear from you for listeners who want to explore your work further, where can they find more information or resources about yourself and your work? So I'll aim to link some of your articles and potentially like a PubMed or research gate for you in the show notes. Is there anything that you would like to promote or share with the listeners in terms of what you're working on, where you're working, and so forth?

SPEAKER_01 50:03

Well, I mean, I had several areas of interest. I mean, as you know, one is that not only nuts, but that has moved to uh individual plant foods and health outcomes is easier in when you do in a control study to test the effect of a nutrient of a food, but not of a dietary pattern. So for practical reasons uh and logistic reasons, we do studies with mangoes, with avocados, with soy, uh, with many types of nuts and different health outcomes. So this is one area of research and uh and publications. Uh, the other one is more uh on nutritional epidemiology with uh not uh different aspects in the Adventist Health study and on sustainability, particularly uh on that. I mean, to see if, for instance, we are now exploring if different levels of sustainability uh relate uh not only to the foods, but also to the way that people consume foods. Because uh, in order to be uh to have a sustainable diet, um, it's not only the foods that you choose, but also you can choose the right foods, but if you uh only use disposable plates or you uh always uh buy things in in um small containers, I mean, that uh are plastic or whatever, and many other aspects, or if you just eat half of the what is served and then you throw it away. So there are more aspects uh besides the food that you choose, uh, in addition to the food that you choose. So I mean, we're uh doing research on on these aspects. And by the way, if anyone wants to listen, I'm actively pursuing recruiting uh a nutritional epidemiologist uh that is interested in sustainability uh because uh we have pending work that needs to be done. So if you or anyone wants to post Dr. Loma Linda, just contact me.

SPEAKER_00 52:09

And I'll share your profile link for Loma Linda University in the show notes for anybody who's interested. So if there's any nutrition epidemiologist out there, it'll have Dr. Sabate's contact information. Yeah. And finally, just because I know we're at time, I can't believe it. But is there a key message or idea you would like to leave our audience with today?

SPEAKER_01 52:34

Well, I assume your audience are people motivated and interested for plant-based diets. Uh I I would probably recycle at the beginning. I think when you make a decision, always consider not only your health, also think about the adequacy and also think about the sustainability. Um historically, uh, nutritionists were only thinking about the adequacy. And what happened is that by uh eating foods such as animal products that are very rich in nutrients, uh we end up not with the best health outcomes. Uh later, uh we incorporated the concept of a healthiness. Uh, so it's not only adequate, but something has to be healthy. Uh, and nowadays uh we have to think about sustainability. Uh the advantage of many plant-based diets is that they can meet the three parameters and probably better than other dietary patterns. But not think that because you uh do not eat much animal products, that that is all what you can do. I mean, the way you consume the foods, the way uh you dispose of the foods and all of these things, I mean, is very important, and we have to be mindful uh of that.

SPEAKER_00 54:11

Dr. Sabate, thank you so much for being a guest on the Plant-Based Canada podcast. It's such a pleasure to get to speak to you always and especially for this interview. So thank you so much.

SPEAKER_01 54:22

It has been a pleasure. Thanks for giving me the opportunity, and uh uh we'll be happy, I mean, to collaborate to help you in other endeavors.

SPEAKER_00 54:32

Thank you so much. This episode was hosted by myself, Stephanie Nishi, and Clint Stamatovich is our audio technician. This podcast featured royalty-free music from Freesound.com. A very special thanks to our guest, Dr. Juan Sabate, for speaking with us and sharing his insights. And of course, thank you for listening. If you enjoy our podcast, please consider supporting the show. You can do this by clicking on the link at the bottom of the show notes. The Plant Based Canada podcast is an initiative of the group Plant Based Canada, which aims to educate health professionals and the public on the evidence behind plant-based whole food nutrition for individual and planetary health. To learn more about the show, visit our website at www.plantbasedcanada.org and stay up to date by following us on Instagram, YouTube, and Facebook at Plantbased Canada.org. Until next time.