so i was working on the red meat video that came out last week and youtube just kept suggesting
more and more meat videos, because they know what we're thinking before we even know it
so creepy. this one said "oxford meat debate" so i was like, it's probably some oxford professors
lecturing about heme iron. boy was I wrong. it was actually a young woman named Mikhaila peterson
sharing a very tragic personal story and i gotta tell you i was riveted from the
beginning. she had a terrible case of autoimmune disease starting as a child and had to have
several of her joints replaced. i was diagnosed with juvenile rheumatoid arthritis when i was
seven with symptoms starting when i was two. i had 37 affected joints. i lost my hip and my ankle. very
touching. she eventually found relief by going on an extreme elimination diet. it sounds like she's
eating nothing but red meat, salt and water. so this struck me at multiple levels, first at a general
human level, i think anybody can empathize with a child going through a situation like that. second,
we have viewers with related issues who contact us and who are hungry for some answers, and third, i've
had several family members including my mother and a brother-in-law who also had extreme intolerances
with excruciating pain, reduction of quality of life and had to go on radical elimination
diets as well, so i've seen this happen before my very eyes. just to clarify, we're not comparing
situations, obviously hers is very extreme, going through this as a child, so we're not saying this
one is the same as that one or better or worse we're just trying to make sense of these extreme
intolerances. and second, we all understand these are anecdotes, mikhaila's, my mother's
we're not trying to derive some overarching scientific fact from these situations alone
we're just trying to get some ideas, discuss the topic and get some ideas as to what might be going
on. now, most people i've talked to would ideally like to see the situation solved and have the
choice to eat whatever they want. that was the case with my family members and that seems to
be the case with mikhaila as well. i don't really want to be on this diet but i can't introduce
anything without having my autoimmune symptoms come back. sometimes it's the monotony, other times
it's concerns about health or ethical dilemmas and another element that i've heard consistently
is an element of social condemnation, almost like feeling a finger pointed at you all the time
and a sense of guilt. my absolutely absurd health experience that's received widespread negative
media attention. so to anybody in that position i always say the same thing i told my mother back
then, don't feel bad, eat what you gotta eat to make the pain stop and have a decent life
there's no shame in that. and the second thing i told my mother was, while you're doing that,
we're going to keep searching for answers, we're never going to stop,
and we didn't, and we eventually were able to find them and reverse her condition but
it wasn't easy and it wasn't fast and i've actually published a video several years ago
detailing that process and i'll link it at the end. now, i'm not for a second suggesting that
everybody's situation is going to be the same, obviously everyone's different, some conditions
can be reversed and some maybe cannot, but it's important to explore that possibility before we
rule it out. so, listening to mikhaila's story, at a scientific level a couple of things occurred to me
one, pretty obvious, were there one or more food allergies involved? she says she had juvenile
rheumatoid arthritis and there are some suggestive links in the literature between food allergies
and rheumatoid arthritis, including some in young patients. another quick clarification,
we're not trying to diagnose her, you don't diagnose people over the internet
whom you've never met, it's not professional, it's not ethical. we're just thinking out loud
what are some issues that could be involved and where can we go next as we try to figure out
this issue in general. i also wondered if there's a gastrointestinal condition
at the root, she did mention she had many health issues but i don't know if there were any
gastrointestinal symptoms, but ulcerative colitis for example, which is a form of inflammatory bowel
is often linked to rheumatoid arthritis and one of the therapeutic approaches to some of these
gastrointestinal conditions is something called a low fodmap diet which is a diet that restricts
several types of fiber, so it's reminiscent of the improvement she reports experiencing on her
low fiber elimination diet. now, maybe her doctors already ruled out all these possibilities or maybe
not, this is just to illustrate the general process that we actually applied to my mother's case
initially her condition was a complete mystery to us and we just kept digging into the literature
we wanted to know everything that was known in this field that was relevant to her situation
and we kept knocking on doors and talking to specialist after specialist until we had some
answers. we actually have a whole video coming on how to do your own research that covers the tools
and the mindsets and this whole process in general for anyone who's interested
in replicating it. the idea of course is to identify the root cause, to get a proper diagnosis
so that you can then intervene at that level if that's possible. so that's what ended up turning my
mother's situation around. now, the tragic thing is a lot of times people who have been through a lot
and haven't really gotten any substantial help from the medical system sometimes give up on
doctors and medicine altogether and i can't blame them. i tried going the medical route and it didn't
work. it was very frustrating and very exhausting for us too, we just kept seeing doctor after doctor
in that field and initially we couldn't get any answers other than "okay so you just avoid all of
those foods that you can't tolerate for the rest of your life, bye". and they weren't trying to milk
us for money or holding back knowledge, nothing like that, they told us what they knew, it just
wasn't much. so we had to keep searching for answers and eventually the solutions we found
were scientific, they were things that had been published and professionals that dealt
with these issues routinely. unfortunately, the more atypical your case the more you'll have
to search because the professionals who have experience in that area will be less common
what i can tell you is, seeing my mother now, much healthier, with a more diverse diet,
happier, it was all worth it a million times. in our case, the key was reintroduction, which is something
i wondered about regarding mikhaila's case as well. so with low fodmap diets there's an initial phase
of elimination, of simplification of the diet, and then there's a subsequent phase of reintroduction
now this is very counterintuitive and a lot of people balk at the suggestion of reintroducing
foods that cause symptoms but this is actually a pillar of the approach, particularly with some of
these gastrointestinal conditions. even things that we find pretty scary and categorical like
peanut allergies and kids, for example, which the default approach is just keep the peanuts
away from my kid indefinitely, and yet this new trial just came out where they took allergic kids,
peanut allergies, and they exposed them to specific doses of peanut protein, and that might sound crazy
because it's counter-intuitive but they were able to greatly improve the allergies and in some cases
the kids even overcame them completely, so reintroduction when done right can desensitize
the immune system in some cases and it can rebuild the ability of the gut to digest some of these
problem foods. so that's exactly what happened to my mother. in her case it was IBS, irritable
bowel syndrome, and she had a strong intolerance to pretty much all legumes, whole grains and most
fruits and vegetables, so she went on a type of low fodmap diet, not quite as extreme as mikhaila's
but in that general direction, and then we went into the reintroduction phase, very carefully and
very gradually, first things like white rice and white potatoes because they're easier to digest
then the whole grains, always very small amounts at first, third step was legumes, and then finally the
rest of the fruits and vegetables. sometimes it would cause a flare-up and we would take a step back
and then slowly move forward again and there was significant hesitation
and fear on her part, understandably. i can't begin to describe the level of terror of
having diseases return. but eventually the floodgates opened and she did almost a 180
between phase three and four, between the legumes and the rest of the fruits and vegetables
and almost it seemed like overnight, she could eat whatever and feel fine
beans, lentils, whole grains, fruits and vegetables, it was really quite something to watch. but if
this process is done randomly or too abruptly or if there's an underlying issue that needs
to be addressed first, then reintroduction can cause symptoms, can cause an episode
so the how is pretty crucial. now, mikhaila does say that she tried to reintroduce some foods and had
symptoms. i've tried to reintroduce plant foods. which is not that surprising so i wonder about
the details of how this was done, ideally if people have that option this is done under the
supervision of an experienced professional, like a registered dietitian with experience in this area
and of course there's always a theoretical possibility that there's an irreversible
condition but we get there by exclusion, it's not the default conclusion, right? now, the second
part of her speech was very interesting because after sharing that very touching personal story
she went on to list some common ideas, things like "saturated fat doesn't cause cardiovascular disease",
"nutrition is all epidemiology", "fiber is not that important", these are very common misunderstandings
and we've addressed them in previous videos but this time it was different, it felt different for
me. because this wasn't a scientist trying to make those points on a scientific basis
and because i had just come from watching her personal story and felt empathy towards
her, i didn't judge those points scientifically, i wasn't in science mode, right? so i was able to feel
where she was coming from emotionally and kind of get a sense of why these beliefs are so compelling
to many people and why they embrace and defend them so fiercely. i think there's an element
of self-image and peace of mind about believing these things much more than, you know, what studies
or what data is out there. in fact, it would feel out of place to do what we normally do
in these videos and start fact checking those statements with a bunch of data
right? it would feel like it's the wrong tone. her speech is not about those bullet points,
it's about her personal story. it doesn't behoove her, it's not her responsibility to know what data
exists or not or what meta-analyses were done or were not done, I mean... medicine is about both
the evidence and the person sitting in front of us so i thought it was very refreshing to see things
almost through her eyes, to almost feel why this world view can be so important, especially in her
situation. now, amazingly it sounds like she changed her entire speech right before the event. i rewrote
my entire speech an hour ago. to include her personal story, which i think was a phenomenal move
because as it turns out this speech was part of a debate on whether we should move beyond meat
on whether humans as a whole should stop consuming and stop producing meat, and the second part of her
speech, with the bullet points, is not compelling, scientifically or personally, but the first part,
with the personal story, in my opinion settles the debate. how can we tell somebody in her position,
who's gone through what she's gone through, that she has to stop doing the only thing she's found,
at least so far, that made the pain stop? it'd be insensitive, it'd be absurd, and she's not going
to listen, and quite frankly, why should she? when we're in pain we want the pain to stop
we don't want rhetoric or bar graphs. if we can offer some real solutions and reverse the
intolerances and fix the underlying issues, like we were very fortunate to do with my family members,
most people will take that. but if we can't, if we don't have something better to offer,
they're going to avoid the foods that cause pain and they're going to fight anybody who tries to
stop them, and that's entirely understandable. so, guilt tripping someone in that position is a waste
of time and quite frankly, it's cruel, it's inhumane. with meat there's usually three aspects that come
up: health, environment and ethics. and i don't think any of the three apply to her situation, and i'll
tell you why. health is about risk benefit, as we talked about last week, what she's doing is clearly
preferable to where she was before, any concerns about long-term cardiovascular risk, risk of cancer,
are completely superseded by the devastating issues she was already having, having joints
replaced as a child, so until there's a real solution to the underlying problem,
this is all she's got. now, the challenge in science is to find a model that explains all
our observations, not just a shred of evidence, so telling her that she needs to go eat a salad
because of this study or because it's healthy for most people, is not medicine. if she's tried that
and if it gives her debilitating symptoms, telling her that she needs to go do it anyway is divorced
from reality. by the same token, we don't want to be glib and extrapolate from this case and my mother's
case and other cases that "oh, i guess vegetables are unhealthy for humans and we should all ditch them".
that's not science either. we want to reach understanding without ignoring people's
individual circumstances or scientific knowledge as a whole, that's medicine. second, the ethics, i see
no ethical problem with what she's doing, feel free to disagree below, it's her immediate well-being
and life on the line. and third, environment. we know from a lot of research, interestingly
some research out of Oxford university, where she's speaking, that we can't solve the climate problem
without changing our food system, and unfortunately red meat is the number one offender with just a
disproportionate carbon footprint, but this works at a global scale, we need to cut back as a team,
the pressure is not on her to cut back, it's on me, i'm incredibly fortunate, no matter what i
eat i feel the same, short and medium term at least. at different points of my life i've eaten more animal
products and less, more processed food and less, i feel the same regardless. so it's on me to do the
heavy lifting, to do a little bit extra, to consume and pollute less through my choices so that people
who can't choose can eat whatever she needs to have a decent life. i think this is obvious. and i'm
very hopeful that lab-grown meats will be scaled up and become a part of the solution soon without
the environmental and ethical issues, that would be a godsend. and like i told my mother, we will never
stop searching for answers. i actually had some gastrointestinal specialists lined up last year
but due to our family health crisis, which a lot of you guys are familiar with, we had to power
down the entire channel and cancel all of that, but now that things are much better, much more under
control, i'm gonna have those people on very soon and we're gonna try to have some answers and some
clarity, alright? these are not the easiest topics in the world to broach, there's a lot of emotion,
but fighting is not gonna take us anywhere, we have to shoot for some scientific understanding and
some real solutions. alright? so let me know your thoughts below, take care, see you next time, bye