Plant-Based Medicine and Healthcare Reform with Dr. Zach Burns

Jasmin Singer: It is such an honor to have you here, and Mariann and I are so excited that we're near you physically, that we're local, because the work you're doing is really cool, and we feel like we've kind of hit the lotto. You know, we're both sort of new to the area, and when a connection like this happens, it's selfishly very satisfying.

So, are you fairly new to the area as well?

Zach Burns: I am. I moved here in August, and part of the draw was there's a really solid vegan movement here, as well as a lifestyle medicine movement. I think disproportionate to the size of the city. So, um, kind of moved for other reasons, but it was a big bonus.

Jasmin Singer: Yeah, it's such a big bonus, and Rochester is cool because it's like, you know, not that this is a PSA for Rochester, but why not? It's like, kind of got all of the big city perks in a mid sized city, so it is nice when things like this happen.

Mariann Sullivan: I will mention that as we are recording this, I think it's five degrees out, just so people know.

Jasmin Singer: Yeah, that's true. There's that.

Zach Burns: The sun is out though.

Mariann Sullivan: The sun is out.

Jasmin Singer: Dr. Burns, we will probably go across a whole lot of topics here today, because there are a lot of things we want to chat about. But first, just a little bit of background. Can you just give us that elevator speech about, like, who you are and what you do, and then we'll get into the details.

Zach Burns: Sure, I am a first year as a fully licensed attending physician. I do family medicine, so that means I graduated residency just less than a year ago, and now they let me loose. I'm on my own. Um, and so I took my first job here in Rochester. It's at the University of Rochester. I'm at a family medicine practice downtown. But then I've carved out part of my job, totally separate from clinical work. I do Moving Medicine Forward. So I'm the Associate Director there. It's a non profit led by the luminary Dr. Michael Klaper. And our mission is to augment medical school curricula to make sure that food as medicine is being taught because it turns out it's kind of important.

Jasmin Singer: So I hear.

Zach Burns: So that's my professional life.

Mariann Sullivan: All right. So I want to start with some policy stuff like there's two different separate parts of this interview. One is your work as a physician, but also you do this policy work, through Moving Medicine Forward. And I think really like it's just something that you think about a lot too. And like your personal story is really interesting, but I wanted to start with this one thing that you talk about, and I'm not sure anyone else is really talking about it. I mean, I think I would have heard it. And that's this thing about the pharmaceutical industry. I mean, everybody's talking about the pharmaceutical industry, obviously it's a huge issue, but until I read some of your work, I hadn't realized how it is truly undermining the adoption of plant based diets. You seem to think that the pharmaceutical industry is the greatest obstacle to why people aren't eating healthy food.

Am I overstating that? Or is that right?

Zach Burns: That's exactly right. You know, there's a lot of criticism of the pharmaceutical industry. It's all over the news, but I don't think people have adequately made that connection between lifestyle medicine. And we should define that because not everyone here is familiar, but within medicine, there's this movement, it's became kind of codified in the last 20 years, and it's advocating for basic things that we've known about for millennia, like eat your fruits and veggies, get enough sleep, avoid drugs, foster social connection. But it's formalizing and legitimizing those things to make them significant in health care, if we have a chance of addressing chronic disease. So, there's a national organization, the American College of Lifestyle Medicine, and they have this huge and growing annual conference, which is the hub for this niche within healthcare. So you have lifestyle medicine, but I think not enough people are talking about why it's been slow to have widespread adoption. Given that it's common sense medicine, and given our horrific prevalence of chronic disease, which is largely preventable. The costs in human suffering and economic costs of our sort of sick scape, or, you know, our sick care system, right? You'd think that lifestyle medicine would have taken off. And so my view is that the pharmaceutical industry is the single biggest hurdle. So I gave a lecture on that at a conference recently, and I've been trying to bring that into our programming with Moving Medicine Forward. Because I think that for learners, for med students, and residents, plant based nutrition and lifestyle medicine is actually more compelling. Once they realize that it actually would have been the default in your classes, on your board exams, in the clinic where you'll practice, it would have been normal already if it weren't for the pharma paradigm, which is kind of invisibly that's our milieu. It's like a fish in water. You don't realize you're in water

Mariann Sullivan: Yeah. I mean, I had a doctor recent recently say to me that the only thing you learn in med school is about drugs. That might have been an exaggeration, but she was frustrated by that situation. On the other side, like, you're equating lifestyle medicine and plant based nutrition.

Are they always synonymous? I mean, there are a lot of theories out there about what's the best diet for your health. Is lifestyle medicine always embedded in plant based as the way to go to improve your health?

Zach Burns: When you talk about lifestyle medicine the connotation is that plant based nutrition is one of the main pillars. Lifestyle medicine is more broad. So, they're going to talk about sleep and social connection and, you know, all these different things. At Moving Medicine Forward, we're more focused on the nutrition pillar. Fortunately, the ACLM, that national organization that I mentioned, they have a plant based orientation, so that's really important, they're following the massive literature we have on the role of plant based diets to prevent and even reverse most of the medical conditions that we're seeing in affluent society. So yes, it does kind of, lifestyle medicine entails plant based nutrition. Of course, you have other movements that are advocating different diets. Sometimes they overlap with a whole food plant based diet, and sometimes they're completely divergent.

Jasmin Singer: So I know we were just talking about the pharmaceutical industry and I just want to go back to that briefly because it's just such a big topic and it certainly is right now. This sort of stranglehold that the pharmaceutical industry has on the practice of medicine in this country, just going back to that, is there any hope, do you think of shifting that?

Zach Burns: Yeah, it's going to be an uphill battle. When I first met with Dr. Klaper, this was a Zoom meeting, he was kind of sizing me up, and at the end, you know, we were thinking about partnering together. I would help him tap into med student communities. I was a student at the time, and of course, I was fired up to be working with this person.

I really, really revered him. I still do. And he said, Zach, just want to make sure you realize we're hacking at the ankles of giants. And, I said, sign me up, you know, even if it means I got to get my shoulders replaced and it'll be banished from the giant's realm. So that's kind of the direction I took five, six years ago with him.

And so it's not popular or, you know, professionally convenient to criticize the pharmaceutical industry. But I think it has to be done if lifestyle medicine is to succeed. Can we succeed? Yes, because it's the winning argument. It's on the right side of history, just like, you know, vegan from the animal ethics standpoint. It's really an uphill battle, but it must succeed because it's true.

Mariann Sullivan: That's what we're always saying here, like no matter what the issue is, we're losing on every front except we have one thing on our side. We're right.

Zach Burns: Yeah, exactly. And that's worth fighting for. Any any progress in history, it's some people realize that it's true, this is worth fighting for. We're not gonna give in because it's more convenient to just kind of acquiesce. But I could expound a little bit on the pharma issue if you'd like.

Jasmin Singer: Yeah, absolutely. I mean, I am just curious, especially in light of, you know, the guy who was murdered, and to be clear, we're not contoning murder. I can't believe that we have to say that, but okay. But I would love to hear any further thoughts you have, because so many people clearly, it was so clear when this happened, hate the health industry, the health insurance industry, I should say.

Paging Dr. Freud. So tell us a little bit more about what your thoughts are here.

Mariann Sullivan: Especially how how... is health insurance and the enormity of that and how completely screwed up it is in this country connected to this whole, uh, dominance of the pharmaceutical industry.

Zach Burns: Yeah, so you know, you're bringing up how convoluted this is. I remember sitting in some med school classes and I'm like realizing, you know, I'm talking to myself like, in addition to learning this physiology and these intricate pathways and all this stuff that I need for my exams, you're also telling me that I'm entering this healthcare industry with all of its, just, it's just such a thicket. But if you can, like, you know, scrape your way out and find some visibility through it, some clarity, then you do it because it's really rewarding work. So, you know, both individually on the patient level and on the population level, if you can make a little dent in some of the structural issues. You're referring to when the UnitedHealthcare CEO was assassinated recently in New York. That's a big moment. You know, there are a lot of erratic people with guns these days, apparently, and that's really terrifying. But there is some symbolism there. If it was kind of politically motivated, it sort of represents how desperate people are, when it comes to health care and denial. So often, basically the business model for private insurance is to deny claims. So you want to see the doctor, you want new medicine or a surgical procedure, the insurance company, the payer, as we say in the industry, ideally they deny it so they don't have to pay for it. Kind of makes sense. They just want to minimize their costs. The problem is, it just limits access to health care. That's a whole conversation we could have about health insurance and access. How it connects to pharma, I'd say, is that it's, it's another monolithic industry that really shapes how health care plays out. And so with pharma, let me try to explain from the beginning like how pharma came to dominate health care. Because now it's more than ever, but this started in the 80s, like, you know, a lot of other industry consolidation happened around then. In the Reagan years, you know, there was more pro business, and so there's certain policies. What happened in the 80s is you started to have, like, privatization of scientific discovery. So even if the scientific studies happening at these universities were funded publicly, say by the NIH, there's a law passed in the early 80s where you could make a patent on the publicly funded discovery, so that it could be sold privately. So you're seeing kind of the transfer of funds from public to private sector. And that was a trend that continued through the 80s and 90s. You started to have the research for these clinical trials, looking at drugs, it went from being at universities, an academic setting, lots of oversight, research faculty, like, scientific integrity, and it gradually started to happen, instead of in the university lab, it happened at these contract research organizations, CROs, where basically the drug company running the trial is in charge. Not as much oversight, more convenient for them. Fast forward to the 2020s, and we have a situation where about 70 percent of clinical trials, and when I say that I'm talking about drugs, right? They're experimenting, they're using a drug, on people ultimately, to see if they can get it approved by the FDA to sell. And that's crucial to their business model as a pharmaceutical company. You got to run the trial, get it approved, market it, make your money, turn it around, invest that money in a new drug. So you have these clinical trials and about 70 percent of them are funded by the industry themselves. About 50%, this was on a meta analysis where they looked at some major commonly cited clinical trials over the last few years. Hundreds of these trials were included in the study and found about 50% were exclusively funded by the industry. That means that it's a trial exploring the utility and safety of a drug funded by that drug's parent company, the manufacturer of the drug.

Mariann Sullivan: What could possibly go wrong here?

Zach Burns: That's the question. There's this inherent conflict of interest, and for a number of reasons, mostly economic, we essentially don't care. We're largely uncritical of this situation.

To hone in on that conflict, you have the idea for a drug. Okay, we're going to target type 2 diabetes using this receptor in the gut. Okay, the concept of the trial is conceived by the company. Then the funding is supplied by them, the design of the trial, because it's, it's a science experiment, it's got to be very rigorous, like you need, you know, there's biostats, like it's a whole thing, as you know.

So the design, who's going to conduct the trial, which involves hundreds or thousands of human beings and their health care, it's conducted largely by the industry. The data that comes out of the trial is interpreted and analyzed by the drug company. Then the write up is written by them in their, what they call, their editorial assistant. So if you look at these trials, sometimes it'll say editorial assistance provided by the parent company. Okay, so then we're at the stage of the write up, the analysis of that trial. Then it goes to the FDA, say it's approved because they've demonstrated a minimal level of efficacy and safety of that drug. So now the company is ready to aggressively market it from all angles. That involves bringing it to some of the prominent medical agencies, like the ones representing cardiology or diabetes or nephrology. And at that point, it gains a lot of legitimacy, all right, and it's published in the prestigious medical journals, and then the doctors, you know, I've seen this firsthand in residency, People go nuts.

It's like, we're like at a Taylor Swift concert. We're going, oh, there's a new drug. There's a new drug and we can prescribe it for diabetes. People are viscerally fired up about this. They're raving about the new trial. You earn points if you've read it and you can cite it for your attending when you're on rounds in the hospital. And then we start prescribing it.

Mariann Sullivan: And, and now we're, now we're getting where the rubber hits the road, right? This is when the patient comes in and you test them and their A1C levels, I can't believe I even know that word, A1C levels are all off and the doctor has to decide what to do. And this is where they turn to the drug instead of saying, try these lifestyle interventions.

Is that how this all connects?

Zach Burns: Exactly. That's how it becomes, you know, technically the first line for a lot of these metabolic or lifestyle diseases, like diabetes, technically it's lifestyle, but it's more like paying lip service to lifestyle. And what effectively happens is, yes, the effective first line becomes starting a medication. And that's all because the medications have gone through the process I just mentioned and been aggressively marketed, not only to patients on TV, that alone is inappropriate in my view. We're one of two countries in the world where it's legal to advertise drugs on TV.

Mariann Sullivan: Well, and they advertise nothing else. Like nothing, all of the ads that I've been seeing are about pharmaceuticals. Well, mostly about GLP ones.

Jasmin Singer: I think that the algorithms are really funny though because just before this interview, I was downstairs and my wife had on the news or something, but it was like Hulu live TV. So the ads are specifically chosen for you. And we got like a older dude who needed Viagra and we're like, yeah, we're middle age lesbians.

You've got us all wrong. But, anyway, I totally digress.

Zach Burns: Yeah, it's almost, sometimes I feel this like immense relief when they get the algorithm wrong.

Mariann Sullivan: Yeah, me too!

Zach Burns: Because

Mariann Sullivan: Yeah.

Zach Burns: Or maybe that's intentional.

Jasmin Singer: Yeah.

Mariann Sullivan: I But then when they do ask you like what thing you like, it's always good to answer incorrectly.

Jasmin Singer: I keep seeing the cutest shoes advertised in front of me for like Skechers, so I click on it and I realize it's shoes for toddlers. Like apparently my style choices skew young and now I keep getting ads for toddler related things. Again, I digress.

Mariann Sullivan: Well, getting back to the topic at hand, I think that you have really demonstrated how the pharmaceutical industry, and I assume the health insurance industry is connected to this, because I do find that, like, there are things they'll pay for and things they won't pay for. This is just personal experience.

And they always seem to be willing to pay for drugs.

Yeah, I don't know, like if you're covered, but there does seem to be some kind of connection there. But, I also want to point out before we leave this, that I don't think you're saying that nobody should ever take pharmaceuticals. That was my mother's stance.

But, there's like, there have been miracles, right? I mean, like, for some diseases that really have been addressed. So how do people negotiate this world?

Zach Burns: Yeah, it's a really important point. I'm not suggesting that we boycott any drug company or their products because in some cases, with some drugs, it's the best option. And there have been transformative drugs created by this industry. So that's why it's a little confusing. And I think that's why the medical community is pretty sympathetic to the industry.

'Cause once in a while we come out with antibiotics or HIV drugs or vaccines and they can be transformative. It's just that most of the drugs coming out in the last couple decades are not transformative. That's like a word that's used. I've seen stats that only about one out of 10 new drugs are actually worthwhile.

Right. The other ones are basically a business enterprise. And so, one distinction, alright, you ask, how does a patient know, like, is this drug real, is it effective, or is it just one of these things they're trying to sell us? I think, generally, when it comes to chronic disease, that's when you know the drug might be more of a marketing scheme. Of course, for some people, if say, their diabetes or their heart disease is not under control, a medication can be the lesser evil, of course, because it's dangerous to be in that physiologic state over time.

So you can reduce your risk by being on some of these drugs, but I think it should always be in conjunction with a broader plan for lifestyle changes. And also, I think doctors need to be taught how to really analyze the literature for conflicts of interest, and really understand the risk profile of these medications so we can adequately discuss that with the patient. Patient deserves to know all the side effects. I think my suspicion is that these days when a doctor prescribes a GLP 1 like Ozempic, we are not sufficiently discussing the things that could go wrong.

Cause it could be that it makes sense to start one, for a patient, but they really should know like what can go wrong so they can make an informed choice about whether they want to go that route.

Mariann Sullivan: I promised I wasn't going to make this interview about me, but now I'm going to tell my own story about like, recently I went to a doctor because I have a arthritic knee and he wanted to prescribe pain reliever. And I said, I have high blood pressure or I keep it under control, but I'm prone to high blood pressure. And he said, fine. And he said, okay, I'm gonna prescribe this medication, some kind of painkiller. And I go home and I look it up. And the first side effect is high blood pressure, like, like I actually told him this was a problem and he still just ignored it. And I mean, knee pain is really annoying, but high blood pressure actually kills you.

Jasmin Singer: I had the same thing happen, but on the opposite end, which is my blood pressure runs low. And I was put on a medicine for a skin issue. I have that is usually given to people to lower their blood pressure. And then when I got COVID for the first time last August, my blood pressure tanked and I passed out and had to go to the hospital.

And it was all because I was on this medicine that lowers your blood pressure. It's bananas. Can you fix

Mariann Sullivan: Like, I really feel like patients have to advocate for themselves and they have to learn as much as they can. And getting into the, more what you do on the every day and off of the pharmaceutical policy issue, which I wanted to start with because I'm so passionate about it. But you are in family practice, and you must run into people all the time who don't know all these details about medications, about diet. How do you address these issues with your patients who really don't know much of anything? Do you try to encourage them to adopt better lifestyle practices? Do they come in asking for pharmaceuticals? How do you negotiate that?

Zach Burns: That's such a variety in family medicine, especially at the practice where I am now, it's really a mix. You have people with basically zero health literacy. They are not sure, you know, like, what the heart does, what the lungs do. Um, they haven't had a basic scientific or nutritional education. And so you always try to meet them where they are. Educate on the patient's level and then I also have patients who are professionals and are interested in knowing more details about a condition or medication, but, you just try to understand the patient's goals. You kind of balance the patient's goals and your goals, like once you know their medical conditions and how to keep them safe, and you find some equilibrium. Often there's an alignment and you don't really have to compromise, but sometimes their goals and yours are not particularly overlapping and you gotta strike a balance. And, because of my nutrition and lifestyle medicine approach, I try to do a lot of counseling regardless of health literacy because you can really do it for everyone and they deserve it. Then people might be more inclined to try some lifestyle modifications because they've been counseled adequately I hope so they really understand the power of lifestyle, and that type 2 diabetes, for instance, is a reversible disease, even if no doctor has ever told them that before.

Mariann Sullivan: Crazy. So many people don't know, have not been told that.

Zach Burns: Yeah, I mean, I don't remember ever, because I asked that question, you know, it's kind of like an informal study in my mind. Has anyone told you that type 2 diabetes is entirely reversible? And most people say no, I don't remember anyone saying yes. The American Diabetes Association has a lot of corporate sponsors from the pharmaceutical industry and everything, and they don't necessarily want type 2 diabetes to go away entirely. Even they have published remission criteria, where it is basically the reversal of type 2 diabetes. So, I just try to make sure that some myths and some things that people tend to be ignorant about because of the way that health and health care is conceived these days. I make sure that people have some baseline truth and so it's really it's a lot of education and then they make a decision and you kind of try to get them better. Family medicine is I was drawn to it because you can make a difference for people like over time you get to know them, you earn their trust, and then you can really make some changes. Like I, I have tons of respect for docs that do acute care. You know, trauma surgeons and they're doing, it's amazing what they do, and I never could do that, but

Jasmin Singer: We have a friend who does that in the ER, and she's just like, her personality totally matches that. She's just like, Hi! Okay! Okay! La! Hoo! Like, there's just this intensity all the time. It's like, of course you work in the ER doing emergency surgery. Of course you do. It totally goes with that. Anyway, go ahead.

Zach Burns: Yeah, no, those colleagues of mine are just incredible, but for me, the gratification comes from knowing someone over time and making incremental changes for like a sustainable, like making their life better over time instead

Mariann Sullivan: Well, another piece of, if I get, sorry, I interrupted you, but another piece of that really is kind of how often you're sent to specialists for everything nowadays, and they only seem to know this one part of the body.

Jasmin Singer: So are your dogs and cats, just so that we're clear, the amount of specialists that my ethical zoo in my house employs, like, you know, the heart doctor for that dog, the, you know, specialty dentist for little dogs, the,

Mariann Sullivan: I mean, I understand how it's happened, but do you think there is a danger that like, well, maybe not a danger, but a special, important role for the kind of work you do to bring it all together? Because sometimes your primary care physician just seems to send you to other people and they don't necessarily know the whole picture. Though, if you do tell them you have high blood pressure, they should know, but I digress.

Zach Burns: That's another reason that I pursue primary care. I think it's really important to have like a holistic care front lines. People come in, I want to be able to address 90 plus percent of everything, every condition that comes in, right. And you got to know when to refer for safety and to consult your specialist colleagues, but most things can be addressed in the primary care setting. And yes, in this culture of referring for everything and having, you know, the hyper specialization, it can feel really disjointed, right?

So people are waiting for months or years to see a specialist and then the specialist really is looking at that organ system because they, you know, say they're 20, 30 years into practice, they haven't thought about any other organ system since medical school or residency. They're really focused, and sometimes you can miss things. Dr. Klaper talks about the blind man and the elephant. You know, this, this feels like a tail. That feels like ears. And sometimes you can overlook the big picture of someone's health. And these days, the big picture is usually what people are putting in their mouth three times a day. That's the big picture and the linchpin where if you can change that, you can likely improve or even resolve entirely. Like, all of the issues on your, quote, problem list. And you can taper or even stop most of your medications when you make significant lifestyle changes. And people don't always talk about that.

So my goal is to make sure people know it's an option.

Mariann Sullivan: So getting to people understanding it's an option and not just your patients, but other people, that's one of the things that you really worked on in medical school and how you got involved with Dr. Klaper. And can you just go back a little bit and tell us about your work in medical school?

Because we've all heard how med students still, after all these years that we've been talking about it, get like, you know, five and a half minutes of nutrition education. That might be a slight exaggeration, but not much. So tell us what you were trying to accomplish when you were in med school.

Zach Burns: Sure, well, it started in the anatomy lab, where you have that, like, milestone in med school where you dissect a cadaver, a dead person. And it's really jarring and scary and it smells like formaldehyde. Everyone's nervous and you have a really intense anatomy professor over your shoulder. And you're in these teams of five or so people, who are assigned to a different specimen. And mine was a 93 year old person, but I was helping out on a different specimen, a 70 something year old who died of a stroke. Okay, and I was dissecting the carotid arteries, the ones in the neck that often get clogged with atherosclerotic plaque, often, basically animal fat. And so I was on one side of the body and my friend Mark was on the other side.

We were just getting to know each other, it was kind of first semester, and we're teasing apart this plaque and, the conversation kind of morphed from, you know, the anatomy to nutrition and healthcare and everything. And we looked at each other over this body and we're like, are you vegan? And you know, we gave each other a gloved fist bump and there were like particles of, you know, debris that rained down and everything. And that started our friendship and our club together. We, we established a group in med school called Plant based Healthcare. That was the platform through which we did lots of advocacy and education on campus, and where we hosted Dr. Klaper, I think it was March 2019, which started our relationship.

Mariann Sullivan: What was the reaction of other students? Where, like, were people hostile to it? Were people excited? Or, like, shocked? Uh,

Zach Burns: People were generally supportive and receptive, I'd say. Let's say I was an eager student group leader. Not every student group like, has this much of a mission behind it. Some student groups kind of serve as a credential when someone's going to apply to, you know, like a subspecialty and they want to have been in the X club. But for me, and Mark as well, this was a labor of love and part of a bigger, it wasn't just plant based nutrition, it was also for the animals, for the climate, all these things that are integral to human health. And even if they weren't, they'd be worthwhile. And so, you know, I was, I probably, like, could have done a little better in med school.

I don't know, I did fine in med school, but I was really engrossed in this student group. And I would, you know, stay late and explore whatever we learned in class that day, I'd make the nutritional connection and look at the literature and write a synopsis and put it in our group so my classmates could start to think about this stuff.

And if there was any professor who seemed a little sympathetic to lifestyle or nutrition, I'd meet with him or her and, really, forge an alliance. I was always out trying to solicit donations for our events. And so we were like a very robust student group. We had stuff really going on. And when Dr.

Klaper came, we had about 400 people from the school, the faculty, and the greater community. So, that's a little taste of the student group.

Jasmin Singer: And how did that develop into your current role with Moving Medicine Forward, like connect some of those dots for us.

Zach Burns: Sure, well, Dr. Klaper, I just knew him from some of the documentaries like Cowspiracy, and I idolized the guy that, you know, I was starting to become familiar with some of these pioneers in the plant based nutrition movement. For whatever reason, Dr. Klaper resonated with me, his style, where he has that resolve. He's not going to compromise, but he also is funny and light when he communicates. And I thought that was really valuable and so I enjoyed who he seemed to be from a distance. And that's why I reached out to him and it was just lucky he was living near my med school at the time. And so he could do an event. And of course we didn't have much funding. He just graciously came for free and spoke. And so around that time, I asked if I could get involved with some of his work. You know, is there any way I can help? And that's when he was launching this initiative, after working clinically for like 50 years, he wanted to devote the rest of his career to shaping the next generation of doctors, so that they don't make the same kind of mistakes and get stuck in the pharma paradigm, like his generation has. He found me to be a worthy subject because I could really like network with med students. I had friends at other schools. I understood the current training model because it had been a while since he was in med school in the seventies, it was sort of a while ago.

And so between us, we could start to build this organization and get med schools around the country and actually now around the world, excited about plant based nutrition.

Mariann Sullivan: Do you ever worry that some plant based advocates overstate the benefits? As if we're never going to get sick and die?

Zach Burns: It's a good question. I think it's an inherent danger when we're getting excited about something. We can think it's the panacea. Of course it's, it's not, and everyone's vulnerable to ailment. But for me, it's like, there's just a lot of preventable illness. It's most of the illness we have is entirely preventable. And, that includes the metabolic conditions, obesity, diabetes, hypertension, but also things like autoimmune conditions and cancers. Because the immune system, right, which can be overexcited in autoimmune conditions or underperforming in cancers because the immune system is required to detect early cancers. When you have all this inflammation from a standard American diet, say, or not getting any physical activity or the other things, then you have inflammation and that fosters different medical conditions. You can overstate it, and we, in the movement, we try to be really careful not to, but right now, the culture is to massively understate its utility.

Jasmin Singer: Yeah, I mean, I obviously totally agree and obviously completely anecdotally speaking, I have noticed that some of those promises often go with some more fringe corners of plant based eating, not so much plant based eating, but like a particular kind, like raw food or, you know, uh, being a fruitarian is going to make you live for a hundred more years, things like that, and certainly erring on the side of exaggerating would probably put us exactly where the pendulum needs to be because of those incredible benefits that you were mentioning.

But one thing I find fascinating about you, and I don't want to overstate this or speak for you, but you are clearly an ethically driven person and I'm curious how that sort of interacts with the work that you do. For example, my understanding is that you're pretty animal rights forward. My first question is, am I miscategorizing that or is that how you would describe yourself?

Zach Burns: Yeah, I'm vegan for the animals.

Jasmin Singer: How do you deal with having such a strong ethical baseline when you're also a doctor? I mean, how do those two things interact with each other.

Zach Burns: It's an important question, and I know what you mean, but think about how that sounds, right? How do you deal with having an ethical baseline as a doctor? Like, yeah, um, actually doctors probably should have, like, an ethical orientation. But the reason I point that out is because today, we don't necessarily find that.

We don't necessarily think of doctors as being particularly ethical or having a compassionate worldview or whatever. But, you know, I think that'd be nice for doctors to see themselves that way and foster those qualities within them. And it would make for better medical care.

I think most of us in medicine, do have a lot of compassion and are doing our work in good faith. Occasionally there's some other people like, so I trained in South Florida where there's some, it's like the capital of medical fraud historically, and there's some shady stuff going on. I had one professor who he opened up to me about how he consults for the tobacco industry. This is someone who my medical school set me up to work with to learn psychiatry.

He said, yeah, you know, on the side, I work with tobacco. I try to make nicotine products seem less addictive. He opened up to me about it. I felt conflicted about that. So yeah, you have some shady characters. And of course the pharmaceutical industry needs to partner with doctors, to be a voice for their new products. So there's that, but I think most of us really do care about patients. For me, there's not a fundamental difference between the patient in front of me and the environment that they live in and the animals that they share it with. It's like, you know, some people call it One Health. It's just, we have these artificial boundaries between different entities. My view is that any doctor who makes that oath, right, to do no harm, well, the thoughtful physician can extend the boundaries of the subjects of harm. It doesn't just have to be the patient in front of you, but, you know, what does it mean if you do no harm to your patient, then you go and abuse your partner, or like, you know, something? That doesn't sound like a consistent ethic. So, you need to strive to do no harm broadly, in your life, and I think that certainly would apply to the 80 billion land animals killed every year.

Jasmin Singer: Also, just so that we're clear, I agree that everyone has a point of view, and as a journalist, I deal with that all the time. People thinking that my sort of veganism and my animal rights ethos is something that I need to overcome in order to be a responsible journalist, not recognizing that everyone has a perspective, whether it's a popular one, like eating meat, or a more fringe one, like not consuming, right, like not, not eating meat.

We are all coming from our perspective. So I, you know, it is sad that that had to even be a question, but I just have a quick follow up. My wife works in human research protection, managing, you know, an IRB at a major university, and she had to go out of her way to make sure that the place that she was working did not also do animal testing as part of their research.

And my understanding is it was very few places actually separated human research and animal research. And she turned down big jobs and this and that. She wound up at a place that was big enough that they did separate them. How do you deal with things like that? Like, for example, how do you parse FDA requirements for animal testing of drugs with your ethical veganism?

Zach Burns: Sure, good question. Yeah, we live in a non vegan world, everyone listening is well aware. And you see this attitude that animals are ours to experiment on, to consume, to wear, you see that playing out diffusely, like whether it's in healthcare or at the grocery store, and so that's, an area that people don't often look at, but yes, drugs and other medical experimentation, they come to us via exploited animals in labs. Now, the interesting piece to me is that actually, at least on the surface, it would seem much more justifiable to exploit animals for that purpose if it had medical utility, and could alleviate human disease, right? That seems actually more justifiable than just eating animals because they taste yummy. So that's one issue. I think it's still not justifiable, given that we have what's called the human synthetic models. Which are really the, more precise way to perform medical and other scientific testing. It's a model that better emulates a human organ system or human tissue. And, you don't run into the issues with animal experimentation where it's just not a viable model for experimentation with drugs and other things cause it's not actually a human being. So that's a whole area. but it's funny how in some ways, animal experimentation in labs is an area where we actually have some legislative traction, more so than transforming the diet in our culture. But it's just this paradox where it would actually make more sense to initially target food that we're eating just because it tastes good.

Mariann Sullivan: So getting back to food issues, a lot has been said about food deserts. I mean, and you probably work a lot with underserved populations. I mean, I think that you have a broad base of, clients or patients right now. And a lot is said about food deserts, but I think that you have spoken about structural obstacles between people, especially those with limited incomes and eating healthy food, are a lot bigger than food deserts.

I mean, a lot of people can get to a grocery store. That doesn't mean they know what to do once they are in it, or that the grocery store is helping them to know what to do, instead of defeating them. And so what are some of those obstacles that get in the way? Like structural obstacles, perhaps that have been deliberately put in place that really get in the way of people eating healthy?

Zach Burns: Sure, well your question reminds me of this rural rotation I did in med school. It was deep in western Louisiana and you know, we have requirements to work in certain rural settings and I thought this would be an exciting one. So I went over there, stayed in the attending physician's renovated horse barn where his daughters used to ride.

It was really different. It was like being in another country, the politics in that area and everything. I mean, it was really a, uh, cultural adventure. And I would meet these patients, they were very sick. It was mostly what they were eating, slash drinking and smoking. And, I had to exist there as a vegan for a month. And so, I went to the local supermarket. It was a full on supermarket. It was not like a bodega. And I would get stuff like my salad fixings and I made it was kind of Cajun style. I got some Cajun seasoning and I would put them on my local yams and I loved it. And I was eating whole food plant based the entire month and also spending like very little money on it.

I was also on a budget at the time. My patients went to the same supermarket. They just didn't shop in those aisles. They didn't get that stuff. They didn't have the education to do it, and also they've been kind of addicted to the processed stuff, which is hypercaloric and gets our dopamine pathways really excited. There's a lot to that, but, you know, and they were undergoing more stress, and so they're even more susceptible, I think to kind of caving to, all right, there's that box of glazed donuts, right? Featured prominently and here's the flavor blasted goldfish and whatever. And you know, when you're in the habit of consuming these things, you keep doing it. The companies selling those products are very intentional with the visuals and also the chemistry of that product. It's really just like it's engineered. to make you eat as much as possible. So you're right, it's more about education than it is about access in most of these cases. I've read national survey data, that shows that actually over 94 percent of the American population is within a mile of a full on grocery store, like the one I'm describing. So food deserts exist and really need to be addressed. But I don't think that can be the excuse. Sometimes that concept is used kind of as an excuse not to talk about this, especially on the left. It's like, well, you know, we should be culturally sensitive and we should be really like, conscientious about people's access. We should, I agree, but also it's a disservice to the patient in front of you if you're neglecting, the ways that we can affordably access healthy food and reverse the course of their life, because of all their medical complications.

Mariann Sullivan: It kind of reminds me, Jasmin, of that time we drove across the country, we were driving across Texas, West Texas, which is like you drive for a day and you don't see anything and then you come to Midway and then you drive for another day and you don't see anything. I mean, Midway is this town that's in the middle of, I would say nowhere, but it's in the middle of Texas.

And, there wasn't one restaurant in town that we could go to that had anything at all. And we went to the grocery store and they had soy milk and they had sweet potatoes that we could microwave, and they had salsa, and it was a pretty good, you know, put together a pretty good meal. It was a little challenging, I admit, but it was entirely possible. But yeah, it's, so much more complicated than just access. And sometimes, I wonder whether you feel this way. Sometimes I feel like there's too much emphasis on cookbooks and recipes in the vegan world as if every vegan is supposed to be a foodie. I mean, there are people who hate to cook. People who don't have time to cook, do you think it would be more useful to try to make it easy to be healthy? Sort of asking for a friend here, but, also, because I'm not much of a cook and, you know, I just, I live alone, like, who wants to cook a whole meal? But also for people who, like, are working two jobs and have to feed their kids. Yeah, those things you can grab are easy and there's not a lot of them that are vegan.

Zach Burns: Yeah, I'm no culinary expert. And for that reason, I used to eat really simply. I like to think it was healthy, but also simple vegan. And so, I would basically make two vats per week. One was a vat of a whole grain could be quinoa or brown rice, and one was a vat of legumes. Could be kidney beans or lentils. And then I would have vegetables. They were either fresh or they were roasted, like root vegetables, yams, and beets, and squash. And I would simply mix and match. I'd take the three things. and throw them in a bowl. And then sometimes I would sprinkle like a seasoning over it. Other times a little drizzle of tahini. Put it in the microwave and it's really satisfying.

You know, some people...

Jasmin Singer: with us.

Mariann Sullivan: Yeah, seriously, that's how I eat. I mean, I'm not as organized as you about, you know, making them, but that's pretty much what I do. Every time I make grains, I make enough for, you know, a while. In the morning I take the grains and put some berries on it and some tahini and a few walnuts.

Zach Burns: Sure.

Mariann Sullivan: It's got to be easy.

Zach Burns: Right, it does. And I think that eating that way can be really satisfying. You just have to get used to it. If you're making a major change, anything can take some time to get used to, but you will. And it can end up being absolutely delicious. And if you have a little more need for culinary nuance, then you figure it out, and you make a little more sophisticated meals, which can also be really efficient. But here's the thing, even if that style of eating tasted worse, Okay, even if the vegan version of whatever product tasted a little worse, which I don't think it has to, but say it did, wouldn't you want to do it anyway? I mean, if you could save an animal's life, if you could, dramatically lower your risk of heart disease, and getting cancer early or Alzheimer's? Like if you could make your little dent in reducing your carbon footprint, like, wouldn't it be worth it leading a lifestyle like that, even if, say, we just, you know, there's this entitlement that I think is pervasive, where whatever we do or consume needs to be, like, optimal and so delicious and whatever. Well, you know, now I'm getting honest, I think we need to take a step back and really, like, do we deserve everything that we consume?

Like, where do we draw the line? It may be that we just actually have a responsibility to be a touch more thoughtful about what we're buying.

Jasmin Singer: Yeah, we've become pretty greedy. I saw this meme that I don't even remember it specifically, but it it was something like, you know, I used to enjoy listening to a song or two, but then one day I was like, I want access to all the songs all the time. And it was kind of like the difference between the analog world, which, you know, I grew up with.

I think I'm like the last generation that grew up with it. I was born in 79. Like after that, like things kind of became a little more digital, I would say as folks became young adults, but like we have anything we want at all times. It used to be interesting to go shopping and find a cute sweater or something.

And now we're inundated with, ads for cute. And now because I'm saying this out loud and my phone is in the same room as me, I will get ads later for cute sweaters. The fact that this relates

Mariann Sullivan: wearing such a cute sweater.

Jasmin Singer: Thank you, Goodwill. the fact that this relates to food and just, like, the fact that we can have anything we want at all times, it's very unsettling.

And, just kind of sticking with that Whole Foods plant based team for just a minute. I hear you. The way you're describing food is like Mariann and my favorite kind of food. When we lived in New York, we used to go around the corner to Suen all the time and get this Buddha bowl plate that had this amazing tahini sauce and just put it on these beautiful yams.

And we were just in heaven. But what about alt protein? I don't mean to open a whole, you know, can of worms at the sort of end of our interview with you, but I am curious where you stand on it as a physician and also as an animal advocate, and are they the same perspective?

Zach Burns: Sure, I would say both as a physician and as a vegan, I support the development of alternative protein products. Here's why. One, it basically solves the climate and animal issues entirely. if our protein kind of food system transformed into one with plant based all proteins or cultivated meats. So that's just, it needs to happen. Like, to say that that's kind of a lesser priority, I think is, again, really entitled and like, we certainly need to phase out industrial agriculture, and this could be the way to do it. So I completely support alternative protein. Medically, I think that you can justify it because, ideally based on the huge amount of scientific literature, we want people basically eating a whole food plant based diet, but as long as they're eating animal protein, if we can tweak and incrementally improve the nutrition profile of those products of the animal protein, that is a win for the human body, for the patients on my panel, right? For instance, if you have a plant based burger, even the, you know, realistic ones that are richer because they have more oil and sodium. You take that compared to a beef burger, and there are some serious fundamental differences, in favor of the plant based burger. Number one, there are no, pesticides, and, herbicides, if it's organic, no pesticides or herbicides. Either way, there's no antibiotics and hormones, okay, in the plant based option. There are certain compounds, in animal protein, especially when you cook it, that you eliminate with the plant based, variety. And those compounds are the ones that have been linked to different things like cancer and heart disease. Some of the components in actual animal protein, you know, from the animal are the ones implicated in gut dysbiosis. The gut microbiome gets all messed up, and those don't exist in the plant based burger. So already, like, even the products that are out there today, I'd rather have my patients eating them in moderation than eating the traditional animal based protein. But here's the thing, because we're talking about alt protein and technology, the product's nutritional profile will presumably improve over time. It's like a phone. You keep updating and making stuff healthier, and you can decrease the proportion of fat, and you can increase some of the nutrients. As long as we have some processed food in the world, and people want the taste of meat in their mouths, I think it's a safer alternative, and a morally, required one, if we're gonna overcome the current food system.

Mariann Sullivan: Yeah, absolutely. It's good to hear someone talking about like, you know, the practical, not just the perfect. Too often, people in food take a very, very strong stand about this is the perfect way to eat. And, there are other considerations. Actually, that does bring up another question, though.

I know we've been on here for a long time, but you mentioned the word processed. Like, is it processed or not processed? Or is there processing and then there's their other process? I guess is process necessary? I mean, cooking is a process, right? Like, is process necessarily a dirty word when it comes to food?

Or do we have to think about what processes harm nutrients and what

don't?

Zach Burns: Yeah, that's a good question. You know, processing and different things, you have, like, mechanical processing, where you squish up the components, and

Mariann Sullivan: cutting a carrot.

Zach Burns: Sure, that's, it's a form of processing and then you have chemical processing, you mix in emulsifiers and additives and you change the texture and make the peanut butter float so you don't have to stir it.

So it's a spectrum of processing. And so sometimes we use the phrase minimally processed, like tofu is an example. It's minimally processed soy and it's recommended. No issues with it. So you just want to make sure that things are not significantly processed. Right? Because that's when you run into trouble with the additives and with the loss of nutrients. That's both what they add and what they take away. So, for instance, like, with, you know, white flour products, baked goods, and, Wonder Bread, and these things, you're stripping away the nutrients because you've taken that wheat, and you take away the fiber and some of the phytonutrients in the water and you make this white flour and you sculpt it into a fluffy, squishy bread, Bread is one of my weaknesses, by the way,

Mariann Sullivan: Oh my god, we're like the same people, like, Jasmin will attest to it.

Particularly toast, even the sound of that word is so lovely.

Jasmin Singer: my God.

Zach Burns: And there, we can get into that at some point. There's some healthy toasts. But, you strip away the nutrients. That's one of the issues we have in this fiber deficient society. Over 95 percent of Americans don't get their daily fiber. What that means is that their gut microbiome is less diverse, less protective against diseases. Like it takes more food to make them feel, satiated. And, things like this. So, processing, you can think of it as the junk they're adding and the nutrients they're taking away. And the reason they do it is to make the thing as palatable as possible. You know, you want the snack with the perfect ratio of sugar, oil, and salt to keep you eating it.

Mariann Sullivan: I feel like there's so much more we could talk about, like, this is stuff that we could all talk about

Jasmin Singer: Wait, what are the healthy toasts? What are the healthy toasts?

Zach Burns: Okay, there's one at our local supermarket here in Rochester, and you can also get it at a ton of different places. It's called Mastermacher. It looks like a brick.

It's like brown bread, very thin and dense. And it's, it's basically grains. It's different grains that are squished into this little slab of bread.

And it's dense and maybe an acquired taste, but when it's toasted, it's absolutely delicious. So, that's an example of, like, a pretty innocent bread.

Jasmin Singer: Yeah. No, I like that bread. I just, Googled it. And yes, I've definitely had that one for sure. I've, I've done a zekeel as well. I don't know how actually, nutritious it is, but it's probably better than that wonder bread from the 80s that you would just squish into a

Mariann Sullivan: know you could squish it into a little ball, it

was

Jasmin Singer: Yeah, it

Zach Burns: Yeah, Ezekiel bread is good, too. Here's the thing with bread, it's like, I don't know if you've heard of the pleasure trap, it was

the

subject

Mariann Sullivan: I

Jasmin Singer: I watched that

Yeah,

Zach Burns: so, you know, we just have to avoid the pleasure trap. Sometimes avoiding sugar, oil, and salt isn't because they're so acutely harmful, but it's because they make us want to eat eat more than we would otherwise. They make the thing more palatable. So when that's the case, because some of the, even the breads we're mentioning, sometimes they have a little sodium, they've been minimally processed, so the grain is broken down. It's not like eating grain, like wheat germs out of a pot. And so when we make the thing more delicious, we're going to tend to overeat. And that's a trap that some of us, really all of us should actively avoid.

Jasmin Singer: Yeah. Totally. Wow. Mariann, where are we? What do we do? How do we end this? I don't know

Mariann Sullivan: Yeah, I think we just tell everybody like we have to end it because it's gotten really long, but we're going to talk about more stuff on bonus. And, actually, I think I should mention that, I had decided this before this interview, but Zach, I'm going to see Zach as my doctor. I hope he does a good job. My life is now in his hands. And I can't wait because I want, there's so much we need to talk about. I, you mentioned salt. Well, we shouldn't talk about salt on the podcast because that's vegan, you know, and the podcast isn't just for me, but I do want to talk about. A little bit more about some of your favorite foods and what you eat and maybe a little bit more policy stuff.

So shall we, shall we, call it a

Jasmin Singer: Well, let me, how can,

how can people follow your work online before we do that? How can they

Mariann Sullivan: Oh, yeah. And I do want to mention like, you have your website and I'm sure you'll mention it, but you have some writings on there. I find them fascinating. I think you must be just a person who loves to write and some of them are quite beautiful.

Zach Burns: Thank you. Yeah, I have a website, www.herbivores.Life, and you can find my writing, which is longer form, vegan themes, some encounters with patients. You might dig those essays. Then there's the blog section, shorter, articles on more scientific topics on the blog. The last one was about how septic tanks can be, distinguished based on what the household is eating, like

Mariann Sullivan: Yeah, that was a little gross for me.

I admit.

Zach Burns: So you know, hold your nose, but there's that one, and there's just a whole blog of, like, more medical and scientific info related to plant based nutrition, so check out herbivores. life if you'd like.

Mariann Sullivan: Yeah, we'll put a, we'll put a link to that in the show notes.

Jasmin Singer: Thank you so much for sticking on with us for so long, Zach. We really appreciate you. And it's nice also to hear you with all of the nuances and the very firm animal rights ethos that we all share, and I just am excited about connecting in person here in Rochester, and even though you're not my doctor, the night's still young, but I really appreciate all that you're doing for animals and for people.

Thank you for sticking on with us today.

Zach Burns: I really enjoyed it, thank you for having me.