Diet Doctor Podcast #5 – Dr. Michael Arata & Stephanie Kennedy

Diet Doctor Podcast #5 – Dr. Michael Arata & Stephanie Kennedy

August 2, 2019 11 By William Morgan


Welcome to the DietDoctor podcast,
I’m your host Dr. Bret Scher.
Today I’m joined by Dr. Michael Arata
and Stephanie Kennedy.
Dr. Mike has an amazing story
as many physicians do
who transition to being more of a lifestyle
and nutrition based physician.
He’s an intervention radiologist
and specializes in limb salvage,
which means he’s sort of the last resort
before someone has an amputation
to try and save somebody’s limb.
It’s very high-pressure intense work.
But like a lot of physicians he realized
he wasn’t really affecting the problem
in a good enough way to prevent it
and that’s when he transitioned.
Plus with some of his own health challenges
which we’ll talk about.
And what they’ve developed
is a functional medicine lifestyle practice
and as part of that they focus
on a low-carb ketogenic diet.
But they focus on it from a plant basis,
so primarily a vegan ketogenic diet,
but here’s the key – with cycling.
And that’s something that’s going
to keep coming up over and over again,
because the more we learn about it
the more we realize how important cycling is.
And that means cycling with intermittent
fasting and cycling with meat.
And we’re going to talk about that.
We’re going to get
into some of the controversies
about plants versus carnivore diet
versus a balance of all that,
talk about their philosophy
of how they approach their patients
and some of the concerns with a vegan diet,
what you need to be careful monitoring for,
and of course talk about their book
that’s coming out, Keto With Plants.
So I really enjoyed this interview,
I like their perspective a lot
and their approach to the patient
and their sort of balanced way
of approaching people
to help them not only understand
the science,
but understand how to implement it
and how to make the changes last.
So I hope you enjoy this interview
as much as I did.
If you want to learn more about us
you can visit us at DietDoctor.com
or you can visit me
at lowcarbcardiologist.com.
Thanks a lot and enjoy the interview
with Dr. Michael Arata and Stephanie Kennedy.
Dr. Michael Arata and Stephanie Kennedy,
thank you so much for joining me
on the DietDoctor podcast.
-Sure.
-Pleasure to be here.
-It’s actually Dr. Mike, right? -Yes.
You’ve had quite an interesting journey
so let’s start with you.
It always fascinates me how people
find their way in medicine
to focusing more on lifestyle
and treating the whole patient.
And I remember when we met yesterday
at lunch, we were talking about it
and I said,
“You must have an internal medicine
or family practice background
to get to this point”,
and you said, “No, interventional radiology”
and that is not what I expected.
So you’re an interventional radiologist,
you spend like all day
in a cath lab like suite
sticking catheters and needles in people
and draining things and opening arteries
and yet you transitioned to wanting people
to work on their lifestyle.
So give us a little bit of background
on how you got to that point.
I think as an interventional radiologist
I was drawn to the technological aspects
of the specialty, the innovative nature.
I mean interventional radiologists have created
all kinds of different treatments
and taken different devices
and modified them
and, you know, it’s very much
a gadget type of field.
-He loves his gadgets.
-I do, no question.
So that’s what really drew me to it
and then, as I got into my practice
I really enjoyed some of the things
you could do
that were alternatives to big surgeries
that could produce outcomes in patients
that couldn’t even tolerate the surgeries.
So they were too sick to have a surgery and
you could step in and intervene
and make a difference in someone
that maybe had no options at all.
So that was very satisfying
but as I got more into limb salvage
most of the patients typically would be
either diabetics or renal failure or both,
and those patients you could get
a good result in the short-term,
but unfortunately most of those patients…
it’s not a long-term solution.
You could spend three, four hours on a case
basically vascularizing someone from their
abdominal area all the way down to their toes
and actually get blood flow back to their
feet, that could heal their ulcer,
but three months later they’re back.
And, you know, when you are doing
one of these cases
wearing 30 to 40 pounds of led
and you know it gets really hot in it
and really it’s actually quite fatiguing
in those long cases,
so at the end of it you’re gratified
by the fact you’ve helped the person,
but then you’re really disappointed
when they come back.
And it just got me thinking,
“There’s got to be something better.
How can we allow this to happen?”
is really what I would start to question.
And I didn’t have the knowledge base,
the experience, the exposure
to understand what got people to that point
to the degree I needed.
Fortunately I started working
with other patients
who had naturopaths
as part of their care team.
And my interactions with them
really started to basically plant the seed
that there is something different.
And I think a key part of this for my story
is I was a biochemistry major as an undergrad.
So when I started discussing things
with naturopaths,
they often talked
about the biochemical aspect of it.
That really resonated with me.
And fortunately one of the naturopaths
I worked with
suggested I should go
to a functional medicine conference.
When I went, my life changed,
it literally just flipped a switch.
And I was just like,
“Oh my gosh, this is it.”
And it really is a biochemical based aspect,
you know, there’s a lot
of different overlapping specialties,
integrative medicine,
functional medicine,
and these things are not that different,
I mean there’s a lot of overlap,
but one of the key things
about functional medicine
is it’s more systems biology
and biochemistry based.
So I think I needed that.
I don’t think I would have made this transition
without that science core to it.
Well, with this knowledge I was learning
I experimented on me.
And being someone that was working
90 to 100 hours a week,
I was a typical American.
I had all the conditions
that you see in middle-aged,
now actually younger adults.
So I was not sleeping, I had sleep apnea,
I weighed 230 pounds,
I had gastroesophageal reflux,
I had skin conditions,
you know, eczema would flare up
all the time.
Too busy taking care of everybody else
to take care of yourself.
Yes, all of these things
that just slowly drag you down
and eventually lead
to more serious conditions.
Well, those things started clearing up,
I started losing weight.
And what did you do?
What was your intervention to–?
Well, the first thing was food
and interesting enough, the first diet
that I tried was a ketogenic diet.
That was the very first one.
You got lucky.
And I felt great
and the one thing I noticed
was the energy level, the clarity of thought,
I mean those were the things
that really stood out to me,
because I was so fatigued,
I was just living on sugar and coffee.
And I literally had one
of those big 22 ounce cokes or whatever…
I constantly had one of those
in my hand all day.
So I was basically, you know, mainlining
caffeine and sugar to survive and function.
Which is not that unusual.
I mean we react to it
like it’s the worst thing in the world,
but it’s actually not that unusual.
You look around
and you see it everywhere.
So that was the big switch
and I started sleeping better.
When I lost weight
the sleep apnea went away on its own.
I also had very bad hypertension.
I first was diagnosed with high blood pressure
in college in my 20s
and I got to the point
where I was on four medications
and still had a pressure of 160/100,
so I was really bad.
That started getting better
and I actually was getting off medication.
So it was an incredible experience
just seeing what happened to myself
when I did something that was not what
I’ve been basically brought up in the system.
And that’s what’s so amazing
that so many doctors have the transformation
by having their own transformation
and then they transform their practice,
because we weren’t taught this.
So we have to be able to go
outside of what we were told
as the way to do things.
So an incredible journey
and then you opened up a practice
where now you’re treating people holistically,
you’re treating not just one problem
in the IR suite,
but trying to treat them in the whole person
focusing on nutrition and ketosis
as a cornerstone of that treatment.
Yeah, I think I obviously had to go
through a lot of educational processes.
Maybe I did too much but I just felt
like I really needed to know this.
And so it was an evolution
and we’ve gotten to the point now
where I do incorporate ketosis.
I think it’s important to understand
where I’m coming from,
I’m not really someone that advocates
or uses therapeutic ketosis.
I mean I think it has its place
but not with the patients that I’m seeing.
So we’re focusing on nutritional ketosis
and while I did obviously jump right into
the ketogenic diet for my first go-round,
I also found that plants
really make me feel well.
And it was kind of a revelation for us both
because we did it together.
The first time we did
wasn’t quite a vegetarian diet,
but it was very plant heavy
and we both felt tremendous.
And Stephanie had been vegetarian before,
so she had more experience with–
I was a carnivore, I would go and have
a big steak and just leave the plants.
So Stephanie, it was your influence then
to get him to try the plants?
It was part of my training,
it’s a functional medicine dietary new plan,
so it’s really plant heavy
and it’s dairy and grain free,
so it wasn’t quite keto but it was
just very plant and clean meats heavy.
And even with a few clients
it’s a challenging meal plan,
because it’s a lot of more intricate recipes
than I prefer to recommend
because it does take a lot of work.
But the few clients I’ve gotten to do it,
have said the same thing.
Them and their husbands were like,
“Oh, my gosh, I feel so amazing!”
And I felt like euphoric,
just like this clean energy buzzing through.
It was pretty amazing
but yeah, it’s a lot of work.
That’s what’s so interesting
about a ketogenic diet
is there are so many
different ways to do it.
It sounds like it’s a one thing
but it really isn’t.
And some people are on one end
of the spectrum and they’re carnivores.
And some people are on the other end
of the spectrum and they’re vegan keto.
And they both can be in ketosis,
they both can get benefits of ketosis
and they both can feel great.
And one of the hard questions is,
“Is there one that’s better?
Or if you’re feeling great
it doesn’t matter?”
I know you’ve had some experience
with a little bit of all of this.
So tell us about not just your own personal
transition to a vegetarian based keto,
but with your clients.
Why you have felt
that’s the better way to go?
I have to step back from trying
to understand why we come to this conclusion,
to get to a really core principle
and that principle is that life is cycles.
You can look at everything in life,
you can look at night and day,
you can look at the seasons, you know,
your birth and your death.
So the idea that we are static and we are
going do the same thing over and over,
it just isn’t compatible with every aspect
of life, no matter where you look.
And so I think that is true with how we eat.
And the other aspect of it
is that when we look at how the body
repairs itself and heals and grows,
it’s response to a stimulus,
so the stimulus is a change.
So I think that’s an important element
to eating.
So I guess what I would say is
there is no perfect diet.
Right.
What is perfect is to change,
to have cycles.
And if you look at the standard American
more than just diet, let’s say a lifestyle,
which we actually prefer over diet,
the typical way
that Americans live is static,
constant stress, not moving,
eating continuously throughout the day
and generally high carbs,
so there’s really not a change
anywhere in there.
It’s a continuous exposure to something
and our bodies are not meant for that,
that’s not how we’re built.
So I think that that’s where
we came to the idea,
let’s combine ketosis with plants
and make it in a way
that we actually incorporate cycling.
And so I think in order to make that work
and be practical, you have to fast.
I don’t think you can do this
without fasting.
So what length in fast do you think
works best in certain situations?
We try to incorporate both,
so we really like time restricted feeding,
because I do think
it’s important to eat breakfast.
Again, that cycle, the circadian rhythm,
key element in my opinion.
So we like time restricted feeding
at least a couple of days a week
and then we also like to incorporate
a more prolonged fast, typically five days.
And one of the great products it’s out there
that really facilitates this is the ProLon diet.
-We love it.
-It is fantastic.
It makes fasting so easy to do.
And let’s be realistic, if it’s not practical,
people are not going to do it.
And that’s what’s interesting
about the ketogenic diet
is that I find people can fast much easier
when they are already in ketosis.
So you can say fasting five days is hard
and for the average person it probably is.
For the average person in ketosis
I’m not sure how hard it is.
It’s not.
At least from my experience.
So with this in mind, we started to see
how can we help patients
and I started working
with my own patients
and my patient population
is largely cognitive patients,
so typically elderly patients.
Again it has to be simple,
it has to be practical.
If you’re dealing
with elderly people in general
or more importantly
cognitively impaired patients,
if it’s not simple, it’s not going to work.
So fasting in elderly people
can get a little tricky.
Well, the easy part for the fasting
element with elderly patients
is intermittent fasting.
A lot of them do it on their own
and they don’t even realize it.
It’s only a 12 hour maybe,
but they are actually doing it regularly.
So getting them to extend it to 15
and 16 hours is not that big a stretch.
It can get a little bit trickier
when you start doing a more extended fast,
but that’s why I think ProLon is fantastic.
And I’m regularly having patients
well into their 70s using ProLon
and finding it quite doable.
And that again kind of fits in
because it’s plant-based,
so it’s just a nice fit for what we’re trying
to do with the patients.
And then the population
that’s on the other end of the spectrum
is I see young patients
with dysautonomia and POTS.
Postural Orthostatic
Tachycardia Syndrome.
Thank you.
Where you stand up and your heart rate
shoots through the roof
and you feel lightheaded and awful.
Exactly, so for that group
the proportion that are related
to autoimmunity it’s estimated to be a 50%,
I think it’s actually higher.
I think that we’re not identifying antibodies
that could be 80% of that population.
So I think it’s a strongly
autoimmune driven condition
and obviously the mitochondria
are very much involved in it.
And then of course the gut
with the microbiome.
So for that population this approach,
this lifestyle actually helps them too,
which is really fascinating,
it has actually surprised me.
Because you have patients
that wouldn’t think that fasting would help
and it really does.
In the cardiology world people with POTS
it’s frustrating,
because there’s not a whole lot
we have to offer them.
You increase your hydration,
you increase your salt,
you can try and wear compression stockings
but it’s fairly un-rewarding,
because the they tend
to not get better very quickly,
but if a nutritional intervention
like this can help them,
I’ve got to start trying that with them,
I haven’t thought of that before.
The first positive response I got
that really blew my mind
is a 22-year-old young lady
and very debilitated,
just basically could not function
and within two days of fasting
she started to tell me, “I’m feeling better”.
And she continued it
and she’s feeling great.
So it was really kind of, “This is incredible!”
and so I started using it more.
And so again it’s kind of two ends
of the spectrum.
I personally wouldn’t feel comfortable
with a child taking this approach and fasting,
but I think a young adult absolutely,
it’s very well-tolerated.
So, Stephanie, you are the day-to-day coach
with a lot of the clients you see
and the knock against a vegan keto diet
is that it’s hard
and you have to really prepare
and spend a lot of time thinking about it
to make sure you’re getting
adequate levels of fat and protein
and preparing all your food.
So what are some of the tricks or the tips
that you think are the top ones
to help people who want to follow
a more plant-based ketogenic diet?
Well, yeah colors, I would say
I do eat the rainbow as I say, not Skittles.
Well, our system.
Yeah, we have a system
where we’re organizing our foods
into like I had Siebel at one point
and I saw this list,
it was like red, green, you know,
you like the stoplights
of foods you couldn’t eat
and it really helped me
because I’d be like at a restaurant,
would put down my list,
it was like a 14 page list or whatever,
it was really fun.
So we’re organizing our foods
into columns like that,
so you could just, “I can eat all these foods
in the green list, all these foods”,
so that’s kind of easy,
but then if you don’t cook or whatever
it’s just a list of ingredients too,
so I have written a lot of recipes and
I hate cooking and I am busy and lazy.
I hate to say lazy, but I am, I admit it.
So I’m trying to cook with that in mind
because I hate doing it.
So it has to be something that can be
like prepared in 10 minutes,
I don’t like all these gadgets
in the strainer
and then then you end up with a huge pile
of dishes at the end of the night.
So they are simple
and they are really tasty.
I would say the key is we treat our food
as a vehicle, with olive oil and MCT oils.
So just anything… I make
really good dressings and sauces and spices
to try to get that in there
and then I like to start the day
with a smoothie.
This would be the first thing
I’d help people add actually,
rather than say,
“Okay we got to cut this and cut that”.
I say, “Let’s add to what you’re already
eating a green smoothie in the morning.”
So a couple of strawberries,
a bunch of spinach,
some hemp and avocado
and MCT of course,
so it’s really fat full and veggie full.
And it sort of feels a lot of voids…
You know, you could eat like a ton of pizza
but you can’t sit down and eat
like buckets full of kale salad,
because all the nutrients that your body
wants have been met
and it’s like, “Ah, I’m good”,
and it shuts it off.
But with pizza it’s still like,
“I still don’t have it, I still don’t have it.”
So you could just gorge.
So starting your day off or a lunch
whatever you prefer for the green smoothie
sort of ripples out and it kind of naturally
has them cut back on other things,
so it’s just a nicer start to, “We’ll meet
and add something to your diet
instead of take it out.”
So I try to do little twists like that
to make these changes a little easier
and we try to incorporate it
a little bit more slowly rather than…
He can just turn on a dime
and transform everything,
but most of us can’t do that.
So I tried to be like, “Let’s prioritize
the changes, let’s do them slowly
and incorporate them
and once it’s like working in your life
then we’ll look and add the next one.”
And so I kind of slow everybody down
and keep it very realistic.
And that’s a great approach
for people to hear
because we talk about so much information
and we give so many tips
and people think they can just run out
and do it right away.
And yeah like you said, most people
don’t work that way, it’s a process.
And so it’s great to have someone like you
who can coach people along
and really help them prioritize the process
to understand what needs to change first
and then what can follow after that.
So people need to keep that in mind when
they’re trying to make lifestyle changes,
because if you try and do too much at once
you can end up frustrated
that it’s not all working.
You could maybe inoculate it
for a short time
and then be like, “Oh, it didn’t work!”
Then you’re like, “Oh, another one
that failed that was just too much.”
Now, when you were talking
about cycling,
and we talked about this a little bit at lunch
the other day,
you also mentioned
about cycling with meat.
So it’s not that
you’re 100% all plants, no meat,
but it seemed like you felt,
if I can put words in your mouth,
that cycling with meat was also important,
so talk to me a little bit about that.
Sure, I think if you separate out vegans,
because there’s a lot of people
that choose a vegan lifestyle,
it’s more than the food.
There are other issues that led them
to that way of living.
And I think that for our style it’s possible
to maintain a vegan ketogenic style of eating,
but it’s difficult.
We will be the first to tell you,
it’s difficult.
If you’re more of a vegetarian plant-based
it’s certainly much easier to do,
but the way we eat
is actually to have some meat.
And the way we do that
is we try to eat meat in a 24-hour period
roughly once a week.
Now we don’t always stick to that.
Certainly things like conferences
and traveling,
it gets a little bit more challenging and
so we’re flexible and pragmatic about it,
but ideally we would say, “Go through your
weekly cycle”, which we do a five-day plan
and we try to encourage people
to do three days of time restricted feeding
in that five days
and then have a meat up day.
And for that day you have meat
with each meal.
Now it’s not necessarily gorging
on huge steaks.
We’re talking small serving sizes,
but you’re having animal protein
with each meal.
And the way I like to think about that
and the way I explain it to patients
is that we are omnivores
and to think there were omnivores
that had access to animal meat every day
is not realistic.
You can just look around the environment
and what would happen
is you would have a kill.
You would capture some sort of animal,
whether it’s a fish or bird,
a rabbit or whatever it is
and you would eat a lot of it.
You would eat it for, you know a day or two,
while it’s still fresh.
And I think that’s how
our bodies are designed
and so that’s how we style the plan
is to do that.
And what it’s doing is providing nutrients
that you don’t necessarily get from plants.
I don’t think that necessarily
animal products are bad in that sense
that some people do think they are
as far as health goes,
but I think the problem is that the meat that
we have readily available is bad.
And my approach
is kind of beyond macronutrients
so we can talk about sugars and fats
and things like that and that’s important
but I think even more important are
the fatty acids that are present in the fats.
And if you look at the meat supply
in this country,
not only is the Omega 6 – 3 ratio
really poor
but you have really elevated levels
of palmitic acid.
Palmitic acid is very inflammatory,
it activates TH1 and TH17,
so you not only have inflammation
but you have revved up immune system
and that’s what causes
atherosclerotic plaques.
So I think that if you have
really good quality wild game
it’s completely different than the hot dog
that you get in your grocery store.
Absolutely.
So I think that’s important.
And if you look at some of the things that
become deficient in vegans in particular,
there are things that actually meats
are very rich in.
So for example B12, carnitine,
those are very key elements.
And in fact if you look at people who are ill,
who are going to try to incorporate ketosis,
they are going to struggle if they have
mitochondrial dysfunction.
So if you’re going to do
a more plant-based ketogenic style diet
on someone with mitochondrial dysfunction,
they are going to struggle without carnitine.
It’s essential.
So meat is a great source of carnitine.
So is once a week enough to supply
those people with the carnitine they need,
or will you still supplement?
And the same question for B12 as well.
Great question, so for the healthy individual
I think you probably would do fine,
which is once a week meat,
but not sick patients.
And so we would regularly recommend
relatively high doses
of carnitine supplementation.
The B12, my preference
is actually to test for it.
I think the routine testing of key nutrients
like vitamin D and B12,
they are so easy to do
and you can actually measure this
and treat it as a titrated treatment
rather than just take this pill.
So let’s talk about that for a second,
because zero is a normal range in the lab
and that is derived from thousands
of patients who they thought were healthy
and they checked their levels
and defined the normal range.
Does that apply…
do you think that’s a true normal range?
And where do you shoot for the levels
in that range?
You can see she’s giggling so…
No, I don’t.
So I like to use the term “reference range”
and the reference range includes
a lot of unhealthy malnourished people.
So certainly with vitamin D levels
I really would encourage people to do
much higher than what’s considered normal.
So like 40 to 60?
That will be a bare minimum.
I am usually shooting for 80 to 120.
Now isn’t there a risk of vitamin D toxicity
at a too high-level?
It is actually quite rare and if you’re going
to get in trouble with vitamin D,
usually we’re talking about 30,000 units
a day before you really see a problem.
For someone who’s got kidney stone issues
might be little difference with renal failure,
but the average person can absorb
10 to 20,000 units a day without difficulty
and not run in trouble.
And with B12 I actually prefer
methylmalonic acid.
I think the B12 levels get falsely elevated
with dysbiosis,
which is an abnormal mix
of bacteria in the gut
which actually produce
B12 levels artificially.
So I don’t necessarily find
that a B12 level itself is very helpful.
Methylmalonic acid I think is more telling.
Now that’s going to be a tough test
walking into a doctor’s office
and asking for it.
That’s not going to happen.
No, it’s true.
But fortunately
now there’s direct labs for patients.
So we obviously encourage people to work
with their doctors,
but if there’s a test that you’re interested in
you can get them on your own,
without your doctor’s order.
Yeah, so I think the good take-home
there is if you walk in your doctor’s office
and they say, “Oh, your levels are fine,
don’t worry about it”,
don’t stop there, dig a little deeper
because what applies to you
is not necessarily what the normal
reference range is.
So rather than just supplementing,
you test with the B12,
but you would supplement
with the carnitine
in someone who does have
some mitochondrial dysfunction,
but someone who is healthy,
eating meat once a week
and you’re fine with not supplementing,
just to summarize that.
Yeah, we haven’t seen that be an issue
and obviously there are going to be
circumstances that may arise
where could be a problem.
But in general I think a healthy individual
with no indication of mitochondrial dysfunction
is probably going to do fine if they’re
getting enough meat one day a week.
And what about Omega 3s and iron
and calcium, any concern with those?
So certainly the mineral component
is a problem
with ketosis becoming deficient
in those minerals.
We’re not really deeply in ketosis.
So I don’t think it’s quite the issue
that you had for example
with the therapeutic ketosis.
And when you say therapeutic ketosis,
are you talking about certain levels
like above three for beta hydroxybutyrate,
or you’re talking about
using exogenous ketones?
What do you mean
when you talk about therapeutic ketosis?
Great question, so our goal is basically
to get to 0.8, to 1.5.
That’s kind of our level of ketosis
that we’re shooting for.
In that circumstance I don’t think
we’re seeing a level of fatty acid oxidation
that we’re going to deplete the minerals
to the levels you would
with someone to 3, 5 etc.
With iron I think that with a menstruating
female it makes sense to supplement iron,
but I think most men it’s not a big issue.
And certainly if you have meat once a week
I think you’re going to be okay,
assuming there are no chronic illness.
The things that I think that can be helpful
in terms of supplementation
on the mineral side,
I think applies to most people
is magnesium.
I think most of us walk around
magnesium deficient,
so that’s one that I give
basically to everyone.
And the other thing with that is
there’s not a good test for it.
So I don’t have a way to titrate it,
so I just kind of give it to everybody.
And generally it makes people sleep better
and when people sleep better,
they feel better.
So that’s kind
of just an automatic one for me.
And then if you look at the other aspects
of the minerals,
I think the food tastes better
when you season it
and so certainly just having them
add salt to the meals,
which most people
are okay with and tolerate.
I don’t think you need to get to the point
where you’re using supplements.
We just haven’t seen that to be a need.
Let me interrupt you for a second,
so, Stephanie is that something that you try
to incorporate in a lot of the recipes,
different seasonings to help
with the micronutrients?
And what are some
of your favorite ones for that?
Oh, gosh.
I’m just thinking about my super lazy salad
dressing would be like olive oil, lemon, Dijon
and then I like to put Rosemary,
or I mean thyme, thyme is my favorite,
and then I always use
Hymalaian pink salt.
I think all of the herbs a really good
but one of my favorite mixes,
I like to get mixes too,
because I like to be quick,
I’m trying not to use the word lazy,
but Trader Joe’s, they have
an organic herb salad mix,
so you get kind of random
bits of herbs in each of them,
just kind of different, like dill,
all kinds of stuff in them,
so we try to use fresh herbs
as much as we can in things
that are so high on antioxidants
and flavor let’s face it.
And what else do I put in there?
I guess I don’t really keep track
of what I do in that.
Well, I think that’s a good starting point
and tips to find sort of prepackaged…
You said that Trader Joe have
the prepackaged ones that you can use and…
Because, let’s face it,
we have to keep things easier
if we’re going to be compliant with it and
that’s probably a big part of what you do
is to help people stay on course.
But I do say you should make
your own dressings,
because in dressings they use canola oil
or soybean oil or whatever as a base.
I mean I’ve got times myself when he’s like,
“I’ve got to go, will you make me a lunch?”
and I get a little tiny Tupperware cup
and just squeeze a half a lemon,
a scoop of Dijon, the olive oil, shake it up,
mix it with some herbs,
I mean it’s so fast but it’s so important
to make your own dressing.
So I definitely don’t cut corners
on dressings.
But Trader Joe’s does have a mixed salad,
I think it’s called the Green Goddess,
and that’s an olive oil based one.
And I’ll fit it out with a little olive oil,
but it’s a nice one
to give you a quickie boost.
So I would like to touch on the Omega’s,
if I could.
Oh, yeah, please.
I think one of important things
to understand about Omega 3
it’s the ratios what’s really important.
And when you’re not consuming
a lot of the more basically…
what’s the word I’m thinking of?
Like the pro-inflammatory Omega 6s?
Yeah, so the food supply that we have
is very much tilted towards Omega 6
and in particular the meats.
So if you’re eating a plant–
The grain fed meats.
Yes, thank you for clarifying that.
So the more plant-based that you eat
the less you’re going to expose yourself
with the inflammatory Omega 6s,
so your ratio is a little bit more healthy.
But the other thing that’s really important
and I haven’t seen this necessarily
in human data but from animal studies,
when animals are fed
a high mono unsaturated fat diet
their requirements of Omega 3s
dramatically change.
And so our main fat in our lifestyle
is actually monounsaturated.
Lots of olive oil, tons of avocados, nuts.
So I don’t think that our clients need
a lot of Omega 3,
because what Omega three they have,
is more effective I think, based on the studies,
and the fact that they don’t have
a lot of inflammatory Omega 6
that they have to balance out.
So in general we’re not using a lot
of Omega 3 supplementation for that reason.
So talking about that balance,
so when you’re not using butter
and ghee and lard as cooking oils,
a lot of people will go to the Omega 6
vegetable seed oils,
that’s sort of like a standard go-to
when you’re not cooking with butter.
So how do you counsel your patients
for cooking oils
and how do you keep them
away from those?
Well we definitely don’t want them
to go to those oils.
No, we teach them that they’re evil.
And what are some
of your favorite substitutes?
Avocado oil.
So we really like to cook
with avocado oil.
And then we just literally encourage people
to drink olive oil.
So if we say at the end of your salad
take your bowl
and just finish the rest of your oil.
So olive oil is fantastic
and we really encourage it.
And then I think MCT oil
is what allows us
to have the level of plants
and carbs that we do.
In fact with our color system
if you do eat one of the red plants,
you have to have a tablespoon of MCT to go
with each serving to neutralize the effect.
So what’s an example of a red plant,
Like a “stop, don’t eat” plant?
Yeah, like the stoplight.
Not the red color,
but a “stop, don’t eat this” example.
So for example we both enjoy
the tropical fruits
and so pineapple will be an example.
So what we’ll do is we’ll actually drown
that pineapple in coconut cream.
That’s what we like to do,
it’s like a Pina Colada.
But you can get the same effect
if you make a smoothie.
Let’s say you put pineapple in it,
put a tablespoon of MCT in it.
What you want to do is, you know,
you’ve got…
the red plants are basically ones
that have carbs greater than fats,
so that is one criteria for the colors
and the grams of carbs are greater
than 15 for the reds.
So an MCT has basically
14 g of fat per tablespoon.
So if you add that tablespoon of MCT
with your red plant,
you basically get towards neutral,
close to neutral on the fat – carb ratio.
Now we would limit that
to one serving a day
but it allows you to have that sweet
that people tend to crave.
So it’s a way to incorporate flexibility
and really stick with the lifestyle.
Those fats in general are not the same
as the other fats, in particular MCT.
The MCT is absorbed directly
across the endothelium.
It does not go through lymphatic and drag
all these inflammatory compounds
like polysaccharide, which is the component
of bacterial cell wall,
which is extremely inflammatory.
I personally think that’s why saturated fats
are unhealthy more than anything else.
Is that they’re dragging all these
inflammatory products in the blood stream.
So MCT is a way to avoid that
and increase the fat content in your diet.
It also is more prone to generate ketones,
so it’s going to facilitate that process.
So we’re really big fans of both MCT oil
and olive oil in particular.
The other oils we’d really encourage you
to completely avoid as much as you can.
And as a practical product… I always
mispronounce the name… Myiaka?
I was going to circle back to that.
If you like butter,
the vegan cultured butter meat…
it’s made out of coconut oil,
but it tastes like cultured salted
delicious delightful butter, it’s so good.
You can cook with it, you can add it
to your vegetables high smoke point.
Exactly, very, very tasty stuff.
That woman is a genius.
And we’ve done blind taste test
and you cannot tell the difference
between butter and this.
No, you cannot…
the texture and everything.
That statement makes me think
of the old days…
I can’t believe it’s not butter.
I’m not taking about that.
Let’s get into some controversies
about plants.
Let’s talk about Dr. Gundry
and his plant paradox book
and the anti-nutrients, the lectins,
the problems that plants can potentially
cause for some people.
What’s your take on that?
I think first of all I really respect
what he has done.
I like people to think out of the box.
but to my knowledge there is not a lot
of science behind what he’s espousing.
My personal take on it is that individuals
that are sick, that have a leaky gut,
are more than likely to respond well
to his way of eating,
because those toxins are going to be
much more toxic to a compromised individual,
whereas a healthy individual
with a very intact gut lining,
with an immune system
that’s well-functioning,
they’re not going to have as bigger reaction
to these things.
I mean, clearly they are toxins,
nature is pretty fascinating
and it’s designed these seeds very well
and there’s a reason
why these compounds are in them.
Just like there’s compounds in other aspects
of plants that are very nurturing to humans.
So I think it’s something that is important
to consider with individuals who are ill,
I don’t think it’s as important
for healthy people.
So that’s kind of our take on it.
Am I speaking for you?
Yes, frankly if we get rid of them,
what else are we going to eat?
So the next step then is that some people
do feel better when they get rid of plants
and that’s where this whole carnivore
movement is coming from.
And Sean Baker being the king
of the carnivore movement,
because of just what a powerful and strong
and imposing figure he is
with the amazing things he’s accomplishing
but then even people like Georgia Ede
who take a more maybe
philosophical approach to it
and she has seen
all the benefits in herself
by getting rid of plants
and going perfectly carnivore.
And what is your take on that
when you see people feeling better
and sort of thriving
on a pure carnivore diet?
think it would go back
to some things that are similar
in the sense of the biochemistry
behind meat, I would say,
in the sense that mTOR
is a fantastic thing to stimulate,
but do you want to have it turned on
all the time your entire life?
I don’t think so.
Elevated levels of insulin growth factor,
I mean these are things
that have positive effects.
But like everything, if we really look at life,
it’s in spurts.
And so I think that these types
of styles of eating can make people feel well,
but I don’t think they’re a good choice
for the longevity of their life.
And that’s the thing,
is we don’t have a snapshot of 20, 30,
50 years of eating a carnivore diet.
We have months, or maybe a year or two.
Oh, people could point to,
I guess the Maasai and the Inuit
that they were close to a carnivore diet,
maybe not completely, but they were close.
So there’s some evolutionary basis there.
Well, I’ve also read some things that
the Inuit diet is not what we think it is.
That maybe is questionable
and I’m not going to say
that that’s a wrong style of eating,
because I don’t think
there is an ideal way.
I think that the way you eat
is very individualized
and I think that the health
of the individual
and perhaps more importantly the composition
of the microbiome makes a huge difference.
And most people have
unhealthy microbiomes.
And so if you eat meat only that is
much easier on the gut to digest
and you’re to have less issues with doing
that with an unhealthy microbiome
than someone who jumps in
and has 50 g of fiber a day at the gate.
They’re going to struggle.
That’s a great point.
So one approach would be then
if you’re having trouble with plants
then maybe need to fix your gut first and
then you won’t have trouble with plants.
And that’s part of the problem
as providers and as physicians
and coaches taking care of these people,
what markers to be followed.
Because when we talk about longevity
sure we could talk about mTOR,
but it’s kind of hard to measure mTOR
on a regular basis.
We can talk about MP kinase and PAK
but those are hard to measure,
so we have to find our surrogate
so we use CRP, we can use IGF-I,
we can use blood sugar and insulin.
But what you find as the best markers
that you think we can follow
to see if somebody’s on the right track?
Well, I think the ones you actually mentioned
those are the ones that I would tend to follow.
I think it also depends
on what the goals of the individual are.
So for someone with purely longevity
or say cancer prevention approach,
that’s very different than say
a cognitive patient.
And I think that for a cognitive patient
we do need to have anabolic effects.
In fact, I often tell my patients, I say,
“If you want to build brain you build muscle.”
I really think the brain
is tied to the muscle.
And so in that individual we have to have
periods of stimulation of mTOR.
I think it’s very important.
That may be an elderly patient
and you may say, well are you putting them
at risk for shorter lifespan
or are you putting them at risk for cancer.
I don’t know for sure, I don’t think so
when it’s pulsed, and I think that’s the key.
If you look at most hormones,
most hormones are pulsed.
So I think you’re okay
to periodically stimulate these things.
I would be very hesitant to have someone
like that be on a carnivore diet.
I just would.
On the other hand if you’re in your 20s
and you’re trying to build a beautiful body,
I mean that’s what you’re going to do.
Who knows if that’s
a good choice long-term though?
Yeah, very good point down.
And now one of your exciting projects
is your book, so Keto With Plants.
And now what inspired you
to write the book?
Well, I think as we kind of were exploring
for ourselves and for our practice
how to blend ketosis
with a plant-based diet,
we really started looking for help.
Who’s doing this?
Where do we look to for guidance?
There’s not many people.
So with that sort of dearth of information
we decided we’re going to do this,
we’re going to try and do the research,
we’re to try and put together the food plans
and make it really practical
so I think that’s really important.
If we’re going to do that for ourselves
in our practice
we should make it available
for everybody.
And I think over the last year or two
we’ve started to see more people
become interested in this
and start to go in that direction
so I think it is a new trend let’s say.
But we feel that getting a book
is a great vehicle for us
to get this experience that we’ve had
out to as many people as possible.
Now is it mostly a recipe book
or is there going to be some
of your coaching involved in there too
to help people stick with the program?
It’s a mixture of a lot…
there’s the science in the beginning
that I’m trying to tone down
so that us, laypeople can…
well, not you two, but me and the listeners
can understand and decode.
So yeah, there’s the science behind it
for those who’d like to know
why they’re doing these things.
Then there’s a little bit
of coaching elements.
So it’s like okay, I know you’re tempted
overall your lives, but let’s not do that
and just lay other foundation
to make sure…
to give people permission to take time
to take care of themselves…
and it’s kind of a mixture of everything
just to lay the foundations for a good start
of a change that’s going
to become lasting.
That was important too to us is that
this change would be lasting for people.
Let’s talk about that.
We spend so much time
talking about that the food,
but there’s so much more
than just nutrition and food
that makes us healthy
and helps our lives.
So you mentioned some of them
with gratitude journaling
and giving yourself permission
to take time.
So tell us a little bit more
about what you think are the important
pillars for people to have in their lives
that will help just make their nutrition
that much better for their lives
and make their lives that much better
in general.
Connection.
Yeah, connection to each other
and well to yourself.
Our modern medicine has separated
our mind from our body so much
and treat them separately,
but the mind drives so much of it.
I found this myself
when I was struggling to lose weight.
I was obeying all the rules
and the scale was just sitting there
and I know I shouldn’t like get on it
all the time, because I don’t like it,
but I went on a five day meditation retreat
and lost weight on the retreat
and he kept telling me,
“It’s stress, it’s stress”,
and I’m like, “You take your stress
and you just shove it… somewhere.
I’m tired of hearing
about this stress nonsense.”
And it turned out he was right…
whatever.
It’s hard to admit that sometimes.
Yeah, sometimes,
but no, stress messes so many things up.
And I didn’t feel
like I was a stressed-out person,
but I guess I just was.
You know, unhappy things frustrated me
and annoyed me really easily.
So with the mindfulness…
that taught me that you can kind of let go
of those recurring thoughts
that drive the negativity.
And you can let go of even weight I guess
if you can’t let go of negativity.
And then as women I think
we don’t give ourselves permission,
because we’re like we need to do this
for everybody else and give, give, give,
but you can’t give from an empty vessel
and you know that’s just really true.
So you actually owe it to your family
to take time to take care of yourself,
so that there’s more of you
to go around,
so it’s really your duty
to take care of yourself first.
So I think shifting the thoughts on that
and then also the restriction thing,
I try to shift the paradigm,
you know, the thinking on that,
that you are giving yourself nutrients
rather than restricting the pizza,
just kind of shift the–
-The focus.
-…the focus of it.
Yeah, and the words you use
and the way you talk about it
can be so important in reframing
someone’s opinion of it
and can affect your success
and their success.
Right, so try to also find
the right motivation,
not, “I want to be sexy”,
or “My doctor said I’m going to die”.
We tried to reframe to be more
like empowering positive psychology type.
Reframed like…
we like to be immediately rewarded,
so I like to focus on how you feel
after you eat a day like this.
So I really try to connect the mind
and the body
so that you are aware
of what you’re putting into your body,
how it makes you feel
and then that becoming a motivator
rather than this long term goal
like, “I’m trying to avoid cancer”,
or “Avoid dementia”.
That’s not motivating day-to-day
when you’re in the trenches.
So we try to get immediate rewards in place
and stuff like that.
So it’s a lot to pack into one book,
and then there are recipes yes, you’re right.
So yeah, it’s coming together.
So now do you have
any meat-based recipes in there?
Because you believe in cycling
and doing this on occasion.
Did you mention that in your book?
We don’t actually.
I think most people have that covered.
You mean there’s enough out there,
that’s a good point, a very good point.
What’s the timeframe?
I am excited to see this book come out.
Well, we got a couple of weeks left
before we have to get it done.
So we’re shooting for 28.
Mm-hmm, of August.
Very good.
This has been a wonderful interview.
I’ve really enjoyed talking to you Dr. Mike
and Stephanie,
thank you so much for taking the time.
Any last words you want to leave
our listeners with
and where can they go
to learn more about you?
Well, first of all, we really appreciate
the opportunity to be here, it’s been terrific.
You can find us online
at www.ketowithplants.com
and so one thing we like to say
is that all of this is something
that we’re into… we’re in together
and I think that working
in a collaborative nature
both as professionals
and as members of society
is the best way forward.
And I think that’s what I’d like
to leave you with.
He means we as in you
and all of your listeners and not just us.
All of us.
Thank you so much for joining us
on the DietDoctor podcast.
-Thank you.
-Thank you.