Today I speak with vegetarian diet advocate Kristie Middleton. I think many of us criticize, or are not welcoming of, a plant-based diet. However, in my continued attempts to be objective, I wanted to give someone from this dietary camp a chance to make their argument.
Dr. R’s Fast Facts
- Too many nuances to list them all here.
- Kristie makes some good points.
- She also makes some points I disagree with and that we talk through.
- Get help with your diet.
- Get a free gut health eBook and be notified when my print book becomes available.
- Healthcare providers looking to sharpen their clinical skills, check out the Future of Functional Medicine Review Clinical Newsletter.
Episode Intro … 00:05:38
Vegetarian vs Vegan … 00:10:10
Schools & Processed Foods … 00:11:42
Sponsored Resources … 00:14:34
Higher Quality Meats … 00:15:54
‘Crapatarian’ … 00:19:25
Dr. Ruscio Resources … 00:21:44
High/Low Vegetarian Benefits … 00:22:42
Low Carb Diet … 00:29:01
(click gray Topics bar above to expand and see full outline/time stamp)
Diet Debate … 00:31:42
Meat & Fat Problem? … 00:35:33
Fiber, Grains & Digestive Issues … 00:41:25
Episode Wrap-up … 00:42:41
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Pros and Cons of a Vegetarian Diet with Kristie Middleton
Dr. Michael Ruscio: Hey, guys. Just a quick prelude on this episode. We had Kristie Middleton on, who is a vegetarian diet advocate. And I wanted to have someone on from the vegetarian camp to give us a showcasing of the other side of the dietary coin, which I think many of us may not be super privy to in terms of some of the arguments or some of the data points for a more plant-based diet. And you know me. Trying to be objective, I wanted to really give someone from that camp of thinking a chance to articulate some of the pros and maybe some of the cons.
And I think the best point that she made was regarding potentially reducing or reducing the amount of meat consumed in schools due to the cost and due to the difficulty of preparation. Not to say that they’re eliminating, but consuming less meat in schools and making that meat of higher quality and also increasing the fresh, plant-based foods.
And there’s an economic argument there where meats are a little bit more expensive. So if the school has a limited budget, less meat but higher quality along with fresh vegetables and fruits and maybe some grains also, but plant-based, I think there is some decent plausibility for that.
Is it ideal? Maybe not. But again, if we’re working within a school system that has a confined budget and resources in terms of personnel and prep, then that may not be a bad compromise.
I enjoyed the discussion with her. She seemed very open minded and certainly not argumentative or hard headed at all. She was a delight. I did find her argument a little bit one-sided in terms of making some broad statements and citing some major foundations.
But I didn’t feel like the evidence specifically supporting one way of eating being better than another was really there, in terms of I was really hoping there would be some sharing of comparative trials where we’re looking at a healthy vegetarian diet versus a healthy paleo type diet, for example, where they showed a favorable benefit from the healthy vegetarian diet.
But usually what the supports were for her argument were processed meat or generalizations of societies that eat more meat and fat, but not really looking at clinical trials where we look at a diet that is maybe heavier in meat and fat compared to a vegetarian diet but also healthy, a healthy application of those.
So I would’ve liked a little bit of better evidence there. But also, I think it can be helpful for us to listen to the other side of the argument, be open-minded, realize that any diet can be healthy and helpful.
But also, understand that perhaps one of the biggest holes in the argument of vegetarianism is exactly as I just went through, where they’re using confirmation bias, reinforcing-type data where they’re telling stories about how people have benefited.
But people can benefit from almost any diet. And so saying how someone benefited on a vegetarian diet and then citing how meat is bad because of processed meat consumption and other vague studies or citing studies where people have improved on vegetarian diets even though they’re clinical trials, yes, we know that will happen.
But what about looking at some of these other diets that have shown benefit and even studies that have shown comparative trials looking at paleo or low-carb next to vegetarian showing favorable benefit when compared to the vegetarian diet? I think that was a little bit factored out of the argument.
Perhaps that’s why I’m an advocate more so of a paleo diet, and in some cases a low FODMAP diet, and in some cases a low-carb diet. Even though I am totally open, I have the opinion that I have because I think it’s clearly what the data suggests.
So I’m grateful and appreciative of her dialogue. I think there were some weaker points that may help make someone feel more confident if they are eating a paleo or eating a lower carb diet. I think you can feel more confident based upon some of the holes in the argument.
Again, I think she did a great job. I’m very appreciative. I’m just being very data driven here and objective. It’s certainly not a criticism at her, by any stretch of the imagination.
And I’m going to keep searching for someone who may be able to bring a very strong evidence-based discussion. I think his name is Michael Greger. He runs NutritionFacts.org.
But again, I think it’s going to be more of the same. I think it’s going to be more of citing a one-sided argument, not recognizing the other side. And for me, I am happy to have someone eat any diet, vegetarian all the way through Atkins, as long as it seems to work well for them.
So with that as the introduction, let’s jump into the show. And quickly, I just want to say again, thank you to Kristie for coming on the show and having a healthy discussion from two different viewpoints on the dietary piece. So here we go.
Hey, everyone. Welcome to Dr. Ruscio Radio. This is Dr. Ruscio. Today, I am here with Kristie Middleton. And we’re going to be having what I think will be a very interesting discussion.
Kristie is a vegetarian advocate. And she wanted to come on the podcast to discuss the benefits of a vegetarian diet. And of course, we oftentimes on the podcast talk about some different diets—oftentimes low FODMAP, sometimes paleo, and even sometimes low carb.
But I’ve also repeatedly made the recommendation or the comment that next to a standard American diet, any diet plan can be healthy. And as Christopher Gardner said, most of the benefit from diet plans probably comes from cutting out processed foods, added sugar and trans fats, and focusing on healthy, whole foods.
And we squabble over the 20% that you could gain from one diet compared to another. So I think we have a good—hopefully in our audience—healthy perspective on diet. And I’m excited again to have this conversation with Kristie to discuss the pros and the cons of these different diets that are available and taking into her account her perspective from someone that’s heavily involved and an advocate of the vegetarian diet.
So with that long interlude, Kristie, welcome to the show.
Kristie: Thank you so much for having me on.
DrMR: Now, can you tell our audience a little bit about your background and your experience before we jump into some of the specifics of the discussion.
Kristie: Absolutely. So I work for the Humane Society of the United States. And a lot of times, people know that I work on food issues. They wonder if that means that I am working on dog food and cat food.
But what we do at the Humane Society is I work with institutions like schools, hospitals, colleges and universities, corporate cafeterias, and others to help them with getting more plant-based meals on their menus and reducing the overall meat that they’re serving. And so at my personal level, I have been a 20-year vegan and advocate of a more plant-based diet.
And I’m also the author of a book that came out in the spring of this year called Meat Less: Transform the Way You Eat and Live—One Meal at a Time. And I wrote the book after having worked with so many institutions and talking to people about their desire to have more plant-based foods on their plates as well as their guests’ and customers’ plates, but feeling like the idea of becoming vegetarian or vegan was so overwhelming.
And so I wanted to give people a resource that gave them information on why more people are eating a more plant-based diet and eating less meat, identify some of the common obstacles to eating that way, and then share some tips, tricks, and some of my favorite recipes.
And so the idea behind the book is that you don’t have to go 100%. It’s just finding something that works for you and moving in a better direction of getting more plant foods on one’s plate.
DrMR: I think that’s a really great approach from it being reasonable, because I’m sure you probably struggle with this same thing, where people sometimes talk themselves out of a diet because they’re trying to do it 100% perfectly. And if they can’t do it 100% perfectly, they don’t feel good about it. And they want to give up. And so giving them a little bit of flexibility makes it much more accessible.
Kristie: Indeed. In fact, in the book I share the story of gentleman whom I interviewed. And he had tried to become vegetarian several times. And he did it both times with his wife. And one of the things that often helps us stick with a diet is if our community or our friends and family are also doing it with us.
But what they found is that once they fell off the wagon and they ate meat accidentally or intentionally, they just decided, “Okay, I’m not a vegetarian anymore. So I’m just going to give this up altogether.”
And so they ended up finding what worked for them was doing a Meatless Monday and then adding more plant-based meals throughout the week. So they’ve been doing that for well over a year now. And they found that that actually works for them.
They feel like it’s doable when it has influenced their eating decisions throughout the week, but it hasn’t felt as rigid as being vegetarian or vegan, which admittedly works for me and works for some people. So it doesn’t have to be that all-or-nothing approach that I think sometimes scares people away.
Vegetarian vs Vegan
DrMR: Right. So I guess wherever you are on the spectrum of vegetarian or being the opposite of vegetarian, which may even be an Atkins diet, the 100% avoidance is pretty much hard across the board. So it’s good that we have that commonality there.
And would you mind just defining—for people that may not fully understand what the difference between vegetarian and vegan is, can you define how those differ?
Kristie: Sure. People who eat a vegetarian diet abstain from eating meat. And usually that includes fish and poultry. I certainly hear a lot of different definitions. But that’s the standard definition.
There are other forms. Some people say they are lactovegetarian, meaning they consume dairy. Or they’re lacto-ovo, meaning they consume eggs and dairy. And then some people say they’re pescetarian, meaning they eat fish, but they don’t eat other animals.
Vegan means that you wouldn’t eat any meat, eggs, or dairy, including fish, poultry, etc. And I think though, that these definitions are what do become scary for people, because sometimes people enjoy that. And that helps with making the decisions such as if you go to the restaurant. And you say, “Well, I’m eating vegetarian. Or I’m a vegetarian.” You know where to go and look.
But at the same time, for people who are just trying to experiment with eating more such foods, they don’t want to be put in that box or in that category. So I try to encourage people to take a more plant-based approach where they are basing their meals on the fruits, vegetables, legumes, whole grains, and these other foods that are abundant that have all of the important nutrients that we need but without having to swap out a label on, necessarily, if that’s a barrier to them making more healthful eating decisions.
Schools & Processed Foods
DrMR: Totally. Totally, totally agree with you there. And something I wonder. It seems to me that, especially if you’re going into school systems where the food quality is probably pretty poor across the board, I would think that that would be an area where just getting fresh foods, irrespective of if it was even meat versus vegetables—just getting away from processed. Because of course, thinking back to the cafeteria when I was a kid, it was chicken nuggets and canned sloppy joes. So everything was just so processed.
And if you disagree, please let me know. But I would think across the board if you’re going to go from processed meat to fresh meat or processed vegetables to fresh vegetables, just getting off processed, onto fresh is going to be a huge step for us.
Kristie: Right. You’re absolutely right about that. So one of the things that we do every day is work with schools. And we find that there are a lot of schools that—if your listeners are not really familiar with the National School Lunch Program, it’s essentially the federal program that helps with ensuring kids get meals while they’re in school. And that could include breakfast and lunch, sometimes even supper.
And what I’ve found over the course of the years is, yes, I went into it with that mentality of school food is bad. But that’s also like saying that people are bad. The food is not bad because the people who are serving it don’t care and don’t want to serve better food.
It’s just a matter of trying to serve hundreds of thousands, or in some cases, tens of thousands of meals on this institutional level. It can be very difficult to do it. And it can be very difficult with the resources that they have available, like limited time, limited staff, and very tiny budget.
But I’m really excited that I’m seeing a lot of progress that’s happening in that space. I live in East Bay, northern California, and I work a lot with Oakland Unified School District, which is a city that has a lot of kids who are on high free and reduced lunch, meaning that they are getting assistance because they don’t have the money at home to necessarily be able to afford the lunch at school and pay full meal price.
And they are really doing incredible work getting more fresh foods on students’ plates. They are doing things like a meatless lean and green day, because that works better for them.
And they’re finding other ways to reduce the amount of meat that they’re serving and get more fruits, vegetables, whole grains, etc. on the students’ menus, because they found that the quality of the meat that they’re able to purchase is unfortunately not what they would like it to be.
So by reducing the overall amount, they can purchase higher quality meat, and that’s something that they felt more comfortable with. So there are a lot of really interesting approaches and a lot of good work that’s happening in this space at school. But we certainly still have a long way to go.
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Okay, back to the show.
Higher Quality Meats
DrMR: That’s actually a really great point. And I think that would be very important in terms of takeaway for some of the people in our audience who might be very paleo or low carb leaning, to understand that part of the reason why the food quality is so low at these cafeterias, just like you said, is because of finances.
And of course, pound for pound, meat tends to be more expensive than vegetables. So maybe the biggest step we can take is exactly as you termed it, or you phrased it, which would be reducing the amount of meat, but having a higher quality meat and also focusing a little bit more on vegetables.
I think that’s a totally reasonable approach if we have to work within a system that’s confined by finances. And I think it’s important, again, just to reiterate this. Let’s say you’re a parent and low carb has worked really well for you. It’s important to be a little bit open-minded to the concept that you may not be able to have the ideal lunch for your child. But you have to make some concessions within what’s available at the school per what the finances will afford.
Kristie: Indeed. Yes, and I’m really glad that you brought up the budget issue. And as I mentioned, that’s one that Oakland Unified faces, as do schools across the country. But I think a lot of individuals do.
And meat prices are rising, and they’re going to continue to rise. And unfortunately, that rising cost doesn’t necessarily reflect an increase in quality of the meat. And so something that a lot of people that we work with do is this concept of meat/mushroom blends or otherwise finding ways to reduce the overall meat and get more fruits and vegetables in one’s diet.
I think it’s especially important for kids, because kids can often be very picky eaters and tend to have very specific ideas of what they want. So sometimes you have to sneak the vegetables in, so whether it’s in a hamburger that you’re adding mushrooms to or that you’re adding legumes to provide some filling, but also to reduce the overall amount of meat that’s being served.
And I will add that one of the reasons that we work with institutions like the schools, hospitals, and others is because, as a nation, we’re simply not eating enough fruits, vegetables, and whole grains.
There was a report that was produced by the Robert Wood Johnson Foundation and the Trust for America’s Health called “The State of Obesity Report.” It came out a couple years ago. And they found that 37% of adults are eating fruit less than once a day and that 22% of adults are consuming vegetables less than once a day.
What’s less than once a day? Not at all. A third of us and a fifth of us are not eating a single piece of fruit or a single vegetable throughout the course of a day. And that’s a problem, because we know that that means that we’re not getting important nutrients. And we’re not getting the fiber that we need to be able to properly digest these foods.
So I think that this approach is not just about reducing meat, but it’s also about eating more of these important foods that we’re just not eating enough of as a society.
DrMR: Absolutely. Yep, and I think most reasonable people who are having the discussion on diet agree that we just have to get some of these broad fundamentals like I opened the discussion with. And that’s really the most important first step.
So if someone is going from no diet at all, they may not have to have the most perfectly balanced, let’s say, paleo diet or vegetarian diet. But just start making steps and incorporating more fresh foods. And I think most of our audience gets that. I don’t think we have a lot of people listening who are totally new to diet.
But one thing I’d like to ask you that just shot into my head is this term that is sometimes thrown around, which is called crapatarian, which is someone who just eats tons of processed grains and chips and what have you. I’m assuming you don’t agree much with that.
But beyond just superficially not agreeing with it, are there certain things that you see within the vegetarian community where people are sometimes falling into the unhealthiest foods allowed within the diet? And do you have any tips or tricks for people to see their way out of that?
Kristie: Sure. Well, I had never heard that terms before. But I have been a crapatarian apparently in the past. It’s never been easier than it is now to be a vegetarian or a vegan, because there are so many of these processed foods that are coming out. And as a person who follows this kind of lifestyle for ethical reasons, I’m really glad to see it. But on the other hand, I don’t need any vegan Hot Pockets in my life.
I think that it’s good in a way, because it demonstrates that these companies are producing it because they realize that there is a demand. But on the other hand, Ben and Jerry’s and Breyers ice cream and, I think, Häagen-Dazs—lots of these mainstream companies are now offering vegan brands. And you can certainly be an unhealthy vegan as well.
And so in terms of ways to address that, I think that just as it doesn’t have to be an all-or-nothing approach to be a vegetarian or be a vegan, it doesn’t have to be an all-or-nothing approach when you’re talking about eating decadent food every once in a while. But I think that I would limit to every once in a while.
And personally, I don’t buy it, because if it’s in my house I will eat it. And so I usually reserve those kinds of foods for a treat if I’m going out, I’m going to a friend’s house for dinner. But if it’s in the house, then my brain is focusing on that.
And so I would really encourage people to take that approach and be very real that it’s difficult to avoid these food products, packaged foods. When we’re hungry, we make decisions. If they’re in the cupboard and we know that they’re there and they’re very accessible, then it’s a lot easier to get to them than if we have to drive to the grocery store.
So my recommendation really is enjoy them every once in a while, and don’t make those the staples of your diet.
DrMR: Sure. Sure.
Dr. Ruscio Resources
Hey, everyone, in case you’re someone who is in need of help or would like to learn more, I just wanted to take a moment to let you know what resources are available. For those who would like to become a patient, you can find all the information at DrRuscio.com/GetHelp.
For those who are looking for more of a self-help approach and/or to learn more about the gut and the microbiota, you can request to be notified when my print book becomes available at DrRuscio.com/GutBook. You can also get a copy of my free 25-page gut health e-book there.
And finally, if you’re a healthcare practitioner looking to learn more about my functional medicine approach, you can visit DrRuscio.com/Review. All of these pages are at the DrRuscio.com URL, which is D-R-R-U-S-C-I-O.com, then slash either “Get help,” “Gut book,” or “Review.” Okay. Back to the show.
High/Low Vegetarian Benefits
Now, the next question I’d like to ask you is, who do you feel can benefit the most from a vegetarian diet? And then conversely, who do you feel can benefit the least?
And just to offer some fodder for the conversation here, in my clinical practice, we oftentimes will have people go on a paleo diet, for example.
But for people who are underweight, a paleo diet or even something like a low FODMAP diet can be somewhat problematic, because it oftentimes pulls out some of these denser carb sources.
And so for patients that are underweight, oftentimes a paleo diet, a low FODMAP diet needs to be modified to allow rice, potatoes, and maybe even some grains, even though we try to be a little bit careful with some grains in the office, because these people need denser carb sources to help with weight gain.
So I’ll throw that out as some populations that may not benefit tremendously from the typical diet that I gravitate toward recommending. So with that in mind, Kristie, who do you feel does the best and maybe the worst on a vegetarian-type diet?
Kristie: Yeah, that’s a good question. I don’t work with patients. I’m not a physician or a dietician. But the Academy of Nutrition Dietetics, which is the trade organization for that field, put out a position paper recently. And they said that vegetarian diets are suitable for everyone through every life stage from infants all the way through older adulthood. And so people can thrive on vegetarian diets.
And in the work that I do, I’ve encountered a lot of people who are suffering from obesity who have found that eating a primarily plant-based diet or mostly vegetarian or vegan diet, if not fully vegetarian or vegan diet, that that has been a great way for them to reduce their weight and to improve their weight management.
So in the book, I share the story of a food service professional whom I worked with who was 327 pounds. And he worked at a university cafeteria. So he had access to food breakfast, lunch, dinner, and in between.
And unfortunately, he underwent gallbladder surgery and had to have his gallbladder removed because he was experiencing some complications. He was suffering from all kinds of joint pain. And it was all he could do to just maintain that weight and not continue to gain weight.
So he started exercising and ultimately found that even exercising wasn’t helping. And fortunately for him, a lot of students on campus were asking for more vegan options.
And his answer to those students was he decided to become vegan while on campus. So he would still potentially eat his other favorite foods including meat, eggs, dairy outside school. But while he was on campus, he would only eat vegan.
And he ended up losing a tremendous amount of weight. He’s down now to about 200 pounds. He said that he feels better than he has in decades. And he really regrets that for so many years he was overweight and obese and suffering.
And so it has been a good way for a lot of people who are really struggling with obesity, I think, to be able to reduce their excess weight and start eating more healthfully. And for Ken, he said that he was just mindlessly eating and, in his own words, just slamming food in his mouth. And now, he’s a lot more thoughtful.
And I would agree. For me, I haven’t ever really struggled a lot with weight. I’ve fluctuated over the years. But before I became vegan, I didn’t think about my food. I wasn’t reading labels. And for a lot of people, I think, to make this transition, it’s really a good way to just start thinking more about where your food comes from, how it’s produced, and the impact that it’s going to have on your health.
Now, another set of people whom I have personally worked with and talked to who have had some benefits from eating a vegetarian or vegan diet are athletes, because a lot of athletes are recognizing that it’s a really good way to eat cleanly to get all of their essential nutrients to help with endurance, to help with recovery, and to reduce some of the nagging injuries and tendonitis and inflammation.
Now, of course, they’re going to have to plan their diets a little more than most of us would. But it’s been, I think, a surprise for many who maybe had, for many years, been told they needed meat to be big and strong or to get sufficient amounts of protein.
But I have a good friend. His name is David Carter, and he was an NFL defensive lineman. And he became vegan and had the exact experience of it reducing some of his nagging injuries, tendonitis. It improved his speed and his endurance. And now, he’s a huge advocate of it.
So I think that many people from many different backgrounds can benefit from eating this way. But what I advocate for is reduction and getting more plant foods on your plate and less meat. And I think that’s something that we could all benefit from.
DrMR: Totally agree. And especially like the two gentleman you outlined, I’m assuming they came from no diet plan at all to then starting on a diet plan, being thoughtful. And I think, again, it’s reasonable to say that any diet that focuses on fresh, whole, unprocessed foods is going to allow someone to benefit, especially compared to no diet at all.
DrMR: And this is where I like to get into some of the finer points now. People then start comparing diets. And again, I think it’s important that we all keep in mind that maybe a loose, arbitrary estimate would be you’ll experience 80% of potential dietary gain from just making the simple shift to non-processed, whole, fresh foods.
But sometimes people are wondering, “How do I best get that next 20%?” And this is where I think more of the debate starts to materialize between different dietary camps.
Low Carb Diet
So I have a few questions that I think will be interesting to compare and contrast our different thoughts and substantiations for those thoughts. But let me first ask you, what are your thoughts on a lower carb-type diet?
Kristie: Oh, man. As a carb lover, I have to say it’s one of the food groups that I really personally enjoy. And I think that for so many people, they have just cut out this entire category of foods on not a lot of information. And I think that’s really problematic in our society in general. And I’m saying that to somebody who wrote a book about food. But we get a little bit of information, and we think we have the full picture.
And so when it comes to carbs, I think just like any food, we have to eat them in moderation. I love bread. I bake bread. But I try not to just sit down and eat just bread. I really try to vary my food.
And there are certainly groups of people that we know have true allergies to wheat and to gluten. And I think that those people obviously should avoid eating those foods.
And I guess when it comes to carbs that there are probably good carbs and there are bad carbs. But I think that we would need to be very careful about all of our meal planning, as we should no matter what sort of foods we’re eating and just be very thoughtful about not just focusing on one food group and demonizing it. But I’d love to hear your thoughts.
DrMR: I think that’s totally fair, because you’re right. “Carbs” is a very broad term. And there are carbs that are going to be more inflammatory. Like for some people, gluten is going to be clearly a bad idea. You have celiac. You have non-celiac gluten sensitive. And then you also have people who potentially don’t process starchier carbs well.
They have an underlying predilection toward diabetes, pre-diabetes. And they have to be careful with too much fruit, too much pasta, even if it’s, let’s say, gluten-free pasta, or too much potatoes, or squashes. And they have to lean more toward things like vegetables and things that have a lower glycemic load or a glycemic index.
So totally in agreement. I think it’s an excellent insight to not just make a broad sweeping term. But I do use that term, because oftentimes the studies that are used will study a low carb diet. Now, I think the more contemporary application of low carb diets also, of course, factors in trying to have people eat non-processed carbs for the carbs that they do eat. And when they focus more on protein and fat as part of that low carb diet, they focus on fresh, whole, non-processed sources of protein and fat.
But one of the things that was very striking to me…And so I recently am almost finished writing a book. It’s been a labor of love and also a thorn in my side at the same time.
Kristie: Well, congratulations!
DrMR: Thank you. Thank you. One of the things I try to do is very objectively go through the evidence on both sides of a particular issue from a dietary perspective. And this is where I really crystallized my opinion where all diets can help.
But if we look more closely at some of the comparative trials, we sometimes see a certain diet outperforming another diet. But what I think happens in this space all too often is, because a diet can help, people who prefer a certain diet only focus on the studies showing that the diet they like can help. And they disregard studies showing that the diet that they don’t like can help.
So one of the things regarding weight loss that I thought was very telling was a meta-analysis that was published looking at 53 clinical trials that showed that lower carb diets tend to have a slight edge for weight loss than do traditional lower fat diets which, of course, also tend to be higher in carb. Now, they both work, but there’s a slight edge.
Now, to be fair, the effect size—and I’m approximating here—but the effect size is only a number of pounds, maybe between 3 and 8 pounds in terms of how much weight you lose on one diet compared to the other. So the difference between the diets is not huge, especially if you’re looking at 3 to maybe 7, 8 pounds difference of weight loss and you’re looking at someone who’s obese. That’s not a ton.
But this is something that I’d be curious—what are your thoughts in terms of looking at that type of analysis? A systematic review with meta-analysis of 53 studies is pretty compelling. But what are your thoughts? What goes through your head when you hear about this analysis?
Kristie: Yeah, I would certainly be interested to read more about it. And I think you’re absolutely right that we gravitate toward the evidence that we want to be true.
Again, though, I’m not 100% pro-carb even though I really do enjoy them. What I support is reduction in meat consumption. And unfortunately, oftentimes what that means for a lot of people is eating a lot more carbs or even a lot more processed foods.
But I think that there is certainly a lot of evidence, whether it’s from the American Medical Association—which just last week put out a position paper encouraging hospitals to add more plant-based foods to their cafeterias and to stop serving as much processed meat—to the World Health Organization to Kaiser Permanente, one of our nation’s largest healthcare and insurances providers, that is just saying, “We need to eat more plant-based foods. And we need to eat less meat,” because there is an abundance of evidence that indicates that the amount of meat and other animal products that we’re consuming is contributing to some of our nation’s biggest killers—heart disease, cancer, stroke, type 2 diabetes—and is also linked to the high amounts of obesity that we’re seeing.
So I hope that answers. I’m not quite sure that it does. But I’d be really interested to see that. And I’m definitely open to hearing conflicting evidence.
DrMR: Well, you know what I’ll do, Kristie? When we get off the podcast today, I’ll shoot you an email, which will essentially just be a cut and paste out of my book with all these statements and references, because I appreciate your open-mindedness. And I think the nice thing about reading the information I put together is it gives you both sides. And it clearly does not show one diet should be done, and the other diet should not be done. It really shows all diets can be helpful.
Meat & Fat Problem?
But coming back to your earlier statement, I do take issue with the blanket statement that things like meat and fat are contributing to things like obesity and heart disease because, again, when we come back to some of these comparative trials, when we put a vegetarian diet next to a paleo diet in some of the comparative trials or a lower carb diet in some of the other comparative trials, we actually see a better shift in the cardiovascular risk profile done via lab work or the body composition parameters that predict heart disease when on either a paleo diet or a lower carb diet compared to a vegetarian diet.
Now again, it’s important to mention that all of these diets shift someone very favorably and are beneficial. But if you look at, again, some of these comparative trials—and I’ll send you all these links here—you see that the paleo diet may lower cholesterol, triglycerides, and insulin, and improve HDL a little bit more than a vegetarian diet.
Now, the LDL is one contention point there. But if you look at the aggregate sum of all the markers, the net shift in the cardiovascular disease profile in some of these comparative trials, actually in most of these comparative trials, for cardiovascular disease has shown a slight favoring of these types of diets which is, again, why I take issue with some of the major associations’ blanket statements that we have to reduce meat and fat consumption as if they’re the main drivers of these conditions.
And I think the reason why I find that most disheartening is probably two-fold. One, I don’t think it’s true. It’s misrepresenting the data. And sometimes, what ends up happening is you lump in people who are eating a lot of processed meat and fat. And therefore, you say, “Well, any diet that advocates meat and fat is now bad.”
And that’s just like me saying, “If you eat canned vegetables every day and you have high sodium and then you end up having a heart attack, you shouldn’t eat any vegetables.” It’s the same kind of logic of the argument. Of course, that doesn’t make a ton of sense.
But the other is because when some people do not do well with processing carbs—potentially, maybe they have gastrointestinal imbalances. And they’re sensitive to FODMAPs in some vegetables. Or they have a predilection toward diabetes. And they read these types of recommendations. They feel pigeon-holed into only eating a high carb, lower fat, lower protein diet.
But if they had only had a truthful narrative on the dietary picture, knowing that if they did a healthy version of a potentially lower carb and higher protein and fat diet that also has ample amounts of fruits and vegetables, they could also be healthy.
So I guess that would be my answer to that. But what would your reply back to that be?
Kristie: Sure. Well, I think it goes back to what I mentioned before in terms of people not really being very mindful about nutrition and nutrition research. And I would say I would agree with most of what you said.
But I think in general, we’re talking about a population of people who are just eating way too much meat. We’re eating, on average, 120 pounds of meat. So there may be patients or certain groups of people who are on a paleo diet who are being much more mindful about what they’re eating. And I don’t think that that’s representative of the general population.
Many of the people whom we talk about I go and work with who are eating anecdotally meat at breakfast, lunch, and dinner. And of course, we know that the World Health Organization declared processed meat as a carcinogen.
And so in general—and I know that we’re trying to avoid speaking in generalities—I think that we’re eating too much meat. And what I’m advocating for is simply eating less meat and eating more fruits and vegetables.
DrMR: Gotcha. Gotcha. But also, just to be careful, processed meat, of course, is different than non-processed meat. And so that’s why I’ve had a few people reach out to me about a recent documentary. I think it’s called What the Health.
And from just a very, very quick, cursory look, it seemed like most of the argument was made looking at processed meat, which of course comes back to my analogy of canned vegetables compared to fresh vegetables. It’s not necessarily a super fair comparison.
But what do you think in terms of if it’s—outside of processed meat and processed fat, do you feel like there is an inherent problem with meat and/or fat? Or is there any data showing that there is inherent problem with meat or fat?
Kristie: Yeah, my colleague, Dr. Michael Gregor has a website, NutritionFacts.org. And he wrote the bestselling book, How Not to Die. And I highly recommend it. It looks at some of the leading causes of death and ways to prevent them.
And I talk a little bit in my book about some of the leading causes of death. But the cholesterol sometimes is bad, sometimes is good. We’re getting mixed messages from the industry and from a lot of the research that’s out there.
But what we know—Dr. Ken Williams, who is the past president of the American College of Cardiology—he’s now eating a vegan diet after himself undergoing some heart issues, which of course is the height of irony. But he advocates for a plant-based diet for heart health.
So I think that there is evidence. We know that cholesterol is found in meat. It’s found in animal products. And cholesterol is what ends up building up in our arteries and leading to heart disease. So moderation, reducing the amount of meat that we’re eating and eating the foods like oats and whole grains and things, apples, that will scrub our arteries are good ways to prevent heart disease.
Fiber, Grains & Digestive Issues
DrMR: What about patients with digestive maladies? Have you had any specific information or people having a hard time with vegetables or with grains, outside celiac of course? Have you come across anyone who might be FODMAP sensitive or who have IBS and doesn’t do well with fiber? And have you found any modifications helpful for those people?
Kristie: Not working directly with clients or with patients, it’s not something I often hear experienced. But the one concern that I do hear from people has to do with eating more beans, because if you’re not eating meat, then where do you get your protein? And of course, we know that it’s found in many, many foods. But a lot of people end up getting their protein from beans or legumes.
And I think there’s a real fear around the ability to digest beans. And of course, we have heard about beans being the musical fruit. So let’s get the elephant out of the room.
But something that we can do is cook our beans from scratch, so using dried beans, and then rinsing canned beans very well is a really good way to reduce the risk of flatulence. But it’s also about just getting used to eating those foods. It’s because once your body gets used to it, then it can digest them a lot more easily.
Episode Wrap UpDrMR: Gotcha. Gotcha. Okay, that makes sense. Anything else? Anything else that you think is important to mention on a plant-based diet as we move our dialogue to a close?
Kristie: Yeah, I think that one of the biggest things that I hear from people is that they just don’t know where to begin. And so whether you’re going to do a Meatless Monday or you want to get to 100%, I think it’s really about taking those first steps.
And that’s one of the things that I love about programs like Meatless Monday. It gives you permission to do a little bit.
So Meatless Monday, if you aren’t familiar with it, if your listeners aren’t familiar with it, is a program that initially started during World War I as a resource conservation campaign, because it was realized, even back then, that meat production was very resource intensive because it requires land. It requires water, fertilizer, these other resources that we could be using to grow food that we could eat directly ourselves.
So it started during World War I. It was brought back during World War II and then again in 2003, but this time by the Johns Hopkins School of Public Health, just a war on preventable, chronic diseases.
And so what I love about this concept is it helps people with getting their week off to a healthy start. You could start with Monday. And you can keep up through a Meatless Tuesday through Friday. Or you could just have your one meat-free day.
Or Mark Bittman, who was a New York Times columnist, wrote another bestselling book called Eat Vegan before 6:00. The concept of that was eat two-thirds of your meals vegan. And then eat whatever you want for dinner.
So it doesn’t have to be this all-or-nothing approach. But identifying the obstacle and what that could be for you may be just you don’t know where to start. So identify one day a week. Cook your favorite meals, and cook them without meat. Or go out to a restaurant and explore a whole new cuisine. There are lots of international foods that are plant based by nature.
But I think that really it’s all about taking the first steps to get there. So I share lots of tips in my book, Meat-Less: Transform the Way You Eat and Live—One Meal at a Time, and lots of my favorite recipes. Most of them are entirely whole foods, plant based. Some of them do contain some of the plant-based meats, but you can always modify them and use beans and legumes instead of the meat.
DrMR: And do you have a website also, or a blog or anything like that where you’re also active?
Kristie: I do. My website is KristieMiddleton.com.
DrMR: Okay. Great. All right. Well, Kristie, thank you so much for taking the time. I think this’ll be a helpful conversation to showcase some different dietary opinions that we’re used to hearing in this audience. But as I always say, it’s good to remain open-minded and look at both sides of an argument so that you can make the most well-informed decision.
So thank you for providing us with some information that may be a little different than what we’re used to hearing.
Kristie: Thank you so much for the opportunity.
Kristie: Enjoy your afternoon.
DrMR: Thanks. You, too.
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