Dr. Matthew Nagra: Yeah, it's great to talk to you too. Thanks for having me.
Toni Okamoto: I met Matt in Washington, just outside of Portland in November 2019, and I feel like we're besties because I'm obsessed with your work. I want to work with you as many times as I can. I'm so glad you're going to be talking to me in real life here on the show today.
Dr. Matthew Nagra: Thanks that means a lot, and I love what you've been doing as well as the same with Michelle all throughout social media over the past several years now.
Michelle Cehn: I've been having fun watching all of the Instagram takeovers you've been doing on Plant-Based on a Budget and seeing what you're eating in your day is so much fun.
Dr. Matthew Nagra: Glad you liked it.
Toni Okamoto: So, we brought you on today to talk about some healthy habits in the new year and to bust some misconceptions around health. But before we jump into that, we want to get to know who you are. Can you start by telling us where you're from and what your family was like? And just a little bit more on a deeper level about you?
Dr. Nagra's Journey to Plant-Based Living
Dr. Matthew Nagra: Yeah, I'll give you a little bit about my sort of transition into plant-based nutrition too. Then it can kind of tie all that together, but I am a naturopathic doctor in Vancouver, BC. I'm actually at my clinic right. And I've been practicing since last September. I actually took a year off between finishing schooling and opening up practice to go travel around and enjoy life a little bit since I didn't really take any breaks all the way through schooling, going back a little ways.
I have been a 100% plant-based (now vegan) for, I want to say about nine and a half years, and that started actually about 11 years ago when I had a personal trainer who really promoted plant-based nutrition and plant-based eating. At least reducing animal food and junk food intake. And one time he wanted me to record everything I was eating. He gave me what's called a diet diary, which is something I do with a lot of my patients where I record, everything I eat for about two weeks. And at the time my diet was absolutely terrible. I was eating a lot of McDonald's and junk foods.
And actually my house was the house that all my friends came to eat all the sweets and treats and all that. I thought, well, he's going to see what I eat and he's going to know how terrible it is. Let's just cheat the system a little bit and I'll just eat super healthy for a couple of weeks and I did that. I cut out the entire dairy, all the junk food, a lot of the animal-based foods, although I still had a little bit and I just felt better. It started losing weight. My skin cleared up my asthma got better and at that point I just realized, okay, maybe he was onto something, pushing this whole plant-based nutrition thing on me. And I decided to stick with it. And I slowly over the course of about two years, I transitioned more and more. I kept reading as much as I could and learning more. And eventually I got to university and decided I wanted to go all in.
In my second semester, I went to a hundred percent overnight and never looked back since, and my parents I do bug them now about how much junk food I ate when I was younger, but they didn't know any different. And I think that's kind of the situation we're in now with a lot of the general population, people just aren't aware of the impacts that these sorts of foods can have on our life, on our health. That's what I'm here for. That's what I'm trying to do is try to inform as many people as possible about how they can take control of their own health by just choosing what it is that they're putting in their mouth.
Toni Okamoto: Sweet! You mentioned that you have been bugging your parents. What were they feeding you as a kid?
Dr. Matthew Nagra: I want to say I had cereal. Actually, I hated milk. I did not like dairy, most of it besides cheese. I did like cheese, but I really didn't like dairy milk, but my mom would always force me to drink it because it's good for your bones and you need the calcium and all those common kinds of myths that we hear, that was one. I'd have cereal with milk. My lunches were often tuna sandwiches, maybe a little bit of fruit or something on the side of that. And then for dinners, dinners were all over the place. Sometimes I'd have the hamburger helper meals. Sometimes I would occasionally have steak or fish or whatever, but a lot of the time, spaghetti, that was my big thing, but it was spaghetti with meat sauce. It was beef sauce, not a healthier version with tomato sauce or pesto or something. I would say it's pretty typical of what you'd see in most Western populations, whether Canadian or American.
Michelle Cehn: What did your parents think when they found out that you were jumping into the plant-based space and changing radically, what you were eating, like when you came home to visit them, did they start cooking differently? Were they thinking you were crazy?
Dr. Matthew Nagra: My dad was actually quite supportive because my personal trainer, the one who was training me who influenced me, actually knew him very well as well. And he knew that he knew what he was talking about. He didn't know necessarily that I knew what I was talking about, but he definitely knew that that the trainer was on top of it. He was actually for it, he thought it was a good idea. My mom, she also trusted me in that I knew what I was doing and that I was well-informed on the topic, but at the same time she was concerned about things like calcium. She was definitely concerned about me not having any milk, especially at the time I was a teenager and you're still growing, your bones are still developing. And that was definitely a concern, but I feel like for the most part, they trusted me. Now when we get to my grandparents or more extended family, they were very concerned. But as far as my parents, I think for the most part, they did at least trust that I knew what I was doing and that I'd be okay.
Michelle Cehn: Yeah, that's awesome; many people don't have any support from their parents. Even if you had full support from your dad is huge and that your mom was trusting you and allowing you that freedom and also respect as a human being to like, kind of step along that with you is awesome.
Toni Okamoto: Have they shifted at all in their diets since you switched over in yours?
Dr. Matthew Nagra: Yeah, it's really funny. My dad actually, he had a heart attack at 40 years old, or at least there's a little mix up between the different doctors about whether it was a heart attack. Maybe it was just unstable angina, which can lead to heart attack. It's another condition. There's a little bit of lack of clarity around what exactly happened, but he had some kind of heart issue when he was just 40, and he was very young, he was fit athletic. People saw him, perceived him as a super healthy person. And then after I started making a lot of these changes, it took years.
It did take a while, but he eventually started shifting as well. And then I think it's been about five, maybe six years now he's been a hundred percent plant-based, maybe like one slip up or something in that time. My mom now for the past three years or so has made the change. And then my sister went vegetarian, maybe, I want to say also about three, four years ago, but has been strictly plant-based strictly vegan since January, since January 1st, I believe it was a new year's thing. They all eventually came around; it just took a while.
Michelle Cehn: That's amazing. I wonder if it's a testament to just how open-minded your parents happen to be, or if having a son who is a doctor, you automatically get more credibility and people take you a little bit more seriously, because I know for so many of our listeners and for Toni and myself personally, the path was definitely not so simple. And those conversations were a struggle to be taken seriously at all when you're talking about plant-based eating. So that's wonderful to hear your parents.
Dr. Matthew Nagra: I 100% agree and it wasn't, it wasn't like I had to jam it down their throats or anything. There was a little bit of interest at different points throughout we'd go on vacation and they'd try to eat like me for a week or two weeks, whatever, or however long we're gone. But there were points where they tried to make changes. They wanted to get healthier and they would make some changes, but then they'd plateau. My parents actually went vegetarian before they went all in as vegan. And after a while, my dad made the switch to vegan and my mom, she was still stuck at the vegetarian kind of stage. And she said, her excuse, sort of was that I've made so many changes. “I'm doing so well,” which absolutely she was.
Eventually, after she was kind of in that stage for years at this point, I just sat down with her. I was like, look, you've talked about how you've made these steps, but there's much more you can do. And at some point you've got to take the next step. And it was just kind of bringing her to that realization that she's hit a plateau and she'd been stuck on this plateau forever and it's time to at least try the next step and move on. It can just be a long process. It may take smaller steps like that. You may need to give them a lot of time before they actually want to take the next step, but just being somewhat persistent, but maybe not totally jamming it down their throat.
Vegetarian or Vegan?
Toni Okamoto: I'm curious why vegetarianism for you didn't seem like enough for your mother. I know for me, if one of my family members became vegetarian, which just seems so far fetched, I would be like, “Oh my gosh, you're vegetarian and it is the best thing ever!” And was it healthier for you? Because you're a doctor because you understand the benefits and we're of course going to dive into this a little bit deeper in a minute, but what was that driving you to get your mom from veg to vegan?
Dr. Matthew Nagra: There's kind of multiple areas there I think. She originally made the change for health reasons. It wasn't ethical for her. For me, it started as a health switch as well, and then it became ethical afterwards. She was making this change primarily for health reasons. I would explain to her like, look, if you want to reap the full health benefits, it's going to be better to get rid of. I know you're not eating a ton of it, or you're saying you're not, but you're getting rid of that extra dairy and whatnot in your diet. But then from an ethical standpoint, I did have my family watch things like Earthlings and Dominion. I've had these conversations because I'm not super public with it on social media, but I am an animal rights activist as well. I do go out and do some of the grassroots activism and whatnot and I would just explain all that to them. My mom never really understood why I do that or why I care so much about it.
I try to explain like, look, this is really important to me. And I'm like, you've done all these things already, but it's just such a small change. It couldn't get past the fact that it was such a small change to make at that point because it wasn't even though she was vegetarian and eating say dairy all the time, it was just like, when she was eating out, she didn't want to bother focusing on what menu items can I have. And that sort of thing is, so she just didn't care as much in that sense, but yeah, eventually something up through to her. I'm not sure exactly what it was. I think I challenged her actually to, I bet you can't do it for like a month or something along those lines.
She eventually took on the challenge and found that it wasn't actually all that difficult, she was able to stick with it. Funny enough, I volunteer at an animal sanctuary. My parents got to visit for the first time, just this past weekend and my mom loved it. She absolutely loved hanging out with all the animals, the cows; she was like snuggling up next to them. My dad was kind of scared about animals, which is really funny, but yeah, my mom absolutely loved it. And now I was able to explain, do you understand why I'm passionate about all of this and what I do.
Toni Okamoto: I think that what you're saying makes so much sense, we expect so much of the people who we keep the closest to us and we want the best for their health. And we want to introduce them to our deepest passions. It just makes so much sense. And it seems like, although you were really passionate about animals, that that was something that you did gradually in a way that wasn't so in-your-face and it didn't make them feel bad, which we appreciate.
Dr. Matthew Nagra: Yeah, there's a right way and a wrong way to do it. I've actually had some of my friends here in Vancouver ask me to just give a talk on how to convert your family or whatever, but I don't think there's any rule to it. I don't think there's any special plan to make that happen. I think everyone's going to be different and maybe I got lucky.
Life as a Naturopathic Doctor
Toni Okamoto: I want to transition a little bit to your profession. What is a naturopathic doctor exactly?
Dr. Matthew Nagra: It's going to vary depending on where you're from. A little bit our training: there are nine, or I think they're actually maybe eight now, accredited schools in North America. And depending on where you're located, what you can actually practice varies a little bit. Basically it's here in British Columbia, we're very much like family doctors or GP's in that we see a lot of the same conditions. We'll treat a lot of the same conditions. I do have prescriptive authority, so I can prescribe medications if necessary, but I have a way bigger focus on more lifestyle interventions. Diet, physical activity, and then I also do a lot of what I call physical medicines. These are things like physiotherapy type therapies and then some chiropractic type therapies as well. That's kind of my wheelhouse beyond that.
We also have training in nutraceuticals. Those are things like supplements, herbal treatments, as well as acupuncture. We do have a pretty broad range of therapies that we can do. But my biggest focus is definitely the nutrition side of things, but like I said, it's totally going to vary from province to province and state to state. I know some states aren't regulated at all. You can't even really be a naturopathic doctor there. Some states like Washington or Oregon, I think are really good for regulation and what they can do. It's a little bit tough to give like kind of a broad sense of what exactly they can do depending on where you're located
Nutrition in the Medical Field
Michelle Cehn: When you were in school studying to be a naturopathic doctor was nutrition, something that they focused on.
Dr. Matthew Nagra: Oh, huge focus. It's every year, the only year we didn't have specific nutrition classes was our fourth year. I'll give a little background on that in order to become a naturopathic doctor, you need to get all the same prerequisites that you get from medical school. Four year undergrad degree, I did mine in microbiology at the University of Victoria. Then you go on to do four years of your naturopathic medical training. The first two years of that, all of the basic sciences, anatomy, physiology, biochemistry, microbiology, and all of that is going to be very similar to what you're getting in a medical school.
In fact, we've had medical doctors actually come through our program to get their MD degrees as well. And they've even said that it's very on par. And actually in some cases like our physiology, they say it's above and beyond what they learn and what they believe is even necessary. The education that we get around all that is pretty extensive. Of course, we don't have quite as much education around things like pharmaceuticals or emergency therapies and then of course surgeries and those sorts of things as well. But that's where we get more into the nutrition and all of that. But it is a huge, huge focus on nutrition.
Michelle Cehn: That's great. I mean, one of the things that we hear a lot now is how, and just to become a doctor, I think, don't they require something like four hours total of nutrition training within that route. And so when you go to the doctor, just a traditional doctor and expect to get nutrition advice, maybe you'll get lucky and get a doctor who has also studied that. But oftentimes you don't.
Okay, I know a lot of people who are very, either, I will only see a naturopathic doctor or I will only see a traditional medical doctor. And it seems to be a very, I don't know, separated groups. Can you talk a little bit about; do you think there's a place for both? Could you like, yeah. Can you just speak to that a little bit?
Dr. Matthew Nagra: I think the best settings to have both, absolutely. I always refer my patients back to their GPS for certain testing diagnostics. In any setting, I don't care which type of practitioner you're talking about, I don't think seeing one practitioner is always going to be the best. Having a multidisciplinary team is always going to be the best route to go. We can send you to the medical doctor to, like I said, I do have prescriptive authority. I can prescribe medications and manage medications. I would rather the medical doctor who has more training than deal with more of those sorts of concerns. Well, maybe I work more on the diet and then I can also run some testing and whatnot myself.
I think the benefit of a naturopathic doctor in cases of, say, if we're treating type two diabetes, for example, where we're modifying diet, well, we can actually modify medications as well, if need be, because that's something that we often see with plant-based diets, especially you may need to lower your medication dose. In a case with a medical doctor, they may not have the training around diet and for a dietician, they wouldn't be able to modify medications accordingly without working with the doctor as well, which is totally fine, I do both. But I think the more people that we have on the case, the better, and the more expertise we can share, especially if we're talking about really complex cases where they're seeing specialists like endocrinologists, and there's no way I can offer what they are from a medical standpoint, but obviously I've the expertise in the nutrition side of things.
Michelle Cehn: A lot of doctors are starting to recommend turning to a plant-based diet, which is really exciting and something that wasn't happening in the not too distant past. Can you talk a little bit about why this is becoming a route that a lot of people in the medical field are turning to and encouraging
Dr. Matthew Nagra: Science is getting stronger and stronger. If we look at the recent American cancer society recommendations to avoid red and processed meat to eat more plant-based foods with an emphasis on plant proteins, those are recommendations given for oncologists really more than anything. They're the ones treating cancer patients. The USDA dietary guidelines are going to be coming out very soon and they just released a preliminary report that talks about very much the same thing, shifting towards a more plant-based diet. More recent Canada food guide also said the same thing … shifting towards a plant-based diet choosing, plant proteins over animal proteins, making water instead of dairy your beverage of choice, which is a huge change.
We're having these massive organizations making these recommendations, actually on top of that, the American college of cardiology and American heart association recommend either plant-based diets or Mediterranean diets as the preferred dietary choices for preventing heart disease. Because these organizations that kind of oversee the professions are actually digging into all the research, compiling the data and finding that this is clearly beneficial. It's able to make its way down to the actual professionals themselves. Because if we look at most doctors, like they don't have the time to go through all the nutrition research out there and to figure out what's best and what's not. They need these committees to actually come up with the guidelines for them. And that's exactly what they're doing. And it's always shifting towards a plant-based diet every single time. I think that is one of the biggest reasons why we're seeing this.
Now More Than Ever
Michelle Cehn: Have you dug in at all into why this wasn't always the case? Why is it just now that all this research is coming out and the medical recommendations across the board are shifting to plant-based have you dug into why we were as off-track before as a human species?
Dr. Matthew Nagra: It's hard. The last couple of decades, especially, there's been a lot of research coming out, especially around diabetes, like Dr. Neal Barnard from PCRM; he's conducted some really good research in the early 2000s as well. It's just compiling, but it's been around for a while. We've known this for a while. Dr. Cornish’s research on heart disease treatment was published back in 1990. That was a really long time ago now, as far as research is concerned, so why it hasn't been published or why these guidelines haven't been made until now, I'm not sure. There's a sort of a threshold that they need to hit for research.
If we look at actual guidelines on medications, they have very strict guidelines on what exactly the criteria is that certain medication needs to meet in order for them to be on the market and for them to be promoted and used across the board or to them to be a first-line therapy with diet. We don't have these strict guidelines about what's necessary and there's always going to be controversy. Instead, we have the dairy industry going like crazy trying to publish research saying that saturated fat is okay. In fact, just a month ago or not even a month ago, a brand new article with the most hilarious conflicts of interest I have ever seen, like the conflict of interest page is two pages long of listing all the conflicts they had in the dairy industry. It's just unreal. They just came out with a new article and my guess is because the USDA guidelines are going to come out soon and they want to push dairy for that.
That's just a guess so don't take that to the bank, but I think that's largely why it's because they have these really high expectations for the quality of research that we see with say medications that don't necessarily, or shouldn't necessarily be applied to diet because it's really tough to do that. But then on top of that, we've got all this pushback, we've got all this, what I call a kind of marketing science out there that tries to incite doubt. And the really funny thing about a lot of this research on say saturated fat or this research saying that dairy and meats and whatever are okay. They don't actually say that these foods that are saturated fat is healthy for us. Instead, they just say that it's not harmful. Even if we take that and we accept that and we say, okay, we have a research thing, it's bad for us. We have research saying that it might not be bad for us. I will still lean towards playing it on the safe side. But then we can go through their science anyway and show how flawed it is and I've made several posts about that. All the saturated fat and cholesterol nonsense out there, but that's kind of where it comes from. And I know it was a really long-winded answer to your question, but hopefully that answers it.
Michelle Cehn: Yeah it's an interesting space to be where a lot of the general nutrition knowledge that exists across human beings comes from marketing campaigns, from industries, trying to sell products. Milk does the body good. You need calcium from milk for your bones to get strong bones for your teeth, like eggs for your protein. We have these things ingrained in our minds that did not originate from the medical community, did not originate from science. They originated to sell products for an industry. So yeah, you're doing some good work and facing a lot of myths that exist and have been spread far and wide, which is what we kind of wanted to jump in today was a lot of the health misconceptions that are out there. It's the New Year. People are trying to step into healthier eating healthier practices. And there are a lot of sort of trendy diets out there and thoughts that could have people actively focusing on doing things that may in fact be doing the opposite of what they hope.
Toni Okamoto: I was just talking to a gentleman working on our bathroom remodel and we had lunch together. I served him a delicious plant-based meal, and we talked a little bit about plant-based eating. And he said, so what do you think about keto? I'm thinking about trying keto and my girlfriend's doing the Bright Line Diet. And so what do you think about these? And I want to be respectful, but how would you answer a question like that?
Dr. Matthew Nagra: Well, I'd asked first, what they are doing the keto diet for.
Toni Okamoto: To lose weight.
Dr. Matthew Nagra: If they're doing it to lose weight well actually this is kind of the best study to date on this subject was just sent to journal. I actually don't think it's even fully published yet, but the results were put out early and it was what's called a Metabolic Ward Trial. They had people volunteer to live in a hospital for a month. They were just living in, you control you exactly what they're eating, you measure all of their blood levels, their weights, you do DEXA scans, which is a way to measure body fat percentage. And they had two diets. They had the plant-based diet, which wasn't even that healthy of a plant-based diet. There were a lot of refined grains and stuff that maybe we don't want too much up against an animal-based keto diet. And they know that these people were absolutely following a keto diet to a T. These people know that the plant based dieters were only eating plant foods and they measured the weight and everything before and after.
I should actually mention that it was two weeks on each diet. And then they switched and did the opposite diets so everybody did both diets. And on the keto diet, they actually had quicker weight loss. So, they lost weight quicker within the first couple of days or first week. But then by the end of two weeks, the weight loss in both groups was the same. The plant based dieters lost the same amount of weight as the keto dieters. However, it was really interesting when they did DEXA scans, measuring actual body fat percentage and lean mass, they found that the keto dieters actually didn't really lose body fat. They lost lean mass so they lost mostly water weight, and maybe even a little bit of muscle, whereas the plant-based dieters lost almost just entirely fat.
The plant-based diet was actually superior, but when someone goes on a keto diet and they lose weight really fast within a few days, they're all happy about the number on the scale. Not knowing that they're actually mostly losing water weight. They aren't actually losing a ton of fat mass, which is what we care about. And then the other things they found was that the keto group was more insulin resistant, meaning that they didn't respond to blood sugar as well. So that's obviously bad at a risk factor for diabetes and so on. But on the weight loss side of things, yes, a ketogenic diet will produce quick short term weight loss, but it's not body fat. And it's only going to be short term. You're not going to notice a super good long-term weight loss by the sounds of things.
Michelle Cehn: Just taking into account weight loss, right? Not the other things that eating that sort of diet can contribute to in the long run.
Dr. Matthew Nagra: Exactly, that's without all the cholesterol and everything.
Toni Okamoto: I also have a hard time believing that not eating fruit is healthy. My parents have tried keto and they're like, “oh, I can't eat an apple.” Or “I can't eat watermelon” — of all kinds of things that I feel like in my life, those are the healthy things that I want to be eating.
Dr. Matthew Nagra: They are absolutely. The global burden of disease study is the largest study on disease, risk factors in the world. And obviously they found the number one thing that's killing us is our diet, right? No surprises there, but within the diet, there are three, the top three dietary risk factors for premature death are actually, it might've been death and disability. I can't quite recall that specific stat, but it was number one too much sodium. So, too much salty food, probably a lot of processed foods in sense too, but definitely too much sodium.
The second one was not enough whole grains. And the third one was not enough fruit, so not enough whole grains and not enough fruit actually topped not enough vegetables and too many red and processed meats. That's how important whole grains and fruits seem to be. And now on fruit consumption, everyone's worried about the sugar from fruit and blood. Fruit and blood sugar control diabetes. There is not a single study out there showing the whole fruits increased risk of diabetes. Actually it goes the other way.
The more fruit you consume, the lower your risk of diabetes, because fruits are incredibly helpful. And because it packs with all the fiber, we don't absorb the sugar into the bloodstream, super-fast, even dates, for example, which are quite sugary by most standards, they don't raise blood sugar very fast. They're actually considered a low-glycemic fruit. Yeah nobody should bear fruit. Fruit is absolutely healthy. Berries are the healthiest, probably of the most nutritious of all the fruits, but yeah, definitely don't want to be, and don’t want to be limiting fruit ever.
Michelle Cehn: I just looked at this stat that I've heard before. This is from the cdc.gov website and it says just one in 10 adults meet the federal fruit or vegetable recommendations. One in 10, 90% of people aren't getting enough fruit and vegetables, which is crazy.
Dr. Matthew Nagra: Yeah, an average fiber intake in the US I believe is 16 grams per day. And depending on if you're a male or female, and depending on which country we're looking at, you want anywhere from like 28 grams to 38 grams a day. They're getting half of what they need.
Michelle Cehn: Gosh, this is so fascinating! So, we were just talking about keto and paleo. Are they similar? Paleo, can you talk about paleo at all and the health implications of that?
Dr. Matthew Nagra: Paleo is a huge step up from keto, for sure from even the standard American diet, what do they recommend? They recommend cutting out junk food. They generally recommend lowering dairy intake. They're usually okay with some whole grains, maybe limiting some up, but the one place that they really mess up is with fruit intake. Again, you need to eat your fruit, where you should be eating your fruit, but if we're comparing it to a standard American diet, it's definitely beneficial. But compared to a whole foods, plant-based diet is not a chance because we're looking at again, fiber intake, it increases, we know that paleo dieters generally eat a lot of meat in their diets, and that's going to be really high in saturated fat, which is going to raise cardiovascular disease risk, which is the number one killer for us. And so for those reasons, I tend to stay away from it and promote more of the whole foods plant based diet.
Again, knowing that it is certainly better than the standard American diet, but what's really funny about it is that it's called the paleo diet as if that's what our paleo ancestors ate. But our paleo ancestors ate based on their location. We actually have evidence based on fossilized stool samples, showing that they were eating over a hundred grams of fiber a day. That's more fiber than most vegans are eating and fiber only comes from plants. Depending on where they're located, the paleo or the Paleolithic diet. The true Paleolithic diet would be completely different. There is no one paleo diet. So, anybody who wants to promote their diet as the paleo diet, it's false. It's a 100% false because there was no one paleo diet. And so I would again, even if we were to try to eat like our paleo ancestors, I don't know why we would want that because their life expectancy was like a couple of decades, right?
They live long enough to reproduce and then they would die like that. That was it. Evolution only cares about you living long enough to reproduce, right? It doesn't care. Our goals today are different. My goal is to live no well into my late nineties or hundreds or whatever, and to be mobile and active and to hopefully prevent any major diseases throughout my life. That's my goal. My goal isn't to live to be 25 if that's the goal I've already passed that right. So I don't understand the whole paleo thing or why it's such a big deal because it just, there is no one paleo diet. And again, there are healthier diets out there. It's certainly a step up from a lot of the garbage out there, but that's a really low bar to set.
Toni Okamoto: So, the types of foods that people were eating back then were just so different. When I see people who are consuming a paleo diet, they're eating the mass amounts of meat. And from my understanding, people back then were eating what they could hunt and sometimes that was scarce. So, it’s something I really don't understand.
Dr. Matthew Nagra: The whole theory behind it makes no sense, but also, Loren Cording, who's one of the fathers of the paleo movement. He actually wrote a really good paper about what optimal cholesterol levels are. Basically they found based on our eight bands or eight cousins or levels as new-borns are LDL, cholesterol levels should be quite low between like about 50 and 70 milligrams per deciliter. And I'm going to get a little technical here, but that's basically where atherosclerosis heart disease just doesn't really develop if you maintain levels like that.
Now he's the father of the paleo movement and he's recommending that. And the funny thing is in today's day and age, the only people with levels averaging in that range are vegans. Other diets generally don't. And that's because even the meat back then, while the meats that a lot of these paleo ancestors would have been eating, if any was very low in saturated fat. It's a far cry from what we're having today with factory farm meat, who's just fattened up to be as obese as possible so we can eat them and so they can grow as fast as possible and all that. It's completely different food that the meat that people are eating today is, is nowhere near what it would have been back then.
Toni Okamoto: The other day, I was chatting with a friend of mine and she was telling me about how many eggs her sister eats. And she eats one of those whole, you know those big, giant crates of them. She and her family of four eat a whole one in a week. And I said, “oh my gosh, the cholesterol,” and she said that her sister said that the cholesterol is good cholesterol and that it's actually really healthy for her to eat that many eggs. And I didn't really know what to say. I'm not a nutrition expert. How would you suggest I handle that in the future?
Dr. Matthew Nagra: Well, it's a really complicated topic. Saturated fat is even clearer than the dietary cholesterol topic, but with cholesterol, basically what happens is there's a plateau. So if you eat no cholesterol, like one of us, because we're vegan and you add cholesterol in, you actually get a larger spike in your actual serum, blood levels of cholesterol. If you already eat your standard American diet, and you're already eating a fair amount of cholesterol in a day, and you add more cholesterol, you don't notice much of a difference at all. That's usually what happens and so what her sister is probably basing this on is actually studies done on populations that eat generally a fair amount of cholesterol to begin with adding cholesterol in that case, not going to have an impact.
As far as the argument on good cholesterol, she's probably talking about the ability of eating cholesterol to reduce HDL or good cholesterol in our bloodstream. But we now know that has no impact. There are studies on people with genetically higher levels and they don't have a reduced risk of heart disease. There are also studies on medications that were being developed to raise those levels and again no difference so good cholesterol actually doesn't seem to have much of an effect at all and eating cholesterol does have a negative impact, but a bigger negative impact in people who already don't eat cholesterol to begin with.
Michelle Cehn: I have a sort of interesting personal story. My husband, one time he fell and hit his head and got a concussion and went to the hospital and had to get all these brain scans and everything. And so he went and saw this doctor who was a doctor who had been practicing for so many decades. He was an older doctor and the doctor took Dan's cholesterol. And he was like, “Oh my God, your cholesterol is the lowest I've ever seen on a patient ever,” and I mean we're vegan. Dan had been vegan for a while, but like, we're not super health food vegans or anything, but he had super low cholesterol. And Dan was like, should I be concerned about that? And the doctor was like, well, I'll tell you this. I would never recommend to a patient to eat more cholesterol. So, even when Dan's cholesterol was the lowest, this older doctor had ever seen in patient history, he was like, “no, just keep doing what you're doing.”
Dr. Matthew Nagra: Yeah and that's because there aren't really negative impacts from having lower cholesterol. There have been studies on drugs called PCSK9 inhibitors, which really just abolish your cholesterol levels down to next to nothing and no negative impacts on hormones or anything. There is the same thing with people with genetically really low levels. They don't have issues producing hormones. There's no real negative impact like that because our bodies are cholesterol conserving machines. Like our bodies are so good and making sure that we have just enough to do what it needs to do and not having more than that. And we're also really good at absorbing and producing cholesterol when we need to as well, so there's no real negative impact. There's actually, this is a really funny one. There are some claims out there that you need to eat cholesterol for brain health. I don't know if you've heard that.
Toni Okamoto: I've heard it.
Dr. Matthew Nagra: There's this claim that you need cholesterol for your brain health, for your hormones and your brain, wherever cholesterol does not cross the blood brain barrier is actually impossible. That's a total myth based on nothing. Cholesterol does not cross into the brain. Our brain has its own set of cholesterol that it produces and does everything with. So again, that's totally false. The one thing though, oxidized cholesterol. When you're eating a lot of cholesterol and some of it gets oxidized into this other more harmful molecule that actually is responsible largely for heart disease that can cross into the brain and actually may contribute to Alzheimer's disease. If anything, the only impact cholesterol is going to have on your brain health is negative.
Michelle Cehn: Just to reiterate, if someone's trying to eat at optimal, healthy diet eggs, yes or no?
Dr. Matthew Nagra: I would say no.
Is Soy Good or Bad?
Michelle Cehn: The next big thing that we hear all the time is people who are scared of soy, which is a big thing. Especially if someone wants to start eating plant-based and they're stepping into vegan living for the first time. A lot of the products out there are made from soy and if they're going to try to avoid soy, it makes things much, much harder. Should people be scared of soy? What do you think?
Dr. Matthew Nagra: The idea that soy is estrogenic that's normally the biggest concern. It comes from a few different places. For one, there have been rodent studies, so they take rats or other rodents and they give them really high concentrations of just the phytoestrogen that's found in soy. It's like a plant sort of estrogen. It has a similar structure to estrogen, but it's different. It's about one in 1000, the strength of actual estrogen. So it's a very weak estrogen, so there's that. And then there's another case, or there's two cases where men were consuming from 12 to 20 servings of soy per day. And they ended up actually experiencing a bit of breast growth. So that's actually where I came from but that's, that's a ridiculously high amount, right?
That's a whole gallon of soy milk plus other soy products on top of that, it was just ridiculous. When we look at any of the data on say, soy consumption through Asian countries, where they consume more than here, we actually find that those who consume the most soy versus the least have better health outcomes and actually don't experience any negative hormonal effects. Soy consumption actually reduces breast cancer, risk reduces prostate cancer risk, and a mutual cancer risk may help with hot flashes, may help reduce cardiovascular disease risks. So it's just beneficial across the board. I would never recommend someone to have 20 servings a day of anything, but if you're having to kind of average one to five or even a bit more than that servings per day. There's no risk there. There's no documented risk in any way.
Toni Okamoto: That also wrote an article on Plant-Based on a Budget with more information and citations and stuff if anyone wants to check that out. Okay, so what about carbs? I posted a picture of rice and beans recently on Instagram and people were like “carbs!”. Can you talk more about carbs and why people are so afraid of them?
Dr. Matthew Nagra: There are a couple of things. I think weight again; they're talking about weight loss, really. I think that's a big one and it's the idea that carbs get converted to fat. That's actually not true and I made a post about that. So, carbs get converted to fat in a process in our liver called de novo lipogenesis. But ultimately the conversion of carbs to fat is incredibly minor. It’s a few percent of what you're eating.They did studies where they overfed people, greatly overfed people on either fat or straight sugar. And they found that the group overfeeding on fat actually put on more weight a little bit. It wasn't a big difference, but a little bit. And they measured the conversion of carbs to fat and it was incredibly small. So what actually happens when people are eating a lot of sugar or carb-y foods, they're burning those carbs as energy because it's the preferred energy source.
And then the fat that they've eaten throughout the day is actually what preferentially gets stored as fat. Now there are exceptions if you eat just an absolutely ridiculous amount, then yeah that can change. But for the most part in that sense, there is no real issue there. On top of that carbohydrate or low carb diets are associated with a variety of diseases like heart disease and certain forms of cancer, which we've already talked about. And fruits, like I mentioned earlier are incredibly helpful and that's one of the sources of carbs that people seem to fear the most. The other one is whole grains. These are things like Brown rice, quinoa, oats, buckwheat millets or gum and there's whey more as well.
Those foods are across the board associated with a lower risk of heart disease, diabetes, and certain forms of cancer like colorectal cancer and are just beneficial. There's actually not a single study. As far as I know, linking whole grain consumption to any kind of disease or even inflammation. Whereas maybe refined grains, refined processed grains like pastries, or even white rice, maybe might be associated. But as far as the whole grains go, we should absolutely not fear them. And the carb fear or the carb phobia is not really predicated on the bulk of the science.
Michelle Cehn: I do have a personal question regarding carbs. I went vegetarian when I was eight years old and until I went vegan in college, my main source of calories was from pasta and cereal. And somehow I survived, but still I have a deep love for pasta. And now I'm much more health conscious, and I love fruits and vegetables and all the healthy, whole grains and foods and everything. But, these days, it's super trendy to be trying alternative pastas that are made from lentils and beans and whole grains. And of course, those are packed with far more nutrients than just standard semolina pasta. But if you're eating an otherwise healthy diet where you're getting tons of nutrients, you're eating whole grains; you're eating fruits and everything. Is it harmful to be eating just semolina pasta in your opinion from time to time?
Dr. Matthew Nagra: I would say having anything time to time, depending on what “time to time means” isn't going to be super harmful. If you're having something once a week, once every other week is probably not going to be a big deal, but semolina is that whole wheat or is it a white?
Toni Okamoto: It's white.
Dr. Matthew Nagra: Okay, basically if you're having white pasta, a better option would be the whole wheat pasta. Pasta is in general, if you're going with whole wheat are actually pretty helpful, they're pretty nutritious. You can get some with pretty good fiber content as well, meaning that there wasn't a whole lot added to it and they're totally fine. I know there's the trend towards more alternative passes and I do eat them. I have some like chickpeas and lentil pasta as well, but I mix it up. If I've had a lot of legumes one day and I want to make pasta for dinner, then I'll go for the whole week past, because I've already had a fair share of legumes. And maybe I haven't had a ton of whole grains. And then if it's the other way around, if I'm blacking lagoons that day, I'll go with the lentil or chickpea past sight. I don't think there's really any harm there.
Michelle Cehn: Also, for anyone listening, who's getting hungry listening to all of these ideas? I was browsing your website before this call and just, you have such delicious looking recipes on there that are so wholesome, healthy, and it was just re inspiring me to get a little more creative with infusing health and choosing healthier options for things like the base of pasta in my dishes.
Dr. Matthew Nagra: I only have a few recipes up there, and I should probably do more too. But the biggest, one of the most popular one is my mom's actually like vegan butter chicken, or butter tofu recipe by far the most popular. And it's super, super good and she perfected it. It's exactly like the butter chicken she used to make when it had buttermilk in it. And when I had the chicken and everything the only is you swap out the tofu for the, the chicken, and then you saw I think it was like a cashew cream for the, for the buttermilk. And it was like exactly the same.
Michelle Cehn: Oh my gosh, go mama. Okay speaking of your mom, your mom, when you first went plant-based she was concerned for your calcium and she was like, you're not drinking milk. How are you going to get calcium? How are your bones going to stay strong? You're still growing. You're a growing boy. This is the concern that so many parents have, but also just everyone who's making a transition away from dairy, I think, has that thought, are my bones going to start breaking? What's going to happen down the line, so what would you say to those people?
Dr. Matthew Nagra: It's actually funny. This is massive study on vegetarians and vegans in the UK called the Epic Oxford Study. And actually, I might as well mention that study did find that vegans or vegetarians have lower mortality risks, the lower death risk during the study period compared to the omnivores, particularly if they had stuck with the diet over long-term. So that's just the kind of a side point, but that study found that the vegan’s vegetarians did have higher fracture risk. However, when you actually look at their calcium intake, when you find the vegans, when you look at only the vegans and vegetarians who consumed at least 525 milligrams of calcium per day for reference the RDI is about a thousand milligrams for most people.
Ss long as they were consuming about half of the calcium that they're supposed to, their fracture risk was no greater than omnivores. Essentially if you're getting at least half of what you're supposed to be getting, you're good to go. For calcium, I'm not usually too concerned about it. If they're eating an overall varied, helpful diet, really good sources of calcium or things like firm tofu or extra firm tofu. Half a block of extra firm tofu can get you more than, I think it's like 600 milligrams or something just ridiculously high. Soy milk or any other plant milks can also be really good sources because they're fortified. And then there's legumes, certain dark leafy greens, like pak choy, for example, broccoli's a really good one. It's really not that hard to get the calcium that we need in a day. And as long as you're getting kind of the bare minimum amount of calcium, like the 525 milligrams, there doesn't seem to be any kind of increased risk.
Michelle Cehn: I've heard things going around about, about dairy calcium and dairy or dairy actually leaching calcium from your bones. Is that a myth as well?
Dr. Matthew Nagra: Yeah, that's a myth on the other side. I think that's a myth that is propagated by a lot of vegans out there, and it's not really based on anything. So yeah, I wouldn't pay too much attention to that one. There's this association between countries that consume more dairy and having higher fracture risk, but what actually may be the case there is that the countries that consume the most dairy are also countries that get less sunshine and therefore less vitamin D. It might actually be the lower vitamin D that's causing the higher fracture risk. And we actually have studies looking at dairy consumption and vitamin D levels. And when you control for the vitamin D levels, you actually find that there's no more increase in risks. So I definitely that's one that I think every vegan at one point or another has said, but I just don't think it's true.
Michelle Cehn: You know what I would love to have you back on to talk about myths that vegans propagate because I think that's something, no, everyone's a little bit scared to talk about, because you don't want to like persuade someone the opposite direction, but it's so important to have accurate health information. And God, you're just such a wealth of knowledge.
Dr. Matthew Nagra: We have enough evidence to promote a plant based diet. Let's make that very clear.
Toni Okamoto: We're running out of time, so Michelle, let's each pick a question to ask. I'm going to ask ... what the deal with collagen is? I keep hearing all about it and I don't understand it, so what's up with that
Dr. Matthew Nagra: Collagen supplements are being promoted for just about everything these days from hair health, to skin health, joints, makes you younger, whatever. There's pretty much little to no research on most of those topics. Where there is a little bit of research is on skin and joint health. With collagen, and it's important to note that collagen is a protein, it's actually a very big protein and we make it in our bodies. It's a part of most of our body structures. When we eat proteins, we break them apart into individual amino acids, which are the building blocks of protein in our digestive tract. And then we absorb them and then we make proteins in our body. And one of those proteins is collagen.
Even from a theoretical standpoint, if you're eating collagen and you're just breaking it down and then going to build it back up again, it's not like you eat collagen and it goes directly to your bones. It doesn't make sense. But then when we look at research on say joint health, we actually do find that compared to a placebo powder, collagen does seem to improve joint health a little bit, improve joint pain a bit, but guess what? So does milk protein. It has soy protein. And so when we're looking at the same, it's not the fact that it's collagen and that's helping it actually appears that just protein itself seems to help.
On top of that, I would say soy proteins even better because soy protein is anti-inflammatory whereas the collagen protein has not been shown to be anti-inflammatory. So from that standpoint there's nothing special about collagen. There's absolutely nothing there. It's just the fact that it is a protein that provides these building blocks, which are amino acids. That seems to be really where the real benefit is, what we should be worrying about is a, you know, making sure our nutrition is good, but vitamin C is really important for collagen and production as well. And where do you find that in your fruits and veggies?
Bone Broth Trend
Michelle Cehn: Yeah, that's a really good point. Okay. One more trend that we want to talk about is bone broth. I know the last time that Toni and I went to the Natural Products Expo West, you always see trends popping up. And collagen was a few years back that started coming into everything. But bone broth was a big one this last time. Can you talk a little bit to that? Is there any science to the benefits of bone broth?
Dr. Matthew Nagra: Yeah, I actually did this on my Instagram stories recently and so people want to watch it where I go through it, point by point, you can see, I have a story highlight just titled bone broth on Instagram, but it's hilarious. There are only eight studies on bone broth, period. Studies with the term bone broth in it that have ever been published on pub med. I searched them all and two of them are completely irrelevant. Two of them are talking about production methods and one of them is about bacterial composition or something. And then two of them are animal studies again we're looking at rodent studies again.
It's interesting, sure, but probably doesn't have much to do with human health. Two of them are looking at minerals and heavy metal content. Both of these actually found that bone broth is a significant source of lead. Lead is really not good for us. That, I believe everyone should understand that by now. They actually found lead levels, exceeding what is considered safe in our water supply. Lead poisoning leads to all sorts of things like growth stunting and a variety of other health issues. And then there were two of them actually looking at humans. One of them was a study comparing, again, collagen into another protein powder. Both groups got bone broth as well. So the protein was like mixed into bone broth.
That doesn't tell us anything about bone broth because both groups got it. So again, completely irrelevant. The last one was looking at the content of bone broth. They found that because one of the claims around bone broth is that it's a good source of collagen. I was just talking about amino acids. They found that it's a very poor source of collagen and precursors. That is the entirety of the science behind bone broth. That is all that there exists. So anybody who ever makes a health claim on bone broth, it is not based on the evidence. It is not evidence-based at all. They have not read the science because it just simply does not exist.
Toni Okamoto: It's crazy how a trend will pop up. And it becomes not only widespread across thousands of companies. It can become a keyword, probably one of the top searches on the internet everywhere. Then it just becomes absorbed by humans as this is a health fact. You just did not say a lot of things that I wouldn't have even expected nor had any idea.
Dr. Matthew Nagra: Well, it's not only that bone broth isn't beneficial based on that, it might be harmful because of the lead content. Like that's what we, I bet nobody whose selling bone broth is a warning. Oh, by the way, bone broth has been shown to contain fair amounts of lead. No one is saying that.
Benefits of a Plant-Based Diet
Toni Okamoto: We've covered a lot of the trends and the fads which is really, really extremely helpful to keep in mind this New Year while we're planning and setting our intentions. Can you tell us some of the benefits that people can expect to see when they go plant-based? Both immediate and in the future?
Dr. Matthew Nagra: So, immediately short term people generally feel greater energy. If you're feeling more fatigued right off the bat, my biggest tip would be to eat more. What can happen is because plants are so much lower in calories. Sometimes you end up eating the same amount of food, but getting way less calories and you're lacking in energy. So as long as you're eating enough food, usually you feel boosted energy. Sometimes there's weight loss. Sometimes a skin health improves, joint pain may even improve. There are a lot of short term benefits like that. In the long-term, what it comes down to is reducing risk of heart disease or type two diabetes.
If you have diabetes or high blood pressure, for example, you may notice that come down drastically. If you're on medication for those conditions, it is actually really important to speak with your doctor. Let them know because you might even need to reduce your medication use, which is a really good thing. And otherwise in the long-term, you end up actually further diversifying your diet. You end up learning new things. New ways to prepare foods, new flavors, new spices, new fruits that you never heard of before.
I think there's that huge benefit that comes along with it. And you just ended up discovering all these things. I always get asked if you miss eating meat. Do you miss having cheese or whatever? And not really what I'm so grateful for is all these discoveries I've made that I never would have before. I went traveling through Thailand and had so my exotic fruits that I never of. That was what was really amazing to me. So yeah, there are benefits all over and I think most people who adopted will probably notice that pretty quickly.
Toni Okamoto: Great! Well, we are so grateful to you for spending time with us! Thanks for chatting about these topics. It's really helping our audience figure out the best ways to be healthy in this New Year.
Dr. Matthew Nagra: Thanks for having me and letting me spread the message.
Michelle Cehn: Are there any final words that you want to share and then where can our audience find you to connect.
Dr. Matthew Nagra: Anything to share right off, to finish up? I would say probably when you're trying to transition, there are a couple simple things to do. For one, you can start one meal at a time. Start with breakfast, try out your oatmeal, tofu, scrambles, toast, whatever it is that you like to do and just make it plant-based and try to stick with it for a couple of weeks. Once you've got that dial in move on to the next meal. Then you can do the same thing and move on to dinner. I think that's a really easy way to ensure long-term success.
And then beyond that is you can take what you're already eating and pretty easily transition it. If you have, spaghetti with meat sauce, change it to whole grain spaghetti and you add tomato sauce instead. Then chop up some veggies or ground tofu in the sauce. And you've got a perfectly healthy vegan meal right there. And it's probably somewhat similar to what you're already used to having. I like to work with people on using what their diet already looks like and making simple changes.
Toni Okamoto: That sounds great and where can people find you?
Dr. Matthew Nagra: I do have a website you mentioned earlier, DrMatthewNagra.com. I post some longer articles there. I've also, if you're located in British Columbia, Canada, I'm happy to see you as a patient as well. And my booking links all there. Otherwise Instagram is where I'm most active also at @Dr.MatthewNagra. I'm also on Facebook at the same name and Twitter. I'm not quite as active on those platforms, but those are kind of the main places to find me
Toni Okamoto: Cool and of course we would really love to have you back on the podcast, maybe next season to discuss even more wonderful plant-based nutrition information.
Dr. Matthew Nagra: One hundred percent.
Toni Okamoto: Stay tuned for that.
Michelle Cehn: Thank you so much, Dr. Nagra.
Dr. Matthew Nagra: Thanks for having me.
About Toni Okamoto
"They say you are what you eat, so I strive to be healthy.
My goal in life is not to be rich or wealthy,
'Cause true wealth comes from good health and wise ways...
we got to start taking better care of ourselves " - Dead Prez