Dr Rupy: Hello and welcome back to the Doctor's Kitchen podcast with me, Rupy Aujla, and today we're going to be talking about principle four, eat plants, or eat more plants, and the impact of largely plant-based diets. I've got Ben Brown with me today, who's a naturopathic doctor, researcher, editor, and director of clinical education for Pure Encapsulations in the UK. He's also author of his own book on gut health, The Digestive Health Solution, and he's co-authored a chapter in Nutritional and Integrative Strategies in Cardiovascular Medicine, which has a lot of crossover with what we're going to be discussing today. Hey Ben, how's it going?
Ben Brown: Yeah, really good, thanks. And thanks for having me on the podcast. I'm excited to be here.
Dr Rupy: Of course, of course. So, to keep the listeners up to speed, in the previous podcast, we've already talked about things like phytonutrients, the chemicals that we find in food, eating colourfully, eating fibre, and the multitude of different chemical compounds that we find in whole foods. So, you as the listener probably already understand that we have a general idea of why plants make up the majority of my plate. Yet, despite this, there seems to be a lot of confusion about what to eat. So, I thought we'd talk about the huge similarity across multiple diets, including those as seemingly opposing as Paleo and vegan and Atkins and Mediterranean, and why they might have similar health benefits. What do you reckon?
Ben Brown: I mean, that is such a great question and observation at the same time, and one of the things you really notice in anyone who's got an interest in nutrition is that there are diet wars. Everyone thinks they've got the best diet and they get a bit standoffish about it. But actually, it's, there are similarities across these seemingly different diets that are responsible for the health benefits, and they're actually quite generalisable. In fact, there was a fantastic study by Dr David Katz at Yale University where they did exactly what you've just asked, is they pulled together all the research on these different diets, like Paleo diets, Mediterranean diet, vegan diet, vegetarian diet, low-carb diet. There's so many. Yeah, and there's more than that. But what they did is they pulled all the, because there's a lot of studies on these now, they pulled all the data together and said, well, what are the things that explain the health benefits of these diets? And actually, they came up with one shared commonality across all of them. Mostly plants.
Dr Rupy: Mostly plants. Exactly. Yeah.
Ben Brown: So, whether you're Paleo or vegetarian, it's the plants.
Dr Rupy: Yeah, exactly. Yeah, yeah. And I think, you're right, there's so much infighting between these different sorts of dietary dogmas. And a lot of the things, apart from eating just more plants, is limiting things like refined sugar and refined carbohydrates and eating a variety of fruits and vegetables. If you just to do those two things alone, it can probably explain a lot of the successes of these apparently completely opposite diets.
Ben Brown: Yeah, 100% actually, and that's another finding that they came up with is that a commonality across these also is you avoid rubbish. You know, so you, it's been said that there's no such thing as junk food, there's food and there's junk. And avoiding this highly processed, highly refined food that's associated very clearly with poor health is one of the best things you can do. So, we need to get away from naming ourselves based on the food that we eat and just talk about real food.
Dr Rupy: I think one of the first studies that I came across where I noticed that regardless of what diet you kind of utilise, you're going to have very similar outcomes. And one of them is called the A to Z diet that you probably come across, a guy from Stanford, Professor Gardner, and they found that after 12 months of these different diets, all the participants lost weight. Some to a different degree, but all of them lost weight. So it really comes down to the individual. It's more about how you feel on that diet, what is more convenient for you as well. And you know, weight isn't the best outcome to measure across like health benefits, but it's still one of the things that is quite easy to measure. And I just found that absolutely fascinating.
Ben Brown: Yeah.
Dr Rupy: Okay, so we've established that diets that largely consist of plants are the healthiest. Are there any that you've come across that have specific protection against things like stroke and blood pressure and cancer and stuff like that?
Ben Brown: Yeah, I mean, that's really pertinent because these illnesses you've just mentioned are some of the major causes of death and disability in society today. So understanding which diets offer the most protection is a really important question. And there has been a lot of work done in this area, both observational studies, which is mean, they look at what people eat and associate risk with disease, or there's also clinical intervention studies where they get nutritionists and health professionals to counsel people in diet, follow them for years, see what happens. And one of the best studied dietary approaches in this particular area is what we call the traditional Mediterranean style diet, which doesn't actually exist. It's just a, it's just a model for healthy eating. So it's like mostly plants, olive oil, nuts and seeds, legumes, not too much red meat, that kind of stuff. But there are studies where they've used this for what we call both primary and secondary prevention of cardiovascular disease, right? And the effects are really striking. Like if you look at primary prevention studies, so that's in people who haven't had a previous cardiovascular event, you're really looking at within about four years’ time of following this kind of diet, about a 30% reduction in risk of death from cardiovascular disease. That is enormous. You can't understate those figures. And then for secondary prevention, people at high risk, you're looking at upwards of around 70% risk reduction, which is just incredible.
Dr Rupy: This food stops people dying.
Ben Brown: Yeah.
Dr Rupy: And this is why I get so passionate about it because it's when you look at those sorts of numbers, it's not even like I need to qualify food as medicine. Food is medicine. And we could do a lot of good by actually heightening people's awareness of just how powerful our lifestyles can be. And listening to those stories and the anecdotes of patients as well as the large-scale studies is something that compounds my belief. But that's absolutely fascinating, hey?
Ben Brown: Yeah, absolutely. And I mean, that's such a great point is that food is medicine. We just need to get the message out.
Dr Rupy: Absolutely. Yeah. Yeah. I think a lot of people get riled up about meat, in particular red meat. I get asked this question so many times. So I'm going to put it to you. Is, is meat healthy? Can we have meat and still lead healthy lifestyles?
Ben Brown: Yeah, I think it's, you know, based on the science that exists today, I think it's quite clear that a small amount of red meat in context, and we need to define, yeah, we need to define what red meat actually is. You know, is it a hamburger or is it a traditional stir fry or something like that? They're very different foods, although they're both technically red meat. But it's quite clear that small amounts of unprocessed red meat as part of a healthy diet are not bad for you, is the key thing there. It doesn't mean you have to eat red meat or necessarily avoid it either, but a small amount as part of a balanced diet seems to be okay. But it really depends on the quality of that food and how you're cooking it. One of the dangers we run into when we're talking about nutrition and food is defining food by its nutrients. And this has just caused so many problems and it really happens with protein and meat as well. You know, we don't eat protein. It doesn't exist in our diet. The foods that it contain are chemically complex and different to protein itself. So it needs to be in context.
Dr Rupy: I think that's a really good point because people seem to package certain foods as certain macronutrients. So I eat meat for protein. I eat vegetables for carbohydrates or fibre or whatever, or phytonutrients, whereas there's protein in a banana. There is protein in everything you eat essentially. And I think actually getting people to realise that protein isn't just from meat, protein is from plants as well, lots of different sources, is something that would have an effect on people's eating habits.
Ben Brown: Yeah, yeah, absolutely.
Dr Rupy: So context is key. I love that word and I use it a lot and I think it annoys a lot of people because people ask me questions expecting a straight answer. Is red meat harmful, for example? And they're just simple, you know, yes or no. It depends on the context. And I think a balanced approach to looking at the studies and recognising that they are correlative is the first thing. But there are some legitimate concerns about having too much red meat. Even if it is the finest quality red meat you can find, having it on a daily basis may not be the best thing. And I think it can cause some a bit of a confusion, right? Because, for example, the Eatwell Plate has meat on it. So I think people expect you to have meat on a daily basis. What do you think of that? Do you have any opinions on that?
Ben Brown: Yeah, that's absolutely right. And I mean, if you look at guidelines on red meat consumption, you know, based from the science by people like National Cancer Institutes and things, because we know that one of the real fears with excessive red meat consumption is increased risk for colorectal cancer. It's one of the main sort of correlates is they tend to recommend, you know, around 200 grams to 500 grams a week from memory of red meat. And that equates in practical terms to one or two meals a week. It's not that much. And you put it beautifully is like this plate has an image of red meat on it. So what does that mean? Like we need to eat it three times a day. It needs to be on every plate.
Dr Rupy: Yeah, yeah.
Ben Brown: Yeah, it's a great point.
Dr Rupy: I was at a recent conference where the audience was asked whether they recommend the Eatwell Plate. And the audience was made up of nutritionists and doctors. Hardly anyone put their hand up. And I think that's quite telling of how even practitioners are quite sceptical of using a one-size-fits-all diet, which I think is legitimate, it's a legitimate concern because I don't give the same nutrition advice, I don't give the same medical advice to different patients. I always tailor it to them. So it really depends on the individual. And I think it's very reductionist for us to just say, you know, you need to go vegetarian to protect yourself against cancer, or you need to have meat for your protein needs, etc. I think it's, yeah, it's very individual.
Ben Brown: Yeah.
Dr Rupy: So where do you think meat sits in with traditional diets? Are we meant to have meat every day or?
Ben Brown: Yeah, I mean, one of the things that I think's really useful as a reference point for informing modern nutritional advice is traditions, you know, and history. And it's been really curious for me to watch this emergence of what we call like the Paleo diet, you know, which is a bit crazy because you can't get Stone Age food. I've looked for it. And, but there is science on the Paleo diet. It's a reasonable concept. But there seems to be this like complete disconnect between popular Paleo diets and the actual research that's been done on traditional hunter-gatherers. Like with popular Paleo diets, like people are waking up and having steak in the morning. You know, but the !Kung hunter-gatherers in Africa who are like practically vegetarian, because it's really hard to catch, you know, animals. It takes a lot of work. So they're mostly living on plants. And then if you look a bit more recently at traditional cultures, the same was true of agricultural societies. You know, they're not eating loads of meat traditionally. It was quite scarce and it was a luxury. So it's mostly plants for them as well. So for what does that say today? Well, it says, well, mostly plants.
Dr Rupy: Mostly plants, yeah.
Ben Brown: It's probably the context of for most people's traditional cultures and history is a mostly plant-based diet.
Dr Rupy: Plant-based, yeah. And bringing this concept of tradition is actually quite interesting because for listeners who aren't aware of Blue Zones, Blue Zones is a concept that was pioneered by a couple of researchers, one of which was Michael Pollan. And they essentially travelled around the world and they tried to analyse why the longest living people were the longest living people. And they went to different parts of the world, including parts of Japan, parts of South America. And they noticed a lot of similarities in how they were living their lives. One of the first observations was a largely simple plant-based diet with little meat. I think it was around 10% or something. But also simple lifestyles, a strong sense of community, faith was also noticed, having family connections as well, and the way they eat their food. I think that is very telling. It's not just about the food or the exact proportion of macronutrients or like, you know, having a Paleo sort of diet. These people didn't have diets, they just ate.
Ben Brown: Yeah, I mean, that's such a beautiful point. I love the Blue Zones work and concept. And really what it speaks to is that it doesn't really matter what your genetics are or where you are culturally in the world, that as long as the food that you're eating and the lifestyle you're living, you rightly point out, is adhering to, you know, some basic principles like traditional, seasonal, minimally processed, mostly plants, you're going to be pretty healthy.
Dr Rupy: Yeah.
Ben Brown: You know, so that's, I mean, that's the beauty of the Blue Zones is it's a simple but really powerful message based on science and observation for all of us.
Dr Rupy: Absolutely. Yeah. And eat mostly plants. That's great. Um, dairy. Now, dairy is a really controversial, hot topic. I get asked about it a lot. And I have the same sort of opinion as I would do when it comes to any animal product, and that's quality first, making sure that you're getting it from a good source, making sure you're trying to consume the best type of dairy that you can. But obviously, this doesn't sit well with a lot of people, and some people might have intolerance, and some people have strong opinions about whether they should be having dairy at all. Do you have any opinions on that yourself?
Ben Brown: Absolutely. It's, um, your, um, advice and opinion on this is 100% on the money is it's all about the quality of the dairy products we're eating. Firstly, if you look at the science, it's pretty clear that certain dairy products can be quite healthy. Others potentially associated with health risks. The healthy ones are typically the traditional dairy products. So they're yoghurt and, you know, cheeses and, you know, these traditional foods, kefir, things like this have some really interesting health properties that are pretty well established. The flip side of that is modern sweetened milk drinks and whey protein and, you know, these sorts of things can be associated with adverse health effects. So keep it traditional. That's really important. Another side of it is that you are what you eat eats. If the cows that are producing the dairy that you're eating are feedlot fed and being fed loads of grain, the dairy that they're producing is not going to be very good for you because it changes the nutritional makeup of the dairy products. Whereas if they're traditionally reared on grass or fed straw, completely different profile and it will be much better for you. So it depends on the health of the animals in fact.
Dr Rupy: Yeah, absolutely.
Ben Brown: You know, so that's a really important side of it. And then the whole concern around dairy sensitivities and things is a little bit blown out of the water. You know, some people have lactose intolerance, but that's easy to identify and easy to avoid. And some people have dairy sensitivity, but that's even rarer.
Dr Rupy: Exactly. Yeah. And I always say, like, if anyone does have symptoms that they think are suggestive of lactose intolerance, then I would speak to your doctor, listen to your own symptoms, and then find out what sort of dietary strategy you should be doing to avoid those symptoms, or find out whether it is dairy at all as well. In a lot of cases, it's not dairy at all. There's a lot of other things that we're doing.
Ben Brown: Absolutely. I mean, most cases of food sensitivity are not actually food sensitivity. People overreact to what they're eating. There could be other reasons for what's going on.
Dr Rupy: There are some people that would argue if you were to go on a largely plant-based diet or whether you were to go fully vegetarian or vegan, there might be some downsides. Are there any downsides that you've come across or that you're aware of if you were to go 100% on plants?
Ben Brown: Yeah, I think, um, if you are transitioning to becoming completely vegan, there are a few caveats and that, you know, really comes down simply to the fact that there are certain nutrients that exist in meat that don't exist in plants or are not easily bioavailable, things like iron and B12 and this sort of thing. So there are a few things you should keep a check on. But generally speaking, if you're structuring your diet well and you're doing this in an intelligent way, not just like eating a normal Western diet and then avoiding all animal products. You'll still get diabetes and heart disease even if you're a vegan. But if you do it smartly and eat whole foods, minimally processed, you know, the advice that you give, you could do it really well and be extremely healthy.
Dr Rupy: Absolutely.
Ben Brown: You know, and we know that vegetarian diets are really good for you. It's really clear.
Dr Rupy: Yeah, absolutely. Yeah. There are some arguments that suggest that it might be a question of genetics. So I'm aware of some people having a genetic snip that prevents them from, say, converting certain types of vitamins, namely vitamin A, into the usable form of vitamin A in the body. Is there anything that you have concerns about from that point of view? Or do you think that's the minimum of people, the minority?
Ben Brown: Yeah, that's such a good point because there's this real trend at the moment to like personalising diet based on genes and this kind of thing. And the way I think about it is, um, in nutrition circles, I'm a bit of an outlier because I don't know my genetics and I don't think it matters much. And the reason I think that is because you need to think of your genes as being secondary to your environment. Your environment and your diet are always going to override these genetic risk factors for nutritional problems and other chronic diseases. So really, when it comes to personalising diet, your genes don't matter that much, I think.
Dr Rupy: Which is quite revolutionary because I think over the last 10, 15 years, even from medicine, we've kind of been drilled into our genetics being the blueprint of our life. Like we can predict our destiny. I remember there being like a baby on the front cover of a academic journal, or maybe it was Time magazine, where in the future, we'd be able to predict exactly what age this particular baby is going to be at risk of having Alzheimer's or diabetes, etc. Whereas actually, that's not the case, like you said. Our environment, our lifestyle has a really high predictive value, if not more so, or definitely more so, than our genetics.
Ben Brown: Yeah, absolutely. I mean, these genes, especially the nutritionally related genes, so these nutrient gene interactions, as what we call them, really become a problem only in Western industrialised diets. You know, that's when they really become pronounced. You know, if you've got a gene, for example, that means you don't metabolise essential fatty acids very well, that's going to be a problem if you're eating the wrong essential fatty acids or not enough of them. But if you're eating a traditional diet that's full of the right types of fatty acids and lots of them, those genes actually don't matter much. Because the diet's fine.
Dr Rupy: Yeah, yeah.
Ben Brown: So it's an interesting way to think about personalising food, but I think there's a bigger picture that just comes down to eating well and that often will override these.
Dr Rupy: Absolutely. And I think the bigger picture is what we need to make loud and clear to a lot of people because I think there is a lot of irrational scaremongering around these things. And people understandably are fascinated by potentially having the key to health or to unlocking that 20, 25% extra energy or extra benefits they can have from personalising their diet. Whereas in the majority of people, particularly the ones I see in the NHS and during my emergency work, we just need to keep to the simple things. And that's what I'm trying to bang that drum about as well. So, um, I think we've covered a lot of things. Um, plant-based protein, what do you think about, um, people assuming that vegetarian diets are protein deficient? And do you think we need to be worried about protein in the diet if we are having largely plant-based diets?
Ben Brown: Absolutely not. And there's a lot of lines of evidence to support that sort of just debunking that concern. And, you know, one of the more obvious ones is the work that has been done at Loma Linda University in California on the Seventh-day Adventists, right? So these people for religious reasons are vegetarian. As a consequence, they're extremely healthy. They get very little cardiovascular disease, they live really long lives. And because of that, they've been studied intensively for many years. And, you know, it's quite clear if you just look at it at a very practical level with examples like that of cultures that are very healthy and but also vegetarian, vegetarianism can be really good for you and you don't need to worry about protein at all. Like these people are doing just fine. The reality is though on a practical sense, um, there are a lot of good protein-rich vegetarian foods, you know, like beans and legumes and nuts and seeds and tofu and tempeh, traditional soy products. So there's even grains to a degree are a great source of protein for vegetarians. So there's a lot of traditional foods that fit well into a vegetarian diet that supply more than adequate amounts of protein for function.
Dr Rupy: Actually, I've got a whole section, a double spread on plant-based proteins in my book.
Ben Brown: Perfect.
Dr Rupy: Just giving people a visual idea of like where you can actually find plant-based proteins. But like you were saying, it's not about just these individual macronutrients, it's about the whole picture. And the more pressing concern, I think, probably in Western diets is lack of fibre. And maybe protein-rich diets that are high in meat might be causing a lot of issues that we see with like, you know, cardiovascular problems and cancers, etc.
Ben Brown: Absolutely. And that's one of the win-wins of vegetarian protein, isn't it? Because it's not just protein, it's beans.
Dr Rupy: Exactly.
Ben Brown: So it's full of prebiotic fibre, it's amazing for your gut bacteria and your overall health. And it's not just fibre, it's full of phytonutrients and vitamins and minerals.
Dr Rupy: Totally. Yeah. Amazing. So keeping on the theme of practicality, I'm just going to give a few actionable tips to get more vegetables in your diet. Something very, very simple that everyone can do. Just having two portions of vegetables every mealtime and fruit in between means you're probably going to be better than 90% of the population in terms of getting your five a day. Vegetables as the focus of your meal with meat on the side is a really simple idea to get into your heads to get more vegetables on your plates as well. You don't necessarily need to commit to three or four days meat-free every week. It seems like a bit of a mountain for a lot of people to climb. And actually from my own personal experience, I used to assume that each meal, particularly evening meals, should have chicken or fish or red meat included in it. And the vegetables were kind of like an afterthought. But actually, once you've started loading up vegetables onto your plate, you'll realise how satisfying vegetable meals can be and how easy it is to carry on with a vegetable-focused diet. So doing things like folding spinach or using root vegetables or tubers, as they're also known, making legumes from scratch, like I teach you in the book, or using canned and packaged products that have lentils, chickpeas, and beans are brilliant for replacing meat and bulking up meals as well. And also eating nuts and seeds are great satiating snacks that introduce fibre and quality whole fats, which are fantastic for health. So I think we've made a bit of a case for eat more plants and the fact that most diets are saying this is the central thing. Um, what do you think, Ben?
Ben Brown: Absolutely. Yeah, it's super simple. Eat plants.
Dr Rupy: Eat plants.
Ben Brown: Plenty of them.
Dr Rupy: Okay, so make sure you subscribe to the Doctor's Kitchen podcast on iTunes, Audioboom, or whatever your favourite podcast player is for notifications so you don't miss new episodes. You don't want to miss any new episodes. And give us a five-star rating. They make a huge impact on how this information is spread. You can tweet us @doctors_kitchen, check out the Instagram, and my website doctorskitchen.com, and you can also sign up for more information. You can tweet Ben Brown @BenBrownND and his podcast is The Positive Health Podcast. I definitely recommend you check it out. It's awesome and it's on iTunes as well.
