Ashlee Williams, MD (Host) (2): Secrets out. Fruits and vegetables are essential for a healthy diet. But what about a mostly plant based diet where most of your nutrients come from plant based food sources? An increasing number of studies show a multitude of health benefits from eating mostly plants. So how do you get started? And what does a healthy plant based diet really look like?  

Ashlee Williams, MD (Host) (2): Welcome to the Healthier You podcast. I'm Dr. Ashlee Williams. And today I'm talking with Dr. Margaret Schweisow, a Kaiser Permanente physician who is Double Board Certified in Gastroenterology and Internal Medicine, and is the Chair for Inflammatory Bowel Disease for Northern Virginia; about plant based diets, the short and long term benefits, and how to get started.

Dr. Schweisow, thank you so much for being here.

Margaret Schwiesow, DO: Thank you so much for having me. It's a pleasure.

Host: Okay, so let's just start with the basics. What is a plant based diet?

Margaret Schwiesow, DO: It's basically when most of your meals come from plants. Centerpiece of your plate, plants mostly. Legumes, vegetables, fruits, whole grains, such as oats, quinoa, farro, millet, bulgur, nuts and seeds, herbs and spices.

Host: Okay, what do you recommend for your patients when they come in saying, hey doctor, I would like to start a plant based diet?

Margaret Schwiesow, DO: So first I try to explain to them what the benefit of eating plants is. And as a Board Certified Gastroenterologist, you know, I obviously start with gut health. I tell them that our gut microbiome, the bugs that live inside of our digestive tract, they need certain food in order to grow. And that food actually comes from plants.

So chicken does not have fiber. Eggs do not have fiber. Fiber comes from plants. So all the things that I just mentioned, they use that fiber from plants to replicate. And as a result, they produce certain inflammatory molecules that help not only your digestion, but they help with other aspects of your body and your health.

Host: Okay. So, you listed a few foods that are not included in a plant based diet, so chicken, any other foods that you would say you shouldn't eat if you're planning on eating a plant based diet?

Margaret Schwiesow, DO: When we talk about plant forward eating, we don't really focus on what you shouldn't eat. I basically give them ideas of what you should bring onto your plate, right? So, mentality of abundance. And when you think that way, then over time what will happen is that all the less healthy food choices will actually fall off your plate naturally.

 But really the general rule of thumb is that obviously you want to really limit ultra processed foods, fast foods. They really have no role on your plate, especially processed meat. We know that processed meat has been linked to colon polyps, colon cancer. That's why I tell them processed meats, ultra processed junk food really has no role in your diet. Now, really, you know, going back to when we talk about plant forward diet, you know, we, we're not talking about any specific diet because when you really think about it, most healthy diets in the world are centered around plants.

Mediterranean diet, centerpiece of Mediterranean diet are plants. Anti inflammatory diet, vegetarian diet, mostly plants, then some animal products. So we're not saying that there's no role for animal product on your plate. We're just saying that your structure of your plate, most of your meal should be actually plants.

Host: Yeah I love the term plant forward instead of plant based and focusing on what you should be eating instead of what you shouldn't. I think that's very helpful. Can you talk a little bit about the health benefits of a plant forward diet?

Margaret Schwiesow, DO: So, like I said, earlier, as a gastroenterologist, we talk about gut health, right? So a lot of times people will come to me and they suffer from a plethora of digestive issues and they are trying to figure out what else they can do to optimize, to reduce these symptoms. And we, really start with the very basic concepts, what is responsible for gut health.

So the you know, there's this growing evidence that suggests that we have trillions and trillions of bugs living inside of us and they actually are the secret to better digestion and better overall health. And that's why I preach eating plants because they are the prebiotic fiber that will allow them to replicate and diversify. We know that the more diverse your gut microbiome species, the better your digestion and overall health.

Host: Got it. So it sounds like there's several benefits to a plant forward diet. We've heard that it can help improve your cholesterol, your blood sugar, your blood pressure. And it's really the foundation of a heart healthy diet. Would you agree?

Margaret Schwiesow, DO: Yes, so absolutely. So, the gut microbiome or the microbial species in your gut are producing the anti inflammatory molecules. We are seeing that they are not only, you know, improving your digestion, they're actually restoring your the lining of your gut. They actually play a role in your insulin, in your glucose metabolism. They regulate your blood pressure. They get rid of the bad cholesterol from your body. They also are responsible for regulating your immune system. So we know there's so many conditions where your immune system is just going in a state of a constant overdrive and these postbiotic products, short chain fatty acids,produced by the gut microbiome; they actually allow, they restore the balance of your immune system. They actually also help with your skin health, your brain health, your mental health. And there's just so many different benefits that you get when you allow the good bacteria to flourish in your gut.

Host: I'm sold. So how do I get started?

Margaret Schwiesow, DO: You know, number one rule that I have, I always tell my patients, don't do it alone. Get your spouse, your significant other, your family members on board. Talk to them about that you want to try to do this at home and just start very slowly. So it's not all or nothing approach, right? We're not going to go in there and tomorrow start eating 30 plants a day.

It's just not going to happen. You'd have to do it very slowly, gradually, and you're going to build a habit. And I always say, you know, if your spouse is sitting there and eating chicken wings and you're trying to eat healthy, it's just, you're not going to be successful long term, right? So that's why I always say, get them on board, get your children on board, or your roommate and do it together because your chances of succeeding will be much, much better.

Host: And also for the sake of just not making multiple meals at one time, right?

Margaret Schwiesow, DO: Absolutely. Because that's actually one of the barriers. People are telling me, you know, what, where do I find a time to cook all this? And I tell them, well, you still have to put something on your plate. Right? So how you start is that maybe let's say if you're thinking on average, like chicken, right? Rice and chicken, chicken and rice dinner. Think about, okay, maybe today, I can think about bringing lentils onto my plate. Maybe today you can explore, let's say, replace ground beef with lentils and make lentil tacos or think about some, a replacement for your staple and bring it from the world of plants.

Host: And starting slow, right? It doesn't have to be all at once. Like, make it catchy like meatless Mondays. Like, this Monday we're going to start without meat and see how it goes from there instead of just diving right in to saying we're not having meat at all for the entire week.

Margaret Schwiesow, DO: So another tip that I have that, let's say a lot of times when we talk about a diet, people are saying, you know, I have carrots and peas every day and I tell them, change it up a little bit. Let's say when you go grocery shopping, just maybe instead of getting carrots and peas, try a different vegetable, try, learn how to use other vegetables.

Maybe, you can cook an eggplant or an artichoke. And the reason why this is so incredibly important is that when you're picking different types and different colors of vegetables, you're actually bringing that rainbow, you've heard the term, eat the rainbow, what you're doing is you're diversifying the microbes that line your digestive tract because you are getting them different nutrients which allow for the growth of different species.

And also inadvertently you'll bring different minerals and vitamins onto your plate because different colors of different vegetables, they have different minerals and vitamins, right? So it's a win win situation.

Host: Yeah. And I think it's great that this plant forward diet is becoming such a thing, like we're even seeing restaurants, right, that are plant based restaurants. When you go out, you can even ask your server for suggestions.

Margaret Schwiesow, DO: Absolutely. Yes. So it's really, you know, it's not as difficult as it seems. It might be very intimidating in the beginning, but I always tell people, you still have to think about creating a meal for yourself and your family members. So just think about, you know, I mean, there's so many great inspirational recipes online.

There's so many great website where I am a fanatic. I love cooking. So when I watch these recipes, my mouth is salivating. Eating plants is so exciting, colorful. There's so many different textures and flavors and you just can't go wrong. So once you start eating like that, your taste buds will change.

Host: Is there any group that you would recommend not making the switch to a plant forward diet?

Margaret Schwiesow, DO: So the answer is no. Everybody will benefit from eating more plants. This includes children. This includes pregnant women, as well as elderly. There's really not a single group where you say you shouldn't eat plants. That's just now remember that when you are strictly plant based, meaning if you eliminate all sorts of animal products, you have to really plan your meals and you have to diversify your diet and you have to include certain supplements.

And these are specific, and I'm talking very strict vegan type of plant based eating where you're really excluding B12 sources, you will have to consider taking B12 supplements. And for most of my patients, I actually recommend daily vitamin D supplement as well.

Host: Yeah, that's good to know. What do you tell your patients who are craving foods that aren't plant based or, you know, meat, sweets, etc?

Margaret Schwiesow, DO: So I actually have an easy solution for this. Let's say if you have a sweet tooth, right? And, my patients are telling me, you know, specifically at night at 8pm after dinner, I am craving something sweet. I'm craving a Hershey chocolate bar. And I tell them, well, first of all, don't bring this stuff into your house, right?

 You really shouldn't have junk food laying around. But if you really absolutely must have something sweet, opt for sweet fruit. Grapes, or dried fruit, figs, dates. I even give people recipes, you know, you can create your own healthy version of a Snickers bar where you actually use dates. Fill it with a crunchy peanut butter, and you can maybe dip it in some dark cacao chocolate.

And that is actually a great snack. It does have sugar, but that sugar is attached to fiber. So the effect of the sugars, it doesn't have the same effect on your sugar spike as let's say, if you were eating a Hershey bar. These are some options, right? And again, go heavy on fruit. If you really must, and you will see the taste of that, the sweetness from a grape or a banana, your taste bud will adjust over time and you will be completely satisfied with having a banana in the evening or an apple with peanut butter.

Host: There's just so many creative solutions, like making a Snickers bar. That's amazing. And then, you know, also making sure you're drinking plenty of water and getting enough sleep.

Margaret Schwiesow, DO: Yes, absolutely. Because that actually, you know, there's usually a reason why you have these cravings, right? So, maybe it's an indication you have something wrong with your digestive tract. So always speak with your doctor.

Host: Okay, so can you still get the necessary protein, vitamins, and minerals from a plant forward diet?

Margaret Schwiesow, DO: Sure. Excellent question. So let's start with the protein. You know, we live in a protein obsessed world and it's probably because the other two macronutrients such as fats and carbohydrates have been vilified. So people think, well, then protein must be the Holy Grail of eating. We have to understand when we talk about protein, we have to understand how much protein do we really need, right?

And this varies based on gender. It varies based on how old you are and what you really what your goals are. So if you are an average size female, your protein needs are anywhere between 45 to 50 grams in a day. For a male, 10 grams higher, unless you are a bodybuilder, you are an extreme athlete, then your protein needs are different.

What I see day in and out is that this protein obsession is really not warranted. We are globally fiber deficient and no one talks about that. An average American consumes 10 to 15 grams of fiber per day, max. But what we need is 25 to 30 grams for a woman. And 10 more grams for a man and we don't get that.

Going back to your question, yes, you can certainly get enough protein on a plant based diet, because plants have protein. The excellent sources of proteins are legumes, whole grains, and vegetables and fruits have proteins as well. Aside from the protein component, they also have fiber. So you'll get a benefit of, let's say, if you're consuming beans or lentils, not only are you getting the protein component, you're getting the fiber component, you're getting all the other micronutrients and vitamins such as, iron, zinc, magnesium. There's so many other nutrients in it that will result in a better overall health.

Host: Any thoughts about pre and probiotics?

Margaret Schwiesow, DO: So the concept of probiotic comes up very frequently because people are interested and they are asking us, they're asking for recommendations, which probiotics are the best. And you will be very disappointed to hear that we as gastroenterologists, say that there is no clear evidence to suggest that a person will benefit from taking probiotic supplements, unless, there's actually three clinical scenarios where there's some evidence that a person can benefit from a probiotic supplement. And this needs to be discussed with your physician directly to make sure you're not in any of these categories. But for the overall, global population, we do not recommend them.

In fact, there could be some harm that comes from a consumption of probiotic supplements. Anything from worsening of digestive symptoms, so worsening bloating, diarrhea, or, or change in bowel habits. They can actually put you at risk of certain intestinal infections and they can actually transfer a certain microbial antibiotic resistance from one probiotic microorganism to the other microorganism; so because there are some potential harmful side effects. And lastly, they're costly. They're very, very costly.

Host: So again, probably always good to just check in with your doctor if you're going to start an over the counter supplement to make sure that it's the right supplement for you.

Margaret Schwiesow, DO: Yes. And then your doctor will determine, let's say, if you, you do have an indication, if there is an indication, they will actually tell you which probiotic to purchase. And it's not really, about a single strand; it's more about, a combination of certain strands,

 Now in addition, I have to tell you something positive. So if you are really looking to increase the good bacteria in your gut, you can certainly do that. You know how? Fermented foods. Fermented foods contain living microorganisms already, right? So what are fermented foods? Fermented vegetables, kimchi, fermented cabbage, which is sauerkraut, pickles, fermented soy products, miso, tofu, tempeh, Kiefer, Yogurt, or Kombucha. These are really great options. If you're really looking to diversify your gut microbiome, bring the living organisms into your gut. You can certainly do that by consuming fermented foods.

Host: Yeah. And I love that all these things are available at your local grocery store.

Margaret Schwiesow, DO: Absolutely. Now, it gets a little tricky with how you select that and how much do you actually need. So I always recommend to use them as a condiment, right? Obviously I don't recommend eating a whole jar of kimchi every day. You're going to start, very, very slow and small portions, and you can expand as you go.

Let's say if you are shopping for fermented foods and, you know, one of the questions that I get asked, you know, there's so many options out there, how do you pick the right kombucha? How do you pick the right fermented pickle? So I always tell patients when you're looking for the good stuff, it has to have, let's say you're shopping for ferment, for pickles, right?

The pickles that have the live microorganism in it, they really only have three ingredients. So it's the cucumber, water, and spices, maybe salt with spices. If you see vinegar, that is not a fermented product. Okay. That does not have the live microorganisms in it. So we do a lot of education about how to really pick these products.

Like same with kombucha. There's so many different brands of kombuchas on the market. How do you know which one is it? And you really want to select products that don't have added sugar, it's not really a healthy option. So, really make sure that you know, understand how to read these labels so you're selecting the right fermented products.

Host: Well, that is very informative. It's really important to know what to look for when you're buying these products and how to read the labels and what to stay away from. Thank you for that information. Thank you so much for all of this great information, Dr. Schweisow. We learned a lot about plant forward eating, its benefits, and how to get started.

Here is a recap of what we learned. Plant forward eating comes with a lot of health benefits, like improved gut and heart health, boosted immunity, and living a longer life free of disease. When first starting out, focus on filling the majority of your plate with vegetables. The fiber in the vegetables will keep you feeling fuller longer, and curb cravings for processed foods.

Avoid processed meats, sugary foods, sodas, white bread, and other highly processed foods. You can get all of the necessary proteins, vitamins, and minerals and nutrients from plants. However, if you completely cut out animal products, you'll need to take a B12 supplement. But always check in with your primary care provider.

Nearly everyone can make the switch to plant forward eating, including children, pregnant people, and people with diabetes. If you are concerned about an existing health condition and trying a plant forward diet, talk to your doctor first. And lastly, have fun exploring new tastes, textures, and spices in the plant world.

There are amazing recipes online to inspire your next meal. For more healthy eating tips from our experts and other health advice, visit kp.org/doctor and listen to more episodes of Healthier You wherever you get your podcast. If you enjoyed this episode, be sure to share it with others who may find it helpful.

Thank you from all of us at Kaiser Permanente. Be well.