Plant-Based Canada Podcast
Welcome to the Plant-Based Canada Podcast. Join us as we talk with experts to explore the field of nutritional sciences and how our food choices impact our health and the environment. We sit down with Canadian doctors, dieticians, athletes, climate experts and others/more, to break down the evidence behind a Whole Food Plant-Based diet, and discuss the practical steps you can take in your efforts to shift toward a healthier lifestyle. The Plant-Based Canada Podcast is an initiative of the group Plant-Based Canada, which aims to educate the public and health professionals on the evidence-based benefits of plant-based whole food nutrition for individual and planetary health. To learn more about the show, visit our website www.plantbasedcanada.org and stay up to date by following us on Instagram and Facebook @plantbasedcanadaorg, and our Plant-based Canada YouTube channel. The views expressed by guests are their own and their appearance on the program does not imply an endorsement of them or any entity they represent. PBC is not responsible for any errors, omissions, or opinions related to the content stated by the guests interviewed. All information in this podcast is provided "as is", with no guarantee of completeness, accuracy, timeliness or of the conclusions obtained from the use of this information. The podcast should not be considered professional advice. Listeners should seek their own individual healthcare advice as needed.
Plant-Based Canada Podcast
Episode 30: Dr. Marianne Trevorrow on Supporting Women's Health on a Plant-Based Diet
Use Left/Right to seek, Home/End to jump to start or end. Hold shift to jump forward or backward.
In this episode of the Plant-Based Canada Podcast we interview Marianne Trevorrow. Marianne is a naturopathic doctor registered with College of Naturopaths of Ontario who has been in practice since 2006. She focuses on the care of identified women with chronic complex pain and reproductive issues, including patients with endometriosis, PCOS, infertility, and problems associated with menopause, as well as pelvic pain pre and post-menopause.
She supports and practices plant based eating as a foundation to good health, as well as being more sustainable for our planet.
Since 2018, Marianne has also taken on a new role as Editor-in-Chief of the Canadian Association of Naturopathic Doctors Journal (CANDJ) -- the professional journal of the Canadian ND Association. She has published in her areas of clinical expertise in several peer-reviewed Integrative Medical journals, and maintains an active social media presence and blog.
In this episode we discuss:
- Dr. Trevorrow’s path to naturopathic medicine.
- How she incorporates evidence-based medicine into her practice.
- Her work with the Canadian Association of Naturopathic Doctors Journal.
- CANDJ’s mission to promote conversations around plant-based eating.
- How diet can impact menopause, PCOS, fertility, and pregnancy.
- Advice for identified women interesting in adopting a plant-based diet.
- Misinformation in the health and wellness space.
Socials/Links:
Website
Studies/Articles:
Eat Lancet Report
Seventh Day Adventist Health Study
Harvard Fertility Study
The Crossroads of the Planetary Health Paradigm: An Indigenous Perspective
This Podcast was hosted and edited by Clinton Stamatovich.
Welcome to the Plant-Based Canada Podcast. Join us as we talk with experts to explore the field of nutritional sciences and how our food choices impact our health and the environment. We sit down with Canadian doctors, dietitians, athletes, climate experts, and more to break down the evidence behind a Whole Foods plant-based diet and discuss the practical steps you can take in your effort to shift toward a healthier lifestyle. Today I sit down with Marianne Travargo, a naturopathic doctor registered with the College of Natropaths of Ontario, who's been in practice since 2006. She's originally from British Columbia, but did her Indie training at Master University in Seattle, Washington, where she was trained as a full primary care practitioner. Dr. Travargo focuses on the care of identified women with chronic complex pain and reproductive issues, including patients with endometriosis, PCOS, infertility, and problems associated with menopause, as well as pelvic pain pre- and post-menopause. She supports plant-based eating as a foundation to good health, as well as being more sustainable for our planet. Since 2018, Dr. Javar has also taken on a new role as editor-in-chief of the Canadian Association of Metropathic Doctor's Journal, or Candy J, the professional journal of the Canadian Indy Association. She has published in her areas of clinical expertise in several peer-reviewed integrative medical journals and maintains an active social media presence and blog. Marianne, thank you so much for joining us on the Plant-Based Canada podcast. It's a pleasure to have you on the show.
SPEAKER_00Thank you very much.
SPEAKER_02So let's jump right into it. I want to give the listeners a sense of you and your background before we get into some of the other questions here about your practice. So tell me how you grew up and what led you on the path to naturopathic medicine.
SPEAKER_00Yeah, it's a bit of a long and winding road. I grew up in British Columbia. I was a high performance road cyclist and then track cyclist during my younger years. I attended McGill University in history and I studied European colonial history and Latin American history. Did that in graduate school as well. Ended up a divorced parent of a young child in the mid-90s. And my son had was born prematurely with asthma and a lot of other health conditions. And I wasn't finding, you know, trying to juggle teaching and raising a child and dealing with his health conditions and my own health conditions, I found that I wasn't getting a lot of answers in conventional medicine that really, other than being given inhalers and antibiotics, that neither of us were really finding long-term solutions for our health problems. And I know for both of us, looking into diet, and at this point, I mean, this is the middle 90s, there was some information on anti-inflammatory diets, but I was interested to know what you could do with simple lifestyle measures to help improve people's lives. And um I was nutrition track at uh so 2000, I made the decision to study naturopathic medicine. I came from my family, quite a few members were conventional physicians. My aunt was an internist, but from one of the first generation of women that graduated from Queen's University in that essence, my mother was a trauma surgical nurse, and I knew from my family background that there wasn't a lot of training into nutrition specifically, but I wanted to be able to do primary care medicine in a way that really improved people's lives. So I went to Bastia University, which at the time was considered the naturopathic school that had the strongest scientific program. They had a research track in nutritional medicine, and that's that was the track I was on there. I spent a year after I graduated doing um postdoctoral work as an assistant research investigator in nutrition and anti-aging medicine, and then ended up for family reasons back in British Columbia. My mother was diagnosed with advanced ovarian cancer. So um I ended up sort of uh changing changing tracks again and ended up in in primary care practice back in British Columbia and um ended up in publications and leadership, partially because, oh I think a large amount was because of my background in in publishing during graduate school and my background as a historian, interested in in supporting and promoting peer-reviewed publications in the naturopathic professions. So um my predecessor at uh CNDJ, which used to be called Vitalink, was a naturopathic doctor by the name of Iba Lloyd. She recruited me for her editorial board goodness back in 2009. She was setting up an editorial board for Vital Link. I've been involved with the journal ever since then. So yeah, that's sort of kind of gets us up to where we are right now.
SPEAKER_02Yeah, yeah, yeah. That's that's that's quite a that's quite a pass. That's that's you're all over the place. I can definitely see you mentioned, you know, uh ovarian cancer and everything like that, probably being a big influencer for heading on this this path. How do you incorporate evidence-based nutrition and specifically you know plant-based nutrition into your practice?
SPEAKER_00Well, interestingly, as I I think I mentioned before we started, I was um at the time at last year, the nutrition department is very firmly um supporting and promoting Mediterranean style diets. So the Mediterranean style diet is not that different than a whole food plant-based diet. Both emphasize whole grains, fresh fruits and vegetables, nuts and seeds, plant-based proteins. Um, and we were some of the studies we were involved with were showing beneficial effects in patients, for example, with insulin resistance and early diabetes, with the addition of legumes to the diet. The Mediterranean, the big difference is the Mediterranean diet includes seafood and smaller amounts of dairy foods and animal proteins. I think the tipping point for me, I was going through, I had menopausal, starting to have menopausal symptoms as my mother was undergoing chemotherapy for her ovarian cancer. And I realized when I was starting to look at the studies that I was also at significantly increased risk for ovarian cancer because I'm I'm her daughter, obviously. So I started to look into what were the studies saying about prevention of cancer. And in another three or four years after that, my father was diagnosed with pancreatic cancer, and that was where I really started digging and thought, wow, this is both my parents now. And after my father passed away in 2014, that was when I finally decided that I had kind of had enough of animal protein. So I I went myself and became whole food plant-based. So um, yeah, how do I incorporate in my practice? I think it's a question of I try to meet my patients where they're at. So, and I tell them it isn't a it isn't an on-off switch. You're not failing because you don't become completely plant-based. The idea is, especially if you've been eating a significant amount of animal protein. And for most of my female patients, the big uh the big switches are usually from chicken and eggs and dairy away from those foods, specifically because they've been led to believe. I mean, we have a very significant poultry and dairy lobby in this country. And the previous Canada Food Guide promoted these foods as healthy. And I think for a lot of my female patients, it's required a bit of a sort of a paradigm shift in their head about no, actually, these foods are not that healthy. And you will um you will achieve your health goals more easily with a more legume-based diet. So it um it can be, it's a process because especially for patients with a lot of digestive issues, which are pretty common in my in any naturopathic patient population, you're gonna see a lot of patients with food sensitivities or irritable bowel or other issues with foods, moving them towards a higher fiber diet is not again something you can do within like a two or three-week period. It's often a multi-month period of retraining your digestive enzymes, retaining the gut microbiota to be able to manage these foods and not create intestinal or gastric discomfort, which you know kind of is dismotivating for for making these changes.
SPEAKER_02I can I can vouch for that for sure. I I was, as I've mentioned to you before, I'm from the Midwest and the States, and most of my diet consisted of you know, cheeseburgers and french fries. So I making the shift to getting cruciferous vegetables and and nuts and legumes, that was definitely difficult in the beginning, but it uh it worked after a while. This is one of my favorite questions to ask. And I think I uh you alluded to perhaps the answer here, but I I always like to ask when you were learning about and reading about data on plant-based diets, um, or predominantly plant-based diets, or looking at the Mediterranean diet or whatever. What was the evidence that really you know stuck out to you as the light bulb moment where, oh, there might actually be something to this? I I can assume from hearing about the conditions your parents had that it might be, you know, um T. Colin Campbell's work or something to that effect.
SPEAKER_00I I read the China study certainly when I was training at Bastier. I mean, I think at the time it was um, if I recall what a lot of my, I mean, the the people that I studied with thought about that diet. They said, well, that was, you know, it was it was good data, but I don't think it would felt overwhelming to them because the studies with, I think the thought was at the time that plant-based, completely plant-based diets were somewhat extreme and that you would be missing certain key nutrients like zinc and calcium and iron and so forth. And um, and that these could be found that a good compromise, a more sustainable type diet, a diet that patients could more likely adapt to was the Mediterranean style diet. And there was such strong data on it for cardiovascular disease and diabetes and cancer and so forth through the mid 2000s. I think the tipping point came for me specifically with um when I started reading things like the adventus study in Epic Oxford, and I was involved in a group where we were, it was a journal club with a number of colleagues and some students from Bastier, which was the school I went to. Um, when I looked at some of the work from you know Epic Oxford, the Eat Lancet report, and started to look at the sustainability piece. And I thought, hmm, you know, I think looking at the issue of where we're where antibiotics are coming into the diet from large poultry and large meat production facilities, the issues with meat slaughtering. I was in Alberta at the time, the poor treatment of workers in the meat production facilities, the issues of you know, chickens, uh industrial chicken production. Like a lot of people, I went through sort of an intermediate stage where I said, oh no, I'll eat grass-fed beef and I'll eat organic chicken, but a lot of the problem with that is that food is very expensive and not sustainable. And I started to look at some of the data from Epic Oxford and that showed that vegan diets were quite healthy. And I think it was, you know, having gone through menopause and being concerned about my own risks of diabetes and cancer, and looking at, well, these are perfectly valid diets for maintaining a healthy weight. That was kind of the tipping point for me, was um looking and seeing studies showing that animal proteins were associated with increased rates of insulin resistance, cancer, the processed meat studies that came out on cancer risk, that was kind of really the tipping moment.
SPEAKER_02I'd love to talk about your work with the Canadian Association of Naturopathic Doctors Journal. Can you tell me about the mission of the journal first and then also you know more about your role there?
SPEAKER_00Okay. I've been the editor-in-chief, I've been the editor-in-chief for the journal vital link since mid-2018 now. Um, Iva Lloyd left to become, she was had taken on the responsibility as president of the World Naturopathic Federation and so was very busy with that. So she left the journal and and I stepped up from the beat, the associate editor, the editor-in-chief that year. I saw that to increase our readership and to increase our impact, we really needed to go digital. So I at that time I formulated a plan which has been implemented in the last year and a half to take our print journal and put it online. Now, this sounds like, well, this should be relatively easy, but no, um, to be to be a credible, peer-reviewed, impactful indexed journal requires a lot of behind-the-scenes work. We were very fortunate that I want to give enormous credit to our executive director at the Canadian Association, Sean O'Reilly, um, our board president Mark Fontes, and the entire board and executive for really showing a lot of faith because this cost us a fair bit of money. It was close to $30,000 for the transition when all was said and done. We were able to get a fantastic publisher in SG Publications out of there in based Ontario that have worked with complimentary, um complementary and integrated medical journals before, and were really able to advise us well about how to upgrade our author guidelines, our research guidelines to have ethical research parameters, our peer review guidelines so that we could have properly blinded peer review, because that's really crucial to, as we're if we're finding out with COVID, it is really crucial to have things peer reviewed so you don't put out data that isn't right, and um, and have appropriate production standards so that each article is going through several sets of eyes, not just one or two editors. So that process has been ongoing for, oh goodness, we just finished the digital transition last fall with our first um our first digital, our first digital edition was September 30th, 2021. Um, my job, so my job is to provide the strategic direction. And as I said, I I the first thing that I want us to do is to go online. Um I now oversee the entire review process. So we make sure that that all of our um all of our peer-reviewed articles, so that will be everything that's not you know editorial commentary, goes through peer review and appropriate peer review, so people that know the subject matter well. Um I promote the journal to authors and readers across North America, and as I mentioned, I think in our preamble, we've increased our readership within six months, approximately 30% from where we were with print. And um we're bringing a lot of um, we're now um, we were losing money on our print editions because we were such small circulation. Now we're we're revenue neutral. So, but it's been it's been a lot of work to get there. So the next step for the journal is we're hoping to get onto the larger indexers. We're on Google right now. We have what are called DOIs for our articles, so they're persistent, what are called uh digital object identifiers, so they're easy to find on search engines like Google. So we are indexed now. We're hoping to be able to apply to the big indexers like PubMed and Web Science next year or the following year.
SPEAKER_02That does that does sound like a lot of work, but I'm happy that you're doing it because it needs to be done. I I think that I think that's really interesting to all the stuff you just you just you said. Um, for someone like me who's not in in the field of academia, this like to to know how things work and how much effort and time and how many you know times that things have to be reviewed, that's very interesting. And it's and it is, it's very, it's a lot of work that you have to do. So definitely appreciate it.
SPEAKER_00Sorry, coming from the social sciences, I think one of the things that that my social science background has really kind of prepared me to do is as a social scientist as a PhD student, which is where it was back in the early 90s, you are used to producing, you know, you're used to writing articles, having them critiqued, having them critiqued before you, you know, you you you write an article, you have your supervisor look it over, you might have a couple of colleagues look it over, you will present this at the conference as a work in progress, then you submit it to a journal. I'm used to having things going through several sets of eyes, and I know how much better it makes the information, you know, it starts as an idea of like, wouldn't this be interesting? And it having that feedback creates information that is more sound, more nuanced, more robust, and ultimately better, I mean, better science, no question about it.
SPEAKER_02Absolutely. So I understand with with the journal that you're and that you're encouraging more plant-based content. Why is it in for you, why is it important to get this kind of work more exposure in an academic setting like this? And do you think that it that exposing this type of data, this type of evidence, will have a tangible influence on on health professionals and healthcare settings?
SPEAKER_00Absolutely. I know that from my colleagues at the University of Toronto that are working on, so a lot of uh colleagues in in the various labs that are working on this, it's um it can be a bit of a hard sell for plant-based studies in conventional journals. So we're hoping to provide a platform, sort of a cross-fertilization platform between conventional medicine, the degradive medicine, and naturopathic medicine. As an editor-in-chief, I have to step somewhat carefully because my role as editor-in-chief is to provide strategic direction, not necessarily to be an advocate for one view or another. But as part of my role, I do I certainly do try and facilitate discussions within the profession by soliciting content in areas that don't necessarily get a lot of exposure. And I know you know we are an independent journal, we have a has a point of pride that we follow the International College of Medical Journal editors guidelines on disclosing competing interests, that industry does not, we do we do not have published industry-sponsored content. So we have to we have to encourage some of our overworked clinicians and senior faculty at the Canadian College of Natural Batic Medicine to write for us. So I I encourage, you know, courage, smooth, I try not to twist arts too much, but um try to try to get people to write in areas that are not necessarily sort of the the sort of cause of the day kinds of things. And and there's a I think a lot of NDs understand that there's an essential congruence between naturopathic philosophy, which is about sustainability and about planetary health and about traditional ways of knowing and certainly about indigenous ways of knowing and diet and health promotion. So um to give you an example, we had a planetary edition back in 2019, which we solicited most of the content for, which is very well received. And as I mentioned, Nicole Redverse, who is a naturopathic doctor who has worked in the Indians and Medicine program in North Dakota, has been instrumental in gaining um gaining licensure for naturopathic doctors in Northwest Territories, and he's now starting a PhD program at Oxford, wrote an excellent commentary piece for us about how planetary health, there's a lack of traditional Indigenous knowledge incorporated into current planetary health paradigms, and I think made a very compelling case and made a lot of us realize that we needed to step up as a naturopathic journal, especially. We needed to step up and sort of lead from the front, so to speak, in terms of supporting our Indigenous ND authors and having specific. I know one of the things that we're working on with my associate editor, who's um, and I'll give a plug to Cindy Gilbert, who's a course coordinator at Canadian College of Naturopathic Medicine for Anti-Oppression Cultural Competency, um, with with these Indigenous colleagues, we're amending our submissions guidelines for indigenous authors and content. We're hoping to have these these guidelines on our website site by mid-2022. So we're working on a specific style guide for how to cite Indigenous content in a an appropriate and sensitive way and not um not appropriate indigenous, traditional indigenous knowledge, you know, treat it with cultural sensitivity. Absolutely.
SPEAKER_02That's fantastic, yeah. I want to switch topics a little bit here. You are, as you, as you alluded to, you're you're also an expert in women's health. I want to know about you know some of the data that we have when it comes to impact on diet and things like menopause, PCOS, and or fertility.
SPEAKER_00Oh, absolutely. I think there's some, there was an interesting study that I pulled a little while ago from Harvard about uh fertility diets and about specifically about fiber and um and hormonal balance. I know that, you know, a lot of my younger women with um, I work a lot in practice with women with various pain and menstrual disorders like uh polycystic ovarian syndrome and um various uh uh menstrual uh dysfunctional uterine bleeding disorders and fertility issues. And a lot of these disorders go back to um why ovulation is dysregulated in women. These are pre-menopausal women I'm talking about. And a lot of that has to do with either environmental toxicants and things like the food. And again, we're we're talking about toxicants that are concentrated a lot of animal proteins, and ovulatory disturbances from diets that are um promoting insulin resistance. So these would be diets that are heavy in animal protein and processed foods. So we know that, for example, um heavy bleeding for a lot of women, heavy menstrual periods, which can cause iron deficiency disorders, are improved by higher fiber diets. Ironically, because a lot of women are taking with anemia from heavy bleeding, are taking other supplements in a word about absorption. But it turns out that when you stop the heavy bleeding by changing the diet away from, I find specifically in women with a lot of uh polycystic and insulin resistant syndromes, that when you when you remove dairy foods specifically from their diet, that often were able to rebalance the estrogen and progesterone during their menstrual cycles, improve ovulation. And when you improve ovulation, you decrease a lot of the worrisome cosmetic symptoms. So sort of you decrease the acne. But when you get them ovulating again, women, the the bleeding is able, they're able to have more life cycles. And we're looking more and more in studies, and I know a lot of work is being done again from the center. For menstrual research at UBC and specifically the prior lab there about the essential role of progesterone and luteal phase progesterone in bone developing bone health in women in their 20s and 30s, and importance of maintaining a good, healthy, high fiber diet specifically to support healthy ovulation. So not so much, not so much with the big studies, but sort of the rubber meets the road moment of well, how do we fix this specific disorder? Maintaining ovulation is what they call a fourth or fifth vital sign, I believe in women, is that moving diet in more of the direction of eating predominantly fruits and vegetables is tremendously beneficial for a lot of my patients. They find their, they find their heavy bleeding stops, they get regular menstrual cycles, they find that their skin clears up often their hair and iron nails improve, and they just frankly feel better.
SPEAKER_02You mentioned a term I'm unfamiliar with, uh toxicant. Um I can assume what that is, but you you know, you said dairy in particular was something that that you found helped with uh people who had PCOS and such. Uh what is the so for the toxicants, what exactly is that uh what it what would be the toxicant in something like dairy that would that would have impact something like uh PCOS or fertility?
SPEAKER_00I mean, I I don't have, I mean, I'm not an environmental, I'm not an environmental medicine or environmental health researcher. So I do think that in terms of how um things like uh PCBs or uh dioxin or antibiotics get into our diet, there's no question that eating higher up the food chain is, I mean, we know this most. I I think it's most obvious in things like antibiotic exposure, um chicken and red meats, definitely in fish. There's a question, I mean, I I don't want to get into an argument with the dairy farmers in Canada over this, but we there we do, I think there is some work being done. I know they're doing a lot of this work, so quite a bit of this work, actually, Simon Fraser, in their um with their environmental health programs. And Philip Landrighan at Harvard, I think, is doing a fair bit of this. But we do know that eating higher up the food chain, I mean, I'm familiar with the larger steps, you know, the Lancet, the Adventist Health Trials, the um the ECIP Oxford data that shows that overall people do people do better on these diets that are lower down the food chain. Specifically with dairy food, what we've seen happen in a lot of my patients is that the the higher, and it's not that we're giving estrogens to cows, but we are milking pregnant cows. So a lot of the dairy industry and and in conventional dairy production, we're we're more likely to see antibiotics entering our diet that way. There's some so the connection is really between this food is we know it's more likely to produce higher levels of insulin. We know it's likely to be um obesogenic, meaning it's more likely to put calorie for calorie, we're gonna see weight gain compared to diets that that contain nuts, for example, or fruits and vegetables. Um now, specifically whether conventional dairy and you know, there's lots of talk in the environmental health literature about PCBs, persistent, which are, you know, um, they were carcinogenic compounds in electrical transformers that you know, questions of it is getting into the food chain from the cows that are in the grass below, uh high tension electrical wires. And I mean, there's lots and lots and lots of controversy about this. But I think sort of the as a clinician, the conversation I have with my patients is in terms of you know, the compounds that you could be exposed to by dairy, even fish these days, especially you know, larger fish like tuna swordfish and that sort of thing, definitely with red meat, where there's no question that increasing cancer rates are linked to increasing intake of these foods. So it's sort of a two-pronged thing. I mean, there's dairy specifically has problems with being a more a food that tends to produce a higher insulin response. But as an animal protein, there's a lot of questions about how much we're contaminating our animal proteins. So I hope that that's a nuanced answer.
SPEAKER_02Yeah, yeah. Well, speaking of how you approach this with your with your patients, I want to kind of throw out a hypothetical to you. So if you have someone who is, if you have a woman who is looking to switch to a plant-based diet, but maybe they're worried about, you know, maybe they saw some headlines that suggested that eating a plant-based or predominantly plant-based diet wasn't the best. So they're worried about uh, you know, getting enough iron or calcium or zinc or some of the things you you said earlier. What's some of the advice that you uh give to them when they ask these type of questions?
SPEAKER_00Well, absolutely. I mean, there's data from the Adventistal study too, which is large population data. You know, you're talking about 70,000, 80,000 people that indicates, I mean, this is, and this again, this is a problem with how the mass media treat studies is they come out and say, oh, study says. But really, when you look at the large population studies, they found that their vegetarians and their vegans, and also people that were vegetarian and eat some fish in the diet, had perfectly adequate intakes of iron and calcium and other foods. So, in terms of, I mean, what I tell patients about what the science says is that science kind of gets us into the ballpark because we're often talking about what's the most likely thing to work for most people. And that's where this evidence-based research really informs what I do as a naturopathic physicianist. This this gives us the best, this is most likely to work moment. And for you, that may look like a diet that is overwhelmingly plant-based. You may be like me specifically, you may have a strong soy sensitivity. So even though soy is a very healthy protein for the vast majority of the world's population, so are people like me that just can't eat it. So we have to, we then there's what we do for the individual patient. So the individual patient, for me, for example, I can eat almost no processed vegetarian foods. I have to rely on legumes, lentils, black beans, white beans, various different kinds of beans, and root vegetables and other vegetables and nuts from my protein. So yeah, that's I hope that that helps with the question. There's a question of, you know, on a population level, yes, this will work. But for you individually, I mean, patients often are coming into me with pain syndromes, with irritable bowel, with heavy bleeding. So then we have to often look at, okay, well, this diet will likely be healthy for you. We may also need to do some lab testing and look at you specifically. So we may need to consider some supplementation for you.
SPEAKER_02You know, that's a that's a really good, that's a really good approach because especially uh in the day and age that we live, everybody likes to be so individualized. And I think everybody also assumes that, you know, that this diet very specifically works for my body, and this doesn't work for your body. But like you said, you you find what the most common thing is that works for everybody across the board, and then from there you can jump into the individualized things because yes, of course, there are people who have really specific instances of or immunocompromised conditions or whatever it is, and they might need to shift their diet for you. You have a soy allergy, so or uh intolerance sensitivity. So which I'm which I apologize for. But but lucky, but lucky, but lucky for you, there's plenty of of other beans and and legumes and things you can eat. But but yeah, that must be tough since there's so many processed uh vegan items, uh plant-based items that that contain soy. But yeah, I think that's a really good perspective and how you approach it is look, this is this generally works for everybody. This you know, there's plenty of data that shows that this is the way or this is the how you should be eating predominantly, and then we can go and get into the individual side of things instead of just being like everybody's different.
SPEAKER_00I think is, I mean, and one other thing that I want to say about that is that I think we also have to be a little bit careful that we don't, because that you know, there's certain kinds of laboratory investigations that have also become fashionable. So you have to be somewhat careful about well, I but can I do this test that will tell me what to eat? And the problem in in the functional integrative medicine space that we have, and the reason why I mostly use the basic laboratory testing is that there's quite a bit of sort of fancy designer testing that really doesn't have independent evidence that it leads to better clinical outcomes. So, and I think this has been a legitimate criticism of sort of the celebrity-driven kind of, you know, the goop style, oh, the the elite veganism. And this has been a criticism of the vegan movement that I think kind of hits home, is that only, you know, only it's people with with a lot of disposable income to buy these fancy foods. And it's one of the reasons why I am definitely not an ND who supports gluten-free diets for the vast majority of my patients, because I think that glutens are for most people are a healthy grain that should be able to be absorbed effectively. Even for a lot of people with even mild celiac, sometimes you can get them eating foods that are very, very low content of gluten occasionally, and they'll be okay once you address other issues with the diet. But it's really, I think it's, you know, these diets are diets that we've talked about of indigenous peoples across the world. You know, my own, I as I mentioned, my own son is his father is Peruvian, and and they were of, they were called miss, you know, they're they're misty, so their their background, which is of mixed indigenous Okechua-speaking people. And the people in the Peruvian highlands ate a diet with you know 3,000 different kinds of potatoes, many of which were very high in antioxidants. Um, they ate primarily a bean-based vegetarian diet. And yet, in the last two generations, like a lot of other areas of the world, including you know, my own family who are northern European, we all started eating a diet that was post-World War II that was higher and higher and higher in meat processed foods. And so both my my son's father's family and my own family were seeing increased increased rates of cancers. So, and cancers that didn't exist in our families four or five generations ago. So, this is all this is all new thing, you know, these are new problems.
SPEAKER_02So yeah, and and I think that's probably something that you've been really keen to realize over time, being that you have a background in in history, right? So yeah, you probably you probably keep an eye on those things.
SPEAKER_00Well, and definitely, you know, it's definitely something that we saw. I mean, I'm going back to my undergraduate days, which is 30 years now, um, I remember doing a course that had a tremendous effect on me on South American agricultural geography. And I remember doing a project, interestingly, on Peruvian agronomy and about what happened to the, you know, the Inca culture, the Quechu and Aimada speaking cultures, and their sustainable, these, I mean, if you go to Peru, you go to Machu Picchu up to Cusco and you see these terraced fields up in the mountains and the way that they were able to take a very chapter, these were, I mean, these are 10,000 feet and above cultures and people that look at very high altitude, and they were able to grow crops and sustain populations. And we look at these days, and a lot of these fields are abandoned, and people are eating processed rice and so forth. So, I mean, and that's that's been the influence. I mean, certainly we see this in Canada. I mean, the the uh post-World War II processed green revolution diet and what it's done to diabetes rates in North America, South America, Europe, South Asia now, and and East Asia, we're seeing it as well. So, I mean, these are these healthy diets for everybody.
SPEAKER_02So before we uh move on from the topic of women's health, I did want to ask you really quickly about what you can tell me about plant-based diets uh compared to you know other more traditional diets when it comes to pregnancy.
SPEAKER_00Absolutely. Sorry, my thinking has really evolved on that. I was taught when I when I trained a bastard in the early thousands that a completely plant-based diet and pregnancy is not healthy, that it was going to be missing essential nutrients, specifically arachidonic acid from animal protein for incorporation into growing fetal grains, and that this was simply, you know, this was not responsible, and that we should be staring our patients away from completely plant-based diets. Now, I think probably, I mean, we've been chatting for a while, so you know I'm I'm not a hard and fast rule about anything, but I have seen with my own eyes women do very well with completely plant-based diets and pregnancy. And one of the interesting things we've seen in data, and I think a lot of these studies have been done since the early 2000s, we're seeing, in fact, an explosion of studies in the last 10 years. We're seeing less rates of postpartum depression, we're seeing less rates of preterm birth, pre-clampsia, some of these uh definitely um pregnancy uh diabetes of pregnancy. And so those specific complications can come from that with eating higher fiber, again, diets that are predominantly fruits and vegetables that incorporate plant-based fibers. You know, there's really, I mean, when you think about it, I mean, most women, I mean, the biggest problem I see in practice with my pregnant patients, other than a certain amount of uncertainty about what should I be eating, because there's there's just so much nonsense information out there about what pregnant women can and can't be eating. I mean, other than most, I mean, all pregnant women should avoid alcohol. I think that's that's fairly well, I mean, that's quite well established. All pregnant women should avoid large fish like swordfish and shark because of the mercury and the other. So toxicants like heavy metals and things like that and dioxins get concentrated on the food chain. So that fish that eat other fish like alvo cartoona, swordfish shark, things like that are just not healthy. And certainly not raw fish and raw meat of any kind because of potential contamination with things like listeria, which is a known um can it can be known to cause fetal loss. We definitely, you know, we definitely want to avoid those sorts of things. And certainly on product, we do not want women drinking raw milk for the same reason, but it could be as exposed to lasteriosis. But in most women, I find the biggest concern they have is that they're they're having um nausea. It's about 50 to 75 percent of women have pregnancy. So the big concern is well, how do I eat anything and keep it down? So surprisingly, diets that are more based in fruits and vegetables are more digestible for a lot of women. So if they're not heavily spiced and and they're you know, eating, I I have I get a lot of my women in their first trimester eating a lot of mangoes and bananas and and apples if they can keep them down. But they find that they're able to, you know, just as long as they take the prenatal multi, these are this is established stuff. I mean, they're the association of folic acid supplementation with prevention of her tube defects and prevention of preterm birth, and and almost all prenatal multis now have iron and appropriate levels of other, you know, zinc and other nutrients for field development. So other than adding specifically an omega-3, which we can now get perfectly adequately in algae-based supplements, this is an argument I get into sometimes with my conventional colleagues. As I say, no, no, no, there's pre-born D DHA in fish all supplements. I say, well, fish, you know, we know our fish stocks are increasingly unsustainable. We know that they're increasingly fish are being contamined with mercury. So yeah, okay, we might think that the mercury's been processed out of this fish oil supplement. But if the fish are eating the algae, which is where they're getting the omega-3s from initially, well, why don't we just have patients eat lower down the food chain? Because A, it's more sustainable, and B, you're getting the same preformed DHA. And I mean, there's questions about enzymes and can you convert it, but I think that the the interventional studies are showing us that these algae-based omega-3 supplements are giving appropriate levels of omega-3 fatty acids for fetal brain development. And this is and the kids and the kids are doing fine.
SPEAKER_02That that last uh point you made about the DHA, that you know, that is something that um that I learned more recently, just in the last couple of years, that it that uh, you know, like you said, there's always the argument where, oh, well, you know, fish have the preformed DHA and and it's that you know, that's why there's some flaw and then a plant-based diet. And it wasn't until like a couple of years ago that I learned that fish don't make DHA, they just consume it from algae. So and it just blew my mind. It's like, well, wait, wait a minute. So if you can get it from the algae-based supplement, which is grown differently from like a fish farm or something, or an actual wild-cut fish, and then the fish are eating they're you know, they're eating other fish or they're eating algae, and then there's the threat of heavy metals and other things. I don't know.
SPEAKER_00Antibiotics and farmed fish. I mean, I mean, for most of my career, when I was talking to women about fish intake, I'd say don't eat farmed fish. And coming from British Columbia, we know about all sorts of problems with the farm fish industry on Vancouver Island, um, which is where I was practicing for quite a few years. But um, you know, at the end of the day, I mean, I'm certainly not going to tell a pregnant woman, like I I mean, this is again, you have to meet the patient where they're at. I think predominantly, and this is what I like about sort of the whole food plant-based movement, is that predominantly patients will benefit if they increase the fruits and vegetables, increase the legumes, increase the nuts in their diet. Now, whether they decide for ethical reasons that they want to be fully vegan or partially vegan, what we call flexitarian, really that's down to them. And I'm not going to preach at them because that's not really my role as a primary care clinician, is to I I want to support my patient to make their own informed health choices.
SPEAKER_02Right. And getting and getting more fruits, vegetables, and legumes on the plate versus not doing it at all is a is a massive makes a massive difference.
SPEAKER_00So exactly. I mean, you think about, you know, classically, pregnant women have been told if they have um there's a condition called hyperbosynchrobiderm, which is morning sickness multiplied by a factor of 10. And it's just these women really suffer. They can't hardly keep anything down, and they're told to offer crackers all day. Well, there's not most processed crackers hardly have any nutrients in them at all. But a lot of I find a lot of my my women can eat things like bananas and brown rice and mangoes, and they do just fine. And there's an enormous amount more nutrients in those food, and they're more pleasant than eating saltines all day, which is actually what I did when I was pregnant with my son. So for whatever it's worth, it's actually a more pleasant way to eat.
SPEAKER_02I want to talk about misinformation, and we've mentioned it a couple times already. But um uh so you know, we've seen a lot of you mentioned goop already, Gwyneth Paltrow's lifestyle uh website that she runs. We've seen a lot of, you know, influencers like her, and even in the plant-based side of things, we see a lot of misinformation. Health gurus, quote unquote health gurus who promote a certain type of eating or lifestyle, who don't necessarily have a background in the things that they talk about half the time, but but these these are the things rather than academic journals, these are the things that are really, you know, making headlines or making news stories. Um, and a lot of people jump onto those bandwagons. So, including even in the, like I said, the plant-based space. So I'd why do you think it is that the health and wellness space is such a breeding ground for misinformation?
SPEAKER_00Well, I think there's, I mean, I you know, I try not to, I try to uh steer patients in the direction of understanding that celebrities and Instagram posts have kind of um dumbed down our conversation of what constitutes good, healthy, promoting, you know, eating with for longevity. I think one of the things that um originally when I was a Mediterranean diet proponent that I thought was was exciting about a lot of the studies that I saw coming out in those years was they were promoting a way of eating from what they called the the blue zones area of the world. And you know, being a being a colonial historian, especially an anti-colonialist, what I was excited about about all about a lot of the blue zones literature was it was parts of the world where people were eating very traditional cost-effective diets. What I'm concerned about with a lot of the new celebrity-driven plant-based community is it's about it's about um being plant-based as a somewhat a virtue signaling, as you know, I am a better person, my hair is better, my nails are better, my skin is better. And I and there's nothing wrong with wanting these things. There's nothing wrong with wanting to maintain a healthy weight throughout your life. But I think that the celebrity-driven industry that tells women specifically, as I said when we were chatting beforehand, that that women should be um extremely slender throughout their lives until they, you know, basically pretty much until you die now. The idea is that you can't let yourself go in your 50. I mean, I I hear this, I mean, these sad. Han-ring stories from women in their 60s and 70s saying that they have been calorie restricting themselves for 20, 30, 40, 50 years and not enjoying their food. I mean, it's just it's heartbreaking a lot of this stuff. So I think that this culture of, well, I eat this and I look this way because I eat this is not a diet. I mean, when you think about these areas in Ikaria and Greece, for example, and that was one of the blue zones of the Costa Rican coast and the mountain hilltops of Sardinia. I mean, people people weren't getting on their Palatin bike every day and eating their powdered, uh, gluten-free, you know, plant-based protein shake. They were eating minestrone, they were eating traditional pasta-based soups, they were eating, you know, fresh tomatoes that they grew themselves, they were eating beans that they grew themselves. I mean, this this is a diet that is accessible to people in high-income communities, in low-income communities, and communities that that don't have access to these new designer, you know, you go into these new designer supermarkets like Whole Foods, for example, with the, you know, with produce that you can get anywhere for quite a bit less money. And it's it is, I find that concerning that the idea is that you can only eat this way, that it's really too expensive to eat this way. No, no, actually, this this um these diets that people have been eating for thousands of years and are often traditional diets the world over, are diets that can and should be accessible to everyone.
SPEAKER_02And you you also mentioned off the top of your answer there, that the dumbing down of nuanced or complicated ideas. And I think the platforms, when we think of the platforms that are used now, which are generally platforms that are used to scroll through or watch something for 30 seconds, like a TikTok. And you and I, I asked you a question about fish oil and DHA. And I think just that answer, we talked for five minutes about it. And yet we have some really complicated, nuanced conversations or sorry, ideas about lifestyle or or eating, a way of eating, and it's dumbed down to like a quick Instagram post or uh, you know, three bullet points, key points or whatever, and or a 30-second TikTok. And it doesn't really lend itself. That's not health advice.
SPEAKER_00That's you know, so and you know, I have two thoughts here. One of them is, you know, this has been a struggle for me in terms of knowledge translation and science translation. And I know we have uh we had an excellent article in a most recent um edition of CNEJ about knowledge translation in the Naturopathic profession. And we're as susceptible to to trends within um within our continuing education and where people are where clinicians are getting our information as everybody else. And a lot of we have to watch out for a lot of industry-sponsored information that's you know, necessarily the best science and the best evidence. Um so yeah, I I have, you know, my my it when on my own website, people have been constantly telling me about my blog posts that you know, you need to make them shorter, you need to do the five points, and and I have gently pushed back for 15 years now. Um, I do think that it behooves scientists and people like myself that come from, you know, a background of understanding how to speak with precision and nuance, to learn how to speak in this new environment. I think that, you know, old, as I say, old dogs can learn new tricks. And I mean, I've I've been, it's it's been 30 years since I've been in graduate school and and learned how to assess, you know, critically think, assess resources with care and with precision. And learning how to negotiate in the new media-driven environment has been a learning curve for me. And I know that many of my quite a quite substantially younger colleagues have had an easier, had an easier time of it than I have. But I think that it it behooves those of us that are, you know, that are trained in these areas. I mean, as like a lot of the practitioners in the Plant-Base Canada, the Plant-Based Canada group, and definitely, you know, shout out to Zara Kassan for founding this group and being our fearless leader and and um keeping the website and the groups and and um the podcasts and you know and and the blog posts going. Um we we can learn how to knowledge translate in a way that fits into this new media environment. On the other hand, I am concerned about how the social media algorithms have sort of driven, driven even posts on social media platforms like Facebook and Instagram have become more and more video-based, less and less informational. And I think that you know, this the way that people are now self-selecting for things that they already agree with is a concerning trend. Now, I mean, and this is something I explained to my junior colleagues, is that one of the great, one of the great advantages to being an anthropathic doctor is that I have in some ways, you know, I hear this criticism from my conventional primary care colleagues that we have a luxury of speaking to patients for half an hour or an hour. But I think it's also a privilege that we're given to be able to have more personal, more fulsome conversations with our patients and a responsibility to do them well informed with best evidence. Now that can translate into this new social media-driven environment, but you know, I think it there's a tension there between as a naturopathic doctor, I want to be able to relate to my patients in a in a personal way that respects their humanity and respects the whole of their picture. Now, um, how I get that message across in the new TikTok environment, it's still, I think it's still a work in progress. And I'm very glad that for the journal, we have a social media expert who does this for us. That's a really editor.
SPEAKER_02That's a you make a really, really, really good point when you when you mention earlier that you know you have you have younger colleagues who can more easily pick up on some of this, some of these trends or these social media platforms or whatever. But before I let you go, that's one of the final questions I want to ask you is there are people who are not well versed in social media or even the internet for that matter. There are people who are not digital natives who didn't grow up with the internet, have trouble determining, differentiating what is true and what's not true, not just about health, but just in general, news, like false news or disinformation or misinformation online. What is some advice that you might have for someone who uh, you know, a grandparent perhaps, or somebody who, you know, you know, is not exposed to the internet as much when it comes to parsing through and navigating what's real and what's not on the internet.
SPEAKER_00Oh my yeah, where do you start? I think what I tell patients when they come in to see me, I mean, I do see a lot of I am because I work with female um gynecologic and pelvic pain syndromes increasingly with with pelvic pain syndromes, because they're just not that they're not being treated well. There's not a lot of attention being given them by conventional uh conventional research. And they come in and they're told, for example, patients with endometriosis being told that a ketogenic diet will be helpful for them when it's actually the opposite that a diet high in animal proteins, when we know what these autoimmune conditions are actually um harm a lot of, and and we're thinking of conditions again, endometriosis is sort of the classic one because we're looking at it more from an autoimmune side. Um, I think that what I tell patients is that there's certain, there's certain websites. I mean, I try to guide them to, well, this is, I mean, I tell the myoclinic, for example, very um, it's absolutely good evidence-based research. Um, CIHR funded research, so research from the University of Toronto. If they're looking for plant-based research, you cannot absolutely steer them to the work being done by the Jenkins Lab. I mean, top shelf stuff being published in very high impact, well-respected journals. I mean, you know, David Jenkins is an inspiration to us all for this generation of plant-based clinicians. I mean, what can he say about what he hasn't done in his career? And um, and he has fostered a lot of uh careers of younger clinicians and researchers like Lord Chiavoli, who's doing very good, important work in that lab there at UT. You know, Harvard Chan, I mean Walter Willett again, what can he say about that? He's you know, founding nutritional epidemiology, being involved in the Eat Lancet report, talking about how we need to adopt more, you know, the confluence of plant-based diets and environmental sustainability and greenhouse gas emissions, and talking about how the 2050, I mean, very, very compelling information saying that we need to move in this direction. So I try to sort of gently educate my patients and give them an idea of where to start because I think it can get overwhelming. And especially if you let people, you know, you you start following people on social media. I as you can tell, I have a you know, a very ambivalent attitude towards Instagram and Twitter, even though I'm I'm very busy on both platforms. I think that it's important to still look at websites, to still read books and to get offline and to to work with people that you um you form relationships with. I think if there's anything we've learned from the pandemic, and this is something I said in in the most recent editorial, which I from C Andy J, which I sent you, is that the the pandemic itself has been a collective trauma and shock to our collective immunity. And if we are to build community resilience and build our collective immunity, that these one-on-one, face-to-face, eye-to-eye relationships are things that we need to prioritize. And we have to treat social media a little bit like processed food. You know, it's um it's very enticing, and you know, it looks very, I mean, it looks like, oh, well, you know, this, I mean, and I do follow uh some of the plant-based talks. I mean, the Alan Desman is work on the UK, absolutely. I mean, great evidence-based stuff. But um, I think we have to, you know, we have to treat it with a certain amount of care.
SPEAKER_02I really appreciate your answer there. I, Marianne, it's been great talking to you. Thank you so much for your time. Thank you for coming on the Plant-Based Canada podcast. I really appreciate the nuance that you take with your approach to everything, and thank you so much for what you're doing with Can DJ. It's great talking to you. Hopefully, we'll talk to you again down the road.
SPEAKER_00Absolutely. Thanks, Matt.
SPEAKER_02This podcast featured royalty-free music from BenSound.com. A very special thanks to our guests for speaking with us and sharing their insights, and of course, thank you for listening. The Plant Based Canada Podcast is an initiative of the group Plant Based Canada, which aims to educate the public and health professionals on the evidence-based benefits of plant-based whole food nutrition for individual and planetary health. To learn more about the show, visit our website www.plantbased canada.org, and stay up to date by following us on Instagram and Facebook at Plantbased Canada org and our Plant Based Canada YouTube channel. Also, don't forget to subscribe on iTunes, Spotify, or wherever you download your podcasts.