In this week's live Q&A, Dr. Marbas and Dr. Miller welcome Dr. Michael Klaper to the PlantBasedTeleHealth Team.
Dr. Michael Klaper is a gifted clinician, internationally-recognized teacher, and sought-after speaker on diet and health. In addition to his clinical practice and private consultations with patients, he is a passionate and devoted educator of physicians and other healthcare professionals about the importance of nutrition in clinical practice and integrative medicine.
Dr. Klaper is the author of Vegan Nutrition; Pure & Simple (no longer in print) and has produced numerous health videos, webinars and dozens of articles for both scientific journals and the popular press. As a source of inspiration advocating plant-based diets and the end of animal cruelty worldwide, Dr. Klaper contributed to the making of two PBS television programs, Food for Thought and the award-winning movie, Diet for a New America (based on the book of the same name). Dr. Klaper teaches that “Health Comes From Healthy Living” and he is dedicated to the healing and flourishing of all living beings and our planet.
“Health is having a body that moves without pain, breathes without distress and allows us to perform the activities of life with complete presence and focused energy. Then, we can love fully and enjoy our lives to the fullest.” – Dr. Klaper
Questions Answered
- (01:09) – Why Dr. Klaper joined Plant Based TeleHealth
- (03:10) – Why does Dr. Klaper continue to see and treat patients directly?
- (03:47) – What is the best treatment for osteoporosis?
- (12:09) – Can we get enough nutrients from a grain-free WFPB diet?
- (17:31) – Recommendations for someone who has had their gallbladder removed?
- (20:48) – What are the benefits and risks of using pure unrefined coconut oil?
- (25:48) – How long does it take to repopulate your gut microbiome?
- (29:36) – What are some proper uses of antibiotics?
- (31:06) – What about cholesterol, Statins, and olive oil?
- (40:09) – How much fiber should we eat in a day?
- (41:53) – What is the best diet to help alleviate rheumatoid arthritis?
- (47:02) – What to do about constipation on a WFPB diet?
- (51:34) – Is oatmeal ok for diabetics?
- (52:51) – What are the pros and cons of juicing?
Complete Transcript
Narrator
(00:06)
We're making plant based lifestyle medicine available to everyone who desires it. With Telemedicine, we are removing barriers that prevent many people from accessing this type of care. Lifestyle medicine promotes healthy behaviors and, when adopted, individuals can expect improvement and in many cases, reversal of chronic disease.
Dr. Laurie Marbas
(00:28)
All right. And Dr. Klaper is with us, so welcome Dr. Klaper.
Dr. Michael Klaper
(00:32)
Thank you. It's good to be with everyone. To be referred to a special guest, actually I'm not a guest, I'm part of the team now.
Dr. Chris Miller
(00:41)
Absolutely.
Dr. Michael Klaper
(00:41)
Good to be here with everyone, absolutely.
Dr. Laurie Marbas
(00:46)
We are so thrilled and honored to have you one, working with us, but to join us it's going to be amazing. So, we're going to leave it opened up to some questions here and I think Chris had a great idea, would like to just describe to us Dr. Klaper, why you chose to join Plant Based Telehealth? And how do you feel like it's going and what you're excited about?
Dr. Michael Klaper
(01:09)
Oh my. Well here we are in June of 2020, and a whole group of forces has converted. I've been doing more and more telemedicine consultations for my own website and I've been doing a lot of teaching at the medical schools. Since the COVID pandemic has certainly limited air travel, more of my efforts are winding up online here. Telemedicine really came into its own due to the COVID virus. It's much more acceptable now. But of course, given my vegan heritage and all of yours, it's one thing to do telemedicine, but to do plant based telemedicine, well that's the crème de la crème there. It just all fit together. You guys exist and you have the vision to do plant based telemedicine. It just was a natural fit.
Dr. Michael Klaper
(02:18)
This is plant based medicine done right. [inaudible 00:02:22] nutritionally with the documented consultations and practice insurance and all those things that real doctors do. So, it's really first class professional operation. I'm really looking forward to the collaboration.
Dr. Chris Miller
(02:40)
Dr. Klaper one of the things that Laurie and I were talking about that I want to share with everybody joining us today is that, you have so much going on. You've been doing this for so many years and you have so many projects right now, right. Working with the medical students and changing the future of medicine and you have these big things you're doing, so many things, but you choose to still see patients one on one and working with people and that's what we think is so admirable and so amazing, and why so many people are loving you and wanting to join and work with you.
Dr. Michael Klaper
(03:10)
I'm a primary care doctor in my bones. Just working through this high tech medium here. It's still a matter of helping people and making their lives better. So it's a great validation of some very positive forces in these increasingly chaotic lives we're living here. This is a way to deliver directed and loving and wise care in a way that many people can have access to. It's just a great fit. I'm really enjoying the rightness of it.
Dr. Chris Miller
(03:46)
That's awesome.
Dr. Laurie Marbas
(03:47)
Fantastic. We do have one question Dr. Klaper. Someone mentions that you had mentioned in the past that Fosamax was not necessarily the best treatment for osteoporosis. She did ask about Prolia, or maybe you have some other suggestions regarding osteoporosis, or your thoughts on that?
Dr. Michael Klaper
(04:06)
Oh my. Well, if people are interested they can go to my website, drklaper.com and they'll find a webinar I did, called Healthy Bones. I go into the whole mechanism behind osteoporosis. But basically, my problem with Fosamax and I believe that Prolia is basically a long acting injectable Fosamax, I don't think they have that much of a different mechanism. [inaudible 00:04:38] little time to talk here. In our bones, our bones are alive. People think they're these dead rods of chalky calcium, but they're really very metabolically active, and there's two kinds of cells. There's osteoblasts that lay down new bone and osteoclast that break down old bone. Why would you want osteoclast? Break down bone.
Dr. Michael Klaper
(05:00)
Because life is a contact sport and every time we bang our elbow on the desk or hit our shin on a coffee table, micro cracks can appear in the bone and the body is very wise. It knows that just like a crack in your car windshield, if you don't fix it, it's going to extend. So the body marshalls the demolition crew, the osteoclast cells to come in and dissolve the old bone and then they get out of the way and the osteoblast come in and make new bones. So wonderful, magical process called remodeling. Well, people are finding their bone density is going down and the belief is that it's a calcium deficiency, which it isn't. What's really happening is that what makes the osteoblasts lay down new bone, it's using the bones. It's carrying objects against gravity. Every time you take some steps with a load of firewood on your shoulder, or carry a heavy tool or all the physical things we used to do, little mechanical stresses go down the bone, they generate electrical forces that stimulate the osteoblasts to lay down new bone.
Dr. Michael Klaper
(06:14)
It's like new muscle. You use them and they get bigger. If you don't use them, they atrophy. They get smaller. The same thing happens with the bone. We used to be, as I said, very active. We spent all day gathering firewood or working with tools, putting shingles on the roof. We were physically active and our bones stayed strong throughout our physically active lives. But in this 21st Century, we've become sedentary. We sit all day. We sit and we eat. We travel to work. We sit, sit, sit and our bones our dissolving. The osteoporosis is largely diffuse atrophy of the bones and just taking calcium pills is not going to reverse the problem. The bones are dissolving. It's like your muscles are getting weaker from not using them, eating a big steak a cow's muscle is not suddenly going to make your biceps bigger, it doesn't work like that.
Dr. Michael Klaper
(07:08)
You've got to use your bones. So the best way to build your bone strength is through a weighted vest, start taking walks with some hand weights, and do those repetitive low grade stresses on the bones that make the osteoblasts build up new bone. So where does all this leave the Fosamax question? The idea behind Fosamax, these kind of drugs, is that they basically poison the osteoclasts. They do that. They make osteoclasts undergo apoptosis and die. Not all of them. It doesn't wipe out all your osteoclasts, but it really stops them from working very well. Why would you do that? The idea is that if the osteoclasts break down all the bone, if you can paralyze them, you'll give the osteoblasts a head start and they'll start building up new bone. Sure enough the bone scans get denser. It seems to work.
Dr. Michael Klaper
(08:06)
The problem is, the reason why I don't like these drugs is that those little micro cracks, they're still there. They're not getting repaired. It's like if you've got an old house, with rotten timbers, you can put a new layer of plaster over them, looks good, but the timbers are still rotten. The same thing, the bones are weakening because you're not using them and they're undergoing atrophy. Well let's poison the osteoclasts, that'll help. No it doesn't. It does not make your bones stronger. The only way to get the bones stronger, is to use them. I think these drugs are, a physiologic parlor trick. The bones look better on Dexascan, your numbers look better, but the bones aren't stronger and if you fall, they still shatter.
Dr. Michael Klaper
(08:55)
So it's, I think, a marketing leap to fool the public. Your Dexascan's better, but the bones aren't getting stronger. I think Prolia is a once a year, twice a year injection, that basically does the same thing. It just stuns your osteoclasts, not fixing the problem. You want to get your bones stronger, use them. Take a walk every day. Never miss a chance to carry packages. Never miss a chance to walk up steps. But again, you get a little six or eight pound weighted vest, grab a couple of hand weights, take a 40 minute walk with that every other day and those bones will get stronger for the right reason. Along with good plant based nutrition. Long answer, but I'm not a big fan of Prolia. It doesn't solve the problem.
Dr. Laurie Marbas
(09:49)
I think that's great. You're speaking to the bones being healthier just from how they would normally be healthy. What if someone already has osteoporosis and they're at a higher fracture risk, or maybe they have balance issues, do you have anyone for someone like that? These are our elder population. Any suggestions there? Maybe someone who can't walk around with the weighted vest or something else?
Dr. Michael Klaper
(10:15)
Well, there's a lot. Anything that stresses the bones, lets the bones know you still love them will work. Remember those osteoblasts are still in the bones, they're still there, they're just waiting for you to ask them to do something like lay down new bone. So anything, get out of that chair. It's really important, but anything that stresses the bone. These elastic stretch bands, they'll work. There are yoga poses that you can get into. If you Goggle yoga for osteoporosis, you'll see books by Dr. Krishna on that subject. As I said these elastic stretch bands, anything that stresses the bone so they'll get stronger.
Dr. Michael Klaper
(10:56)
But again, these weighted vests, you buy them and the better ones, they're just a vest with a bunch of empty pockets on them, they don't weigh anything, but the come with a box of little sandbag weights, one pound each and you just pop in one pound or two pounds and just go out for a walk with that. Just wear that for a month or two until you feel stronger and then put another two pounds. Slowly, slowly build up to six or eight pounds. You don't need 30 pounds of weight on you. It's the repetition. There's 1000 steps in a mile. So you walk a mile in one of these vests 1000 times that weight has gone down your spine, down your hips and down your leg bones and it has an effect as the weeks go by. Just wear it to go to the post office, vacuum the house. Wear it with these light weights and the repetition really works magic there.
Dr. Laurie Marbas
(11:55)
Perfect.
Dr. Michael Klaper
(11:56)
But anything that stresses the bones will work.
Dr. Laurie Marbas
(11:58)
Awesome. We get a lot of questions on osteoporosis so that was really helpful, so thank you.
Dr. Chris Miller
(12:03)
That was a great description, thank you for explaining that. About the bone remodeling.
Dr. Laurie Marbas
(12:09)
Absolutely. It's just the house builders and the house demolition, both needed. There's another question, either one of you guys want to answer, because I know Chris you have a lot of experience with nutritarian diet, but someone's asking, can you get enough nutrients using a whole food plant based nutritarian diet without, I'm thinking this is, some Omega-3 supplements, but no grains. If either of you want to highlight what vitamins or minerals are in grains that maybe they want to be concerned about if they're cutting out all grains.
Dr. Michael Klaper
(12:41)
Dr. Miller.
Dr. Chris Miller
(12:44)
That's a good question actually because when you go whole food plant based, you learn about the different food groups which include vegetables, fruits, whole grains and a healthy protein like a legume, maybe nut or seed or a form of soy product. So we learn about these four food groups so if you cut out one of the food groups, what are you going to be missing out on? But the truth is, that the whole grains, the nutrients from whole grains, while they have been proven to be beneficial, we can get those nutrients from other foods actually. So studies are showing now that people who eat whole grains actually have less heart attacks, less strokes and do well long term, but some people don't tolerate grains. So we do take it out of some people's diets, especially people with autoimmune disease, who have inflammatory bowel issues. The grain itself, even if it's not gluten grain, it can irritate an already irritated gut. So for people like that, we do take the grains out.
Dr. Chris Miller
(13:39)
Grains are actually really high in several different things. They're high in amino acids, but we know we can get that from other foods, including legumes, green leafy vegetables, nuts and seeds. They're very high in many different minerals, which are a little bit harder to obtain sometimes. So things like Zinc and magnesium, cooper, but you can also get that from an otherwise well balanced plant based diet. You can get that from eating beans. You can get that from eating plenty of leafy green vegetables. The B vitamins are high in grains and they're also high in your leafy green vegetables. The minerals are going to be high in nuts and seeds and a broad array of legumes as well. Making sure that you're eating diversity in your nuts and seeds, your legumes, your green leafy vegetables. Plenty of that. Colorful fruits and vegetables. You can get enough of that.
Dr. Chris Miller
(14:30)
But I do also recommend, if someone is avoiding something, a whole group like that of the plant based groups, to look into a multi-vitamin that might make sure that you're getting enough of your minerals. Things like selenium and zinc, magnesium. Those are the ones I start to get worried about. That are a little bit trickier to make sure you're getting enough of and absorbing enough of.
Dr. Laurie Marbas
(14:51)
Fantastic, [cross talk 00:14:54].
Dr. Chris Miller
(14:54)
If you want us to look at your diet and make sure you're getting enough of everything, I have people keeping a very detailed food journal. So I can look at exactly what they're eating and make sure they're getting enough. That we're not missing anything. Part of being healthy isn't just cutting out animal products, cutting out processed foods. It's getting enough of all the nutrients. So we have to make sure we're not deficient in anything. If you have any questions with that, we can always help with that.
Dr. Michael Klaper
(15:21)
I think it was very well answered. There's little to add there. Just want to point out that when people, in the classic sense, people talk about grains, in a classic botanical sense. You're talking about members of the grass family and if you look at oats and wheat and corn, they're really official members of the grass family. Many of them have gluten and other components that people don't like to eat, fair enough.
Dr. Michael Klaper
(15:49)
However, in our broad brush labeling of things we often group into those, the grain rubric there plants that are not true grains at all. Quinoa really is a fruit. It's a green leafy plant. These are the tiny, they're seeds I guess, of the quinoa plant. Buckwheat is not a grain and millet is not a grain, truly. It's not a member of the grass family. So, before you take out, “Oh I can't eat grains”, you may find that there's just a small amount of buckwheat or quinoa added to a soup, “Gee, I'm able to enjoy that”. Slowly build up and find yourself, you can tolerate these non-glutinous grains Dr. Miller talked about. They're often very helpful and very nourishing.
Dr. Chris Miller
(16:40)
I can add one point about that. Thank you Dr. Klaper, that's a great point. For people that aren't tolerating a lot of them at the beginning, we take them out initially. But that's not the whole plan. A healing long term plan is about having a very diverse micro-biome. So we need different forms of fiber. Whole grains are such a good, and the non actual grains as Dr. Klaper just pointed out, are such good sources of fiber, that we do want to bring them in ultimately because healthy people have a diverse microbiome. My goal when I'm working with autoimmune people, and it was my goal for myself as well, was it had to be eliminated initially because they seemed to irritate me, but as soon as we improve, we bring them back in. Even in small amounts, find out which ones you do tolerate and re-populate your microbiome.
Dr. Laurie Marbas
(17:31)
Perfect. I think those are excellent, excellent answers. We do have another question. Kathy said she “lost” my gallbladder surgically about 10 years ago, I've been whole food plant based for about a year. I'd like to know if there are any specific suggestions diet wise for this situation. Either one of you?
Dr. Chris Miller
(17:49)
Do you want to take something Laurie?
Dr. Laurie Marbas
(17:51)
Sure. I'm just trying to keep track, there's multiple questions here. I feel like [inaudible 00:17:58]. So basically yeah, absolutely. The gallbladder just helps you absorb certain vitamins. I would say you just definitely want to make sure you're keeping track of vitamin D, some of these more fat soluble vitamins. If you're having diarrhea, you want to cut back on some of the fat if your diet. It depends on what you mean by whole food plant based diet. Some will include more nuts, some don't. As far as optimization of your, anything fat soluble, that would be my concern. But Dr. Klaper, Chris go ahead. I'm just trying to organize these questions here.
Dr. Michael Klaper
(18:32)
Well, I find most people do very well without a gallbladder actually. The gallbladder, it's a little sac that hangs under the liver and it stores up bile in between meals. Then when you eat a fatty meal, the gallbladder squeezes and a squirt of bile goes down the duct into the intestine. Help you absorb your fats. If the gallbladder gets really diseased and generating stones and infections, it's best to be taken out of there. Then the liver keeps producing bile. It just goes right down the duct. There's a steady little drip, drip of bile into the intestine. It's not a problem for most folks, it just gets absorbed into the blood stream. Goes back up to the liver, re-secreted down and the bile goes around and around from the bowel to the liver and back down to the intestine again. Most folks really don't have much problem, but some do.
Dr. Michael Klaper
(19:30)
Some find the steady drip, drip of bile can as Dr. Marbas said, can create some loose stools. If that's the case, you want to make sure that you got some good soluble fiber in your meals to make for nice formed stools. Whole grain, legumes, lots of salads and fruits. As Dr. Marbas said, if you lost that ability to get that squirt of bile if you don't have a gallbladder, you don't want to be eating huge amounts of fatty food. You don't want to be putting lots of olive oil on your salad and egg yolks and avocados and nut butters. Don't [inaudible 00:20:18] you'll overwhelm your bile's ability to deal with all that fat.
Dr. Michael Klaper
(20:26)
Be judicious with the fats. Avocados are wonderful, but again, I would have some rice or something with it to make for more solid stool there. Avoid the huge amounts of high fat foods. Other than that, most people really, they get along quite well without a gallbladder.
Dr. Laurie Marbas
(20:42)
Yeah, absolutely. Most people do very well without it. Chris, did you have anything else to add there?
Dr. Chris Miller
(20:47)
That was great. I agree.
Dr. Laurie Marbas
(20:48)
Okay. So we have a few, I'm trying to go back and forth, make sure, we're getting three different sections here. This is actually a very interesting one. What are your thoughts on health benefits, dangers of unrefined, virgin coconut oil? I tend to be a fan of no oils at all. Coconut oil has high saturated fats, but I'll let you guys go ahead and express your answers.
Dr. Chris Miller
(21:11)
I'll just say real quick, my feeling on it. I'm not a fan of coconut oil in general. Although, before I say that I will say I put it on my skin and I love it. So, it's actually really helped my skin. Some of the wrinkles going away. I'm a fan of it for that and it smells really good. But as far as eating it, there's so much data now on saturated fat and coconut oil still is made up of a large amount of saturated fat. So it may have some of these medium chain triglycerides, which have been proven to be beneficial for the brain, but there's too much of the saturated fat that I'm not a fan of.
Dr. Chris Miller
(21:46)
I'm not a fan of it for autoimmune. I'm not a fan of it for the studies on Alzheimer's disease showing that people who ate more saturated fat, more Alzheimer's. Heart disease, we know that it's a risk factor for those. Some people, when they eat more of the saturated fat, their cholesterol shoots way up. It seems so dangerous to me. Unless you're using it for your skin or maybe your hair, I'm not really a fan of it. That's my take.
Dr. Michael Klaper
(22:11)
Beautifully answered. That's exactly my take as well. You're asking the wrong guy if you're talking about swallowing coconut oil. I'm not a big fan of oils for many reasons as Dr. Miller just mentioned. Saturated fats are pro-inflammatory. They certainly raise cholesterol. No other animal crushes the fat out of its food and pours liquid fat on its food. But, if you want to eat a piece of coconut, that's fine, but the coconut oil itself. I haven't used any oil on my food now for a couple of years and your tastes really change. When we want to do a stir fry, we have vegetable broth in the fridge, or my wife makes up a vegetable soup, a couple tablespoons of the vegetable soup broth and put that in the skillet, or just chop up an onion and start stir frying it, it's get all wet and juicy. That's what we stir fry our veggies in. Not only do they come out tasting great, but if you then wind up eating vegetables that have been sauteed in oil, I can't eat them. When we're at a restaurant, when we used to go to restaurants a few months ago.
Dr. Michael Klaper
(23:24)
I remember, the main dish came, sauteed vegetables, but we didn't realize they were sauteed in oil and we couldn't eat them. They were just dripping in oil. It was so unappetizing. Once you stop using the stuff. What do you use it for? You saute your veggies, which I said, anything veggie will work. And you make salad dressing with oils. You could certainly make salad dressings without olive oil or any oil, coconut oil. Throw some veggies in a blender with some walnuts and a piece of an orange and give the button, salad dressing. You don't really need to use liquid oils at all. And coconut oil, as Dr. Miller said, is really loaded with saturated fats. If you want to get some medium chain triglycerides there's safer ways to get it than out of any vegetable oil, but especially coconut oil, I think.
Dr. Chris Miller
(24:21)
I've noticed something about that also, and probably you guys have as well. But, patients who take out the oil completely tend to heal faster when we're reversing chronic illness. Sometimes when it's healing, it's going slowly and we really tease out what people are eating. If they're still eating oil it seems to halt that. I don't know if you guys notice the same thing.
Dr. Michael Klaper
(24:42)
I agree.
Dr. Laurie Marbas
(24:43)
Go ahead Dr. Klaper.
Dr. Michael Klaper
(24:44)
I was going to say, and I agree with your good use of coconut oil is to use it topically. I use it on my scalp and it makes my hair grow luxuriously. So I'm a big fan of topical coconut oil for that.
Dr. Laurie Marbas
(24:59)
Not only brilliant, but a great sense of humor, Dr. Klaper. I just wanted to point out too that I love the point that you made that you're literally pouring liquid fat on foods. An oil is not a whole food guys. So this is a very simple thing. You want to do a whole food plant based diet, not extract all the fat, 100% fat and drop it on your food. But also, with my diabetics if they go out to eat, they eat an oily meal, their blood sugars are really messed up for at least two to three days. So, you really have to think about that. There are so many pre-diabetics and diabetics walking around. Oil as we all agree, you don't need it. Other than unless you want to make your hair grow luxurious.
Dr. Michael Klaper
(25:41)
Absolutely. I'm writing a book on it. It's a very thin book.
Dr. Laurie Marbas
(25:48)
From now on, anyone that asks me, “What about hair growth?” I'm going to say, “Well, you can refer to Dr. Klaper's coconut oil.” Fantastic. We've got a bunch of other questions. I think this is a really good one here, how long does it take to repopulate your gut biome after taking antibiotics if eating a whole food plant based diet?
Dr. Chris Miller
(26:07)
That is a good one.
Dr. Michael Klaper
(26:07)
Oh my, Dr. Miller?
Dr. Chris Miller
(26:07)
I don't know that I know exactly, but this is what I'm going to say. We know a study when patients were given ciprofloxacin just a short course of cipro, and cipro is a relatively narrower antibiotic, it's quinoline antibiotic, it's not one of the broad spectrums that we use in the hospital sometimes. So patient took a short course of cipro for something like a UTI. Three days. And they studied their microbiome. They monitored it and they found that for three years it took for them to fully start to repopulate. Some patients never completely regained the exact same distribution that they had. So, a long time is my answer. Based on that. But the answer isn't always in probiotics. The answer is definitely in pre-biotic foods. So eating the fiber rich food to repopulate it as aggressively as you can, and the diversity of fiber rich food.
Dr. Chris Miller
(27:02)
That comes back to what we were talking about before, getting the legumes, the different types of legumes. Getting the whole grains or the pseudo grains or the different types of food that are going to broaden. The different vegetables, the different fruits and repopulating it. That's my answer based on that one study that I know of.
Dr. Michael Klaper
(27:21)
I think that's well answered. I too have heard those same studies. I've heard several gastroenterologists say once you take these potent antibiotics, it really puts a dent in your flora that lasts a long time, if ever. That certainly chastened me as far as, I wasn't a big antibiotic [inaudible 00:27:44] to begin with, but it certainly makes you think two, three, four times, doctor what are you doing? As you pull out your prescription pad. Now, god bless antibiotics, I'm was for that if there's a rip-roaring infection. Someone's got a pneumonia or a bad urinary tract infection, absolutely. The antibiotics are definitely needed. But we can't pretend, you can't do one thing in the body. Everything has a cascade of effects that come from that.
Dr. Michael Klaper
(28:14)
So, but when hear you this, “It takes three years before”, yes microbiologists could dissect out the changes that have happened. Is it that serious? Does it really matter? Does it really cause disease down the line? It's such an impossibly complex system as all the trillion of microbes in your gut, does it really matter? It matters a bit and if you come through an autoimmune disease like Dr. Miller's patients often do, it's not something you want to go tinkering around with randomly though. I would not prescribe antibiotics for this if it's indicated. But again, as she said, it's the food. It's the food. You want to repopulate that. The antibiotic never kills off all the good bacteria. There's always some still down there. If you feed them, they respond. So again, that whole food plant based diet, especially with the resistant starches that you find in the legumes, lentils and the beans et cetera. The microbes really like that. Get on that whole food plant based diet ASAP and the microbiome will rebalance itself. It will heal. It seldom causes a permanent deficit that I'm aware of and that matters at all.
Dr. Laurie Marbas
(29:36)
I'd like to echo exactly what you're saying. A couple things too, when we're looking at antibiotic resistance that's so significantly on the rise, because our children, our infants are being prescribed so many antibiotics that maybe most of the time are viral and now we're giving them antibiotics and these little burgeoning microbiomes, we don't even give them a chance to really flourish. I tell people, when you take an antibiotic, it's like let's say you're in New York City, you have all these amazing different cultures and ethnicities and it makes a very vibrant and exciting and healthy population, but when you take an antibiotic, you may wipe out the very small percentage of that one population that you need when you get sick in the future. Again, antibiotics have saved many lives and they're very important, but we're going backward in the sense of what's available.
Dr. Laurie Marbas
(30:25)
A lot of doctors when they prescribe antibiotics for years for acne, to prevent urinary tract infections recurring. Really speak to your doctor. Say, “Do I really need this?” It will be so refreshing for our doctor to have that conversation with a patient. “Do I really need this? Or are you just giving it to me because you think I want it?” If you have those types of conversations, your doctor is going to go, “You know we can probably wait, let's see what happens.” Or maybe there's some other ways to look at it. Please have those conversations with your doctor. That's great.
Dr. Chris Miller
(30:56)
If you do need it, you can repopulate is what I think we're all saying.
Dr. Laurie Marbas
(30:58)
Yes, absolutely.
Dr. Chris Miller
(31:00)
Don't be stressed if you've taken them. You can repopulate it.
Dr. Michael Klaper
(31:05)
Absolutely.
Dr. Laurie Marbas
(31:06)
Absolutely. But majority of those antibiotics that are prescribed are not necessary. The majority of the time, in outpatient setting I should say. So let's see. Boy, there's so many different questions. So, let's go to heart disease. So, we have a question here, someone is on a very compliant whole food plant based diet and still has a cholesterol 200, and no known heart disease, would a statin be recommended? Then with that, someone else, just in the heart disease realm, someone said her doctor told her to get my LDL where it was supposed to be using olive and canola oil. Any of you like to talk about that?
Dr. Michael Klaper
(31:48)
Dr. Miller, [inaudible 00:31:51].
Dr. Chris Miller
(31:51)
I'll touch on the olive and canola oil. The studies that have done anything to support those oils were comparing to people who were eating meat based diets and eating butter and fat. So when you compare olive oil, canola oil to the butter, then yes they improved. But if you compare people eating those oils to a whole food plant based diet with no oils like we have been talking about, those people actually did better. More of a drop in total cholesterol and LDL.
Dr. Chris Miller
(32:18)
So number one I don't recommend adding the oils, absolutely not. I recommend adding more fiber if anything. Bringing in things like oats. Steel cut oats are oat [inaudible 00:32:30], the whole oat not processed. Quinoa and barley, things like that are really good for lowering cholesterol. Also legumes really good. A little bit of unprocessed soy is good. The form of Tempe, tofu or edamame or whole soy beans are good for lowering cholesterol. Berries. Things like that. I would really focus on those types of foods and not adding the oil. Just a small amount of nuts and seeds too. It should be a very small amount is also helpful in building a diet like that.
Dr. Laurie Marbas
(33:01)
I can help with the statin question. I work with Dr. Kim Williams regularly on the journal and I've spoken to him extensively about that statin discussion. So, certainly if someone has heart disease and they're placed on a statin, we really need to speak to the cardiologist about that, because they probably may need to stay on it, okay. But if we're talking to someone saying that they don't have heart disease, there maybe is some genetic component keeping that, I don't know if you meant by total cholesterol or LDL, I'm assuming total cholesterol. Really the focus let's look at the LDLs, when you talk to Dr. Williams. So his suggestions are if you look at the studies, if you are under 60, specifically 58, your heart disease risk are significantly dropped. So if your LDL is not under that and you have maybe some genetic components of heart disease, for example my dad has his first heart attack at 38. My mom's dad died at 46. So genetically I am not the most foreseen.
Dr. Laurie Marbas
(33:53)
But, eating a whole food plant based diet, my LDL is fine. However, if you have that concern, speak to your Cardiologist. And you're eating a very compliant whole food plant based diet, a small amount of statin might be warranted to decrease those additional further risk. We all know, someone who may be on a whole food plant based diet and still has a heart attack, there are other factors. So, there's some things to consider. I wouldn't write it off the table. Of course, statins have side effects. It has to be balanced with benefits versus risk. That's why we're physicians and we make those decisions with the patient. So, so very important, that you are fully educated at the risk versus the benefits and then have that discussion with your very knowledgeable physician about that. Someone like Dr. Williams, or someone who understands the studies and the risks long term and I think you'll come out at least ahead on doing the best that we can in those circumstances. I don't know if anybody else has anything else to say? We have some other questions too though.
Dr. Chris Miller
(34:47)
I do actually check, if someone is concerned and their cholesterol isn't coming down and the question is how aggressive you need to treat it, well I think we need to do further studies. That's where I might consider a carotid intima media thickness testing. It's a CIMT its called. It's an ultrasound just of the neck and it shows if you have thickening of the endothelium of the carotids. If you're starting to show early thickening there, that means you have thickening anywhere throughout your heart or your blood vessels anywhere in your body. So, if someone is showing that they have disease, then that's someone that I would want to be a little more aggressive to get that down. I would look at things, and I would also do blood work, so I would like at things like their oxidized cholesterol, because it's not just the total cholesterol, but actually the oxidized LDL. It's when it gets oxidized that it gets sticky and it sticks to your blood vessel wall.
Dr. Chris Miller
(35:39)
So if you have a cholesterol of 200, but it's not oxidized and you have no plaque, I would not start that person on a statin. I think that they're doing okay. But if they have thickening there and they're starting to show plaque and they have oxidized cholesterol, and here's an interesting thing, autoimmune diseases make your cholesterol oxidized. So, a lot of people, myself included, I'm whole food plant based for 10 years almost now, and I still have some oxidized cholesterol sometimes. Because of that, it sticks to my blood vessels more than it should, even on a whole food plant based diet. Certain people are going to have higher risk factors or they're going to have certain other inflammatory processes. People with asthma, people with allergies. People with autoimmune diseases and we're going to want to be more aggressive and we're going to look deeper than just a total cholesterol number because actually that number doesn't mean a lot to me unless I know what's going on in your body.
Dr. Chris Miller
(36:31)
I would say pursue some of the other workups and you can do CIMT testing locally by you, or your doctor can order it or we can order it. I check that on some of my patients when we're worried about taking it to the next level.
Dr. Laurie Marbas
(36:43)
And the cardiac calcium score too can be helpful. Also, our lipoprotein, little A, is another big thing to be measured. Lots of different factors guys. It's not a simple question. I don't know Dr. Klaper if you had anything else to add to that?
Dr. Michael Klaper
(36:59)
I think Dr. Miller was really touching on something important. I don't believe that the atherosclerotic plaques developed on our artery wall just because your LDL exceeds a certain number. These are inflammatory lesions. These arteries are being injured. The owner of the artery, meal after meal is putting molecules in that blood stream. Yes, the animal protein, but the high fructose corn syrup and the phosphoric acid and the cola drinks and the oxidized vegetable oil from the fries and the polysorbate 80 emulsifiers. All these things rip up, or really injure that precious endothelial lining on the inside of the artery walls and once that gets injured then, as Dr. Miller is saying, the oxidized cholesterol, which get oxidized as you grill the steak and fry the chicken, then oxidized cholesterol then pierces through that injured endothelial lining and then the inflammation starts.
Dr. Michael Klaper
(38:02)
This is an active process. This is artery abuse on the part of the owner of the arteries. This isn't just a passive how high is my LDL? It's how are you taking care of your artery walls. The studies showing of if your LDL is of such and such a level, they're all done in meat eating folks. I don't know any studies that look at LDL in whole food plant based eating people. The folks who are eating the cheeseburgers and drinking the beers and the soft drinks and the processed foods, they're doing something else all together to their artery walls. They may have a cholesterol of 210 and the long term vegan eating rice and beans and greens may have a 210, but they're at very different risks.
Dr. Michael Klaper
(38:51)
I wouldn't put that vegan person on a statin, assuming that, as Dr. Miller said, their inflammatory markers, their high sensitivity CRP, the [inaudible 00:39:04], their oxidized cholesterol, if they're all low and their arteries look good on ultrasound, they don't have the disease of atherosclerosis. I'm saying there's a difference between the hypercholesterolemia, just an elevated level of cholesterol in your blood, versus the active inflammatory fire that's burning in the walls of the arteries with someone with the disease of atherosclerosis. They're not the same thing. Cholesterol is not an evil molecule, your liver makes it. Because your adrenal glands need it to make cortisol, your nerves use it to make myelin. It's okay to have a lightly elevated level of cholesterol, as long as you don't have all those inflammatory processes going on in your arteries. Take care of your arteries. Keep those rice and veggies going through your endothelial linings and the odds of you developing the disease of atherosclerosis are very small. Even if your cholesterol is a bit elevated.
Dr. Laurie Marbas
(40:09)
Okay, so here we have another question, it's pretty straightforward. And I don't know if there's a magic number, what is the quantity of fiber we should be getting in a day? I know what the USDA recommends, but I tend to recommend higher. But, Dr. Klaper, Dr. Miller?
Dr. Michael Klaper
(40:23)
Five pounds a day. More is better. I've never written too much fiber on a death certificate. But seriously, when you look at people eating traditional diets, they really are eating the greens and the beans and fruits and vegetables, the folks in Africa eating their standard diets. They're eating massive amounts of fiber, 30, 40, 50, 60 grams a day. We average somewhere between five and 20 grams a day. So, whatever you're eating, double it and shoot for at least 30 grams I would say, but 40 or 50, 60 is absolutely just fine.
Dr. Michael Klaper
(41:12)
I think when they look at the fossilized fecal dropping of the paleolithic folks, they were eating massive amounts of fiber, 100 grams a day when they have these massive stools, which is really what the [inaudible 00:41:27]. They pass these fiber stools all day because they're eating their natural all plant based diet. You want numbers? Try to exceed 30 grams and you'll be fine.
Dr. Chris Miller
(41:38)
I think we should have a fiber eating contest here.
Dr. Michael Klaper
(41:40)
Yes.
Dr. Chris Miller
(41:40)
How much we're eating and who can eat the most? Then who's the healthiest. Whoever wins is probably going to be the healthiest person out there.
Dr. Michael Klaper
(41:49)
Here, here.
Dr. Laurie Marbas
(41:53)
We do have a fiber deficiency issue in the United States, probably much more than any other nutrient you need to worry about, absolutely. That's a great fun question. All right, so there is another question here, Chris, probably right up your alley. What is the best diet to help alleviate rheumatoid arthritis? Any good foods to eliminate or include?
Dr. Chris Miller
(42:13)
Number one with autoimmune disease is whole food plant based diet. So the first foods that we want to eliminate are animal products because they're high in saturated fat for one. They promote Omega-6 fatty acids, so pro-inflammatory fatty acids and all of the toxins that come with animal [inaudible 00:42:35]. So we want to eliminate that. Then, after animal products, that includes dairy too. So all dairy products including butter. Including even yogurt and probably one of the biggest triggers for autoimmune is dairy products. Even the slightest bit will keep an autoimmune disease flaring horribly. So, that's got to go absolutely. That's the number one thing I have people get out first and foremost, even before the meat products. That's got to go.
Dr. Chris Miller
(42:59)
Then oils really do have to go. People heal faster and that's what i' talking about. That oil in the gut lining, it just causes more inflammation, even any oils. I haven't really noticed, people are like what about avocado oil? What about? I haven't really noticed, people just don't heal as well. So the oil's got to go.
Dr. Chris Miller
(43:17)
Sugar and processed food has to go. Even on a whole food plant based diet, and this trips up a lot of people. So we're eating plant based, I'm plant based, but it's processed. So tortillas, that's processed unfortunately. So we see all these fun recipes and we're trying to go plant based, but we have to really remove all of that. We want to eat the brown rice. Eat the wild rice. Or the corn, but don't eat the corn tortilla. Taking all that out, that's the first step and for some people that alone is enough, but for some people it's not.
Dr. Chris Miller
(43:48)
So then we start going anti-inflammatory is what I call it. An anti-inflammatory, healing plant based diet, which is going to be more raw, a lot more raw vegetables. This is where the grains and the legumes, they bother some people initially. So depending on how bad your gut is, your microbiome, some people aren't going to tolerate those initially. The goal is going to be to bring them back in, because like we're talking about, you need them back in, but initially if you find you're still really achy and you're on a good whole food plant based diet and you're eating a lot of raw green leafy vegetables, drinking plenty of water, and you're still feeling really achy, I start to play with removing a little bit of those grains, removing a little bit of those legumes and that's also the time when we'll look at specific food sensitivities.
Dr. Chris Miller
(44:33)
Studies show about 10% of people, maybe even a little less, are going to have a problem with nightshade vegetables. The nightshade vegetables are the tomatoes, the eggplant, the white potatoes. What is it, the peppers. Cayenne pepper, all those yummy spices. Now those are really healing, wonderful foods. And they're foods that I want people to be eating in general because they're very anti-inflammatory. But people with rheumatoid arthritis, if that happens to bother you, you want to take it out for about a month, maybe two months. See how you feel, if you notice a difference. Then bring them back in. Bring them in one at a time. Watch how you feel with those.
Dr. Chris Miller
(45:10)
That is another one that can bother some, but truthfully most of my patients can eat nightshades and the ones that can't, are able to usually bring them back in as we heal the gut. When we take out any pro-inflammatory foods, the gut heals. It really heals. Eating lots and lots of raw green vegetables, the flax and chia seeds. Loading ourselves with these anti-oxidants, these vital nutrients, the gut will heal and then you can bring those foods back in. Eventually you bring in the legumes and then you bring in whole grains back in.
Dr. Chris Miller
(45:41)
Beyond that, there are individual ones that some people have. Some people have a sensitivity to corn initially, or some people citrus might bother them, but this is individualized and it's not everyone and I don't recommend starting by eliminating all that, I just recommend starting with the good anti-inflammatory, lots of raw healing diet and then from there we can play with it more. Rheumatoid arthritis does really well with diet. So if you're struggling with it, please see one of us because we're happy to work with you with that.
Dr. Laurie Marbas
(46:10)
Absolutely, and Chris I will say, Rochelle said do all three of us help make these dietary adjustments? Yes, absolutely. It depends on what state you're in, Rochelle. We can even work with that. If you'll go to plantbasedtelehealth.com, and request a portal invitation, if you haven't already, and then we can make an appointment and we can put you with one of us to help you get on the right track.
Dr. Laurie Marbas
(46:34)
I love sending my autoimmune patients to Chris and she's amazing. She's my personal doc, so that says something. Great answer.
Dr. Michael Klaper
(46:46)
I listen to that answer, I put a bow on it. That was just a perfectly delivered answer. I couldn't have agreed more.
Dr. Laurie Marbas
(46:54)
Perfect.
Dr. Michael Klaper
(46:55)
Like guitar string and resonating. Exactly in harmony there, it's great.
Dr. Laurie Marbas
(47:02)
Fantastic. I do have another question. There's so many. Let's go to the constipation questions. I think on occasion some people get this. This might be an interesting question for you. My question about constipation and how to feed my gut to restore my microbiome, which we discussed a little bit. She goes, I've been consistently eating whole food plant based diet for four years. I decided to juice for two days and since that time several months ago, I've been having trouble with constipation. I'm trying more water, warm lemon water, magnesium and psyllium fiber. I also have tried kombucha. I came in on the end of the antibiotic microbiome discussion, perhaps you already addressed this. How about those who are on a whole food plant based diet, and do have some issues with constipation continuing, any suggestions?
Dr. Michael Klaper
(47:44)
Absolutely. For eight years I was on the staff at True North Health Center in northern California and we would have people come in and constipation was a common complaint. I got tremendous respect for an old time treatment for constipation, when people would complain about it. After breakfast, back in the commercial kitchen there we would take a little bowl of water and we would put four or five prunes in the water and let them soak all day. By evening time they would be all rehydrated, big, plump confections. Come dinner time, after the person ate their dinner out would come the four or five soaked prunes and she would have that for dessert.
Dr. Michael Klaper
(48:31)
Well you do that every night for four, five, six nights you put four or five soaked prunes down there, Mother Nature knows what to do with them. It's a very effective laxative. Lots of jokes about prune juice, etc, but it really does work. There are [inaudible 00:48:49] and the sugars in the prunes that really do stimulate. Before you reach for the magnesium oxide and all that kind of stuff, putting soaked prunes down there every evening for a week or so and see if that doesn't take care of your problem. Plus the rest of your diet needs to be full of rice and beans and high fiber foods. But that moves things right along.
Dr. Laurie Marbas
(49:07)
Yes it does. I love that. I'll put a bow on your answer. That's fantastic.
Dr. Chris Miller
(49:16)
I did see, I wasn't constipated, but everybody was having their prunes and I felt left out so I asked for those prunes too.
Dr. Michael Klaper
(49:23)
They taste good too, yeah.
Dr. Laurie Marbas
(49:26)
Oh my goodness, that's great.
Dr. Chris Miller
(49:28)
What I also do, in addition to prunes, for my patients, the number one reason for constipation is dehydration.
Dr. Michael Klaper
(49:34)
Good point.
Dr. Chris Miller
(49:37)
It's like water slide. If you sit on a water slide and there's no water, it's going to get stuck. It's not going to go down, but as soon as you add a little water, whoosh. It moves through. I would say make sure you're really drinking enough water. And you'll probably already doing this because whoever asked that question, you've been whole food plant based for four years, so you're probably already doing this, but I would make sure you're eating some flax or chia seeds. That really keeps things moving through. Raw vegetables seem to help and there are certain other foods that have a lot of pectin in it. So apples with the skins can be helpful. Prunes of course are number one, so I have everyone eating prunes as well. Taking a look at your general diet, making sure you're not eating processed plant foods and then, hopefully with all that, you'll get that under control.
Dr. Laurie Marbas
(50:21)
I've had some amazing, this is a mechanical issue, but those little squaty potties that you can now put underneath your toilet and you bring your legs up.
Dr. Michael Klaper
(50:29)
That's important.
Dr. Laurie Marbas
(50:30)
They actually work really well for some people. There's some anatomical concerns here. Just the mechanical. Yeah. It's just literally the mechanics. If you watch a little kid poop, having raised three myself, they squat down and they do. Okay, so it makes sense. Lift the legs up a little bit, it's a little stool it works great. You can order them online.
Dr. Michael Klaper
(50:51)
If you sit on the toilet and if your feet don't touch the floor, you really should get one of these plastic platforms to help flex your hips a bit. It will improve the mechanics. I agree.
Dr. Laurie Marbas
(51:05)
Absolutely. When my babies were little and they would have a little gas and I would just flex their hips like that, the gas just passed. It's the same idea. That's a free mom advice there for you. That's extra.
Dr. Chris Miller
(51:18)
That's why yoga moves help too. Now we're into passing gas, but if you're really gassy or bloated, do yoga poses, going in certain moves. Lay on your left side, moving your leg and doing certain flexes, moves it right along. Your gut starts to move and pass all your gas.
Dr. Laurie Marbas
(51:34)
All righty, I will never look at yoga class the same again. There's a really good question here. I get a lot of diabetics, but this, I'll let you guys answer as well. I like plain oatmeal with egg whites for breakfast. I'm a type two diabetic, controlled by diet and lifestyle. Is oatmeal okay? I like it because they say it helps lower cholesterol and it's good fiber. Thank you.
Dr. Laurie Marbas
(51:58)
I'll just put in my two cents here real quick. First of all Jean, please I would love to work with you, or one of us, because if you're already eating egg whites, there's definitely room for improvement it looks like in the diet. Because a whole food plant based diet will do tremendous. If you're already controlling your numbers as a type two diabetic, maybe hopefully we could reverse your type two diabetes. So, certainly oatmeal is phenomenal. If you do steel cut or groat oats, it's a little more time consuming, but those are fine. But there is some other things that we can do dietary wise to really get your blood sugars way under control or reverse. Literally, the whole food plant based diet is so important. Low fat, whole food plant based diet. Do you either of you have any other suggestions?
Dr. Chris Miller
(52:44)
I agree. I'm going to put a bow right on that answer Laurie. Awesome. I do recommend working with one of us, we can help you. But that's a great answer. Yep.
Dr. Laurie Marbas
(52:51)
Absolutely. I think we have time for one more last question, which actually I think is our last question we got here. Here you go. Both of you have experience with this, so I will leave it in your hands. How do you feel about juicing? Benefits and cons.
Dr. Michael Klaper
(53:11)
Dr. Miller do you do juicing?
Dr. Chris Miller
(53:14)
I am a juicing. I think people who know me know that I'm a fan of juicing. So, I am a person personally had so much inflammation in my body with my lupus that I couldn't get it under control with a whole food plant based diet and I had so much pain and felt terrible. It wasn't until I started juicing that I was able to reduce the pain significantly. So, when I work with patients, I don't think it's for everyone. It's not for weight loss. It's not for diabetics. We have to be very careful, but again when our guts are so inflamed, when they're amassed with certain people, people with inflammatory bowel disease, people sick with autoimmune diseases, people with just a lot of inflammation of any sort, the green juice, it takes out the fiber. So we talked about fiber. We need fiber in our diet which is why you have to be careful with juicing.
Dr. Chris Miller
(53:59)
But when you're so inflamed, that fiber could be what's irritating you. So you take out the fiber and you flood your body with these life giving, wonderful, beautiful phytonutrients and all these anti-oxidants that are just so good for us and it actually can pretty quickly quelch the inflammation. I am a fan, but it does have to be a vegetable based juice. It's not a fruit based juice, because that will spike your blood sugar way too much and be risky. It's made with things like leafy greens. A little bit of carrot maybe or beet. And some lemon, lime, things like that. You can put other vegetables in such as cucumber, zucchini I like to put in mine to make it taste good. A little ginger, a little turmeric. So you really hit your body with antioxidant and anti-inflammatory all at once.
Dr. Chris Miller
(54:45)
I am a fan of that. But if you're using it for weight loss, or you're diabetic or you just need fiber, you're trying to have fiber, then I don't recommend it for everyone. But yeah, I'm a fan.
Dr. Michael Klaper
(54:57)
Beautifully said. They are medicinal, they have a use in specific cases and a glass of juice a day is not a terrible thing, but again, you're discarding a lot of valuable fiber and a lot of the phytonutrients, the vitamins, minerals are attached to the fiber that wind up in the compost. If you're an avid juicer there. I'm more of a fan of green smoothies etc. but if you've got an irritated gut lining or you've got to really get those nutrients into the system, on an expressed level to calm inflammation then the recipe there that Dr. Miller gave you for those green juices, I think would serve you very well. I think that's a very appropriate answer.
Dr. Laurie Marbas
(55:40)
Fantastic. And just to end that, which is a brilliant answers is, why is it not for diabetics? And that is just because it's so quickly absorbed, it will really shoot up your blood sugars and we don't want that in our diabetics.
Dr. Chris Miller
(55:50)
You want the fiber in your diabetics too. To help stabilize the blood sugar.
Dr. Laurie Marbas
(55:55)
Yep. The fiber is super important with stabilizing the glucose absorptions so you don't get this super quick rise. You get this slow gradual rise and as far as smoothies, I love smoothies at any time, but if you're a diabetic as well, that's fine, but just drink it slowly over an hour or so or even a little longer. Just sips. You imagine all that food you put into that smoothie, you're not going to eat if you're chewing and gulping down in five minutes. You're going to chew it over time.
Dr. Laurie Marbas
(56:23)
Same thing, just small sips and gradual. That will help with that too. Any other final words anyone before we head out?
Dr. Chris Miller
(56:32)
Super fun. Thank you guys for these awesome questions. This was fun.
Dr. Michael Klaper
(56:36)
Great questions. Very intelligent. Very enjoyable. Very informative for us all. Thank you everybody who participated. Well done.
Dr. Laurie Marbas
(56:42)
Thank you everyone for joining us. We'll be here again next Thursday. Same time. Same place. And thank you for your time. We so appreciate you. Again, it's plantbasedtelehealth.com. You can see myself, Dr. Klaper or Dr. Miller and we are so excited to meeting you. Take care, bye.
Dr. Chris Miller
(57:00)
Bye everyone. Stay safe.
Dr. Michael Klaper
(57:02)
Bye-bye.
*Recorded on 6.04.20