Plant-Based and Healthy
Plant-Based and Healthy
Debunking anti-nutrients, like lectins, phytates and oxalates in plant-based diets - with guest Dr. Matthew Nagra, ND
In Episode #5 I interviewed Dr. Matthew Nagra and we discussed the research on the so-called anti-nutrients, like lectins, phytates and oxalates.
In this conversation we also discussed:
- Dr. Nagra’s journey to becoming plant-based.
- His experience with treating cardiovascular disease with dietary and lifestyle strategies.
- Micronutrients of concern while on a plant-based diet.
- Dr. Nagra’s advice on transitioning into a plant-based diet.
- His favorite plant-based foods.
Quote: Bruce Lee "If you spend too much time thinking about a thing, you'll never get it done. Make at least one definite move daily toward your goal."
Resources:
- https://plantproof.com/all-podcasts/
- https://twitter.com/MattMadore576
-https://www.brendadavisrd.com/books/nourish/
References:
https://pubmed.ncbi.nlm.nih.gov/7407532/
https://ift.onlinelibrary.wiley.com/doi/abs/10.1111/j.1365-2621.1983.tb14831.x
https://pubmed.ncbi.nlm.nih.gov/15228991/
https://pubmed.ncbi.nlm.nih.gov/32987890/
https://pubmed.ncbi.nlm.nih.gov/20515779/
https://pubmed.ncbi.nlm.nih.gov/26041677/
https://ift.onlinelibrary.wiley.com/doi/abs/10.1111/j.1365-2621.1980.tb02631.x
https://bmcnephrol.biomedcentral.com/articles/10.1186/s12882-020-01925-3
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About your host: Dr. Travis Cox - BA, DC, MSc is a Doctor of Chiropractic with a focus on Functional Medicine and plant-based nutrition. He is the creator of PBandHealthy.com and host of the Plant-Based and Healthy podcast. Connect with him on Instagram, Twitter and Facebook @yourvegandoc #pbandhealthy. And remember, individuals inspire and communities create change!
Audio credit: Thank you @katetrajanmusic for your lovely voice on the intro/outro and @craigritchiemusic for the super catchy music track for the intro/outro... many thanks!
Dr. Travis Cox (host):
Welcome to Dr. Matt Nagra.
Dr. Matthew Nagra (guest):
Thanks for having me. Happy to be here.
Dr. Travis Cox (host):
Yeah. My pleasure. We'll get right into it. We'll go into the first question. Just pretend your mind's eye. You go back in this plant-based and healthy time machine. Remember back when you first decided you want to be plant-based, just describe for our listeners what that experience was like.
Dr. Matthew Nagra (guest):
Well, it wasn't overnight decision or it wasn't a sense, but I had educated myself on the matter a lot prior to making that eventual shift. When I was a teen, I had some health issues. I started adopting a more plant-based diet. But it wasn't until a couple years later when I was in university one day and I just realized that over the last couple years I started noticing I was feeling so much better eating more plant-based.
Then I got to university and I started sliding the other way again. You're eating cafeteria food and all of that. There was a point at which I just decided, "You know what? I know I'm not feeling as good as I could. I know I have felt a lot better. I know that that happened when I was eating more plant-based." Obviously, compared to a lot of the stuff I preach about now, maybe not the most scientific approach, but that was just how I felt, which is the same situation for a lot of people.
They just feel better a certain way. Then they want to adopt that pattern or that dietary pattern. At that point, it's overnight, I'm doing it a hundred percent plant-based. I told all my friends, they were like, "Oh, you're crazy." I was living at the university. I was living off my Vitamix that I had in my dorm room and a little mini fridge and the salad bar and trying to get by with all of that.
It wasn't ... I had an idea of what I was doing, but it was that I'm going to switch at this point and I made a really firm decision about that.
Dr. Travis Cox (host):
Got it. It sounds like you had more, just a touch of what it was like, "Hey, eating more plants, I feel better. I'm going to do more and more of that." Then you just slowly transition into being whole food plant-based.
Dr. Matthew Nagra (guest):
Yeah.
Dr. Travis Cox (host):
Of course, you got some pushback from your friends, like we all kind of do.
Dr. Matthew Nagra (guest):
Yeah.
Dr. Travis Cox (host):
In doing that transition, did you have any unique, specific experiences with concerns or any kind of specific obstacles you had to overcome in that transition?
Dr. Matthew Nagra (guest):
See, now looking back, I think there definitely could have been things, certain nutrients of focus. I could have targeted a little more now. I knew about B12. I was making sure to take my B12. I was taking my vitamin D and a couple of the key ones. But I feel I could have been a little more focused on like, "Okay. Am having my calcium fortified plant milks regularly? Am I getting that and a few other nutrients there?"
But I wasn't all that concerned. I knew that the big ones, the B12, especially I was taken care of. Then I was just ... I don't know how much I like the term. But I was intuitively eating, so to speak. Again, over time I've learned so much more and really delved into the research on this. I have a better understanding now than I did at the time.
Dr. Travis Cox (host):
Got it. Yeah. That's obviously awesome that you realized or knew that you had something with B12 and vitamin D, but it's not so easy for everyone. I'm glad it was easy, smooth sailing experience for you. Is there anything you wish would've known at that point, when you did that switch?
Dr. Matthew Nagra (guest):
I was very much influenced in the earlier days by the whole foods plant-based and the raw food camp and that kind of thing. Originally when I first started getting interested, and so maybe I wish I knew more about some of the research behind like oils, for example, and especially how beneficial increasing whole grain intake and that. It could have been where ... Which are things and which are really common thoughts in the online nutrition space now that those are things to fear and to avoid.
I wish I knew better about those at that point. I feel I could have had a little more flexibility with my diet in the early days. But that would really be about it. I got there eventually. That was just me working off my own anecdote to start. Then as I learned more, I expanded and, I think pretty healthy diet now, that's a little more well-rounded and a little more inclusive.
Dr. Travis Cox (host):
Absolutely. That's great. What would you say is your favorite condition or type of patient to work with in that realm?
Dr. Matthew Nagra (guest):
I feel there's two ways I can answer that. For one, going into practice, one of my focuses, or one of the areas that I really wanted to work in was cardiovascular disease. I have a lot of patients with high cholesterol or high blood pressure. I have some patients who've had a heart attack. They're coming in to see me to like, "Oh, my doctor gave me statins. I don't want to take a statin."
Then I end up being the one telling him, "No. You need to take a statin.
Dr. Travis Cox (host):
Totally.
Dr. Matthew Nagra (guest):
But then I'm like, "But we can also target your diet." Because with those sorts of cases, when it comes to their lipids and that we can see drastic improvements by switching up their diet. Just massive improvements in some cases, especially if you do more of a portfolio style diet change. I know that really impacts their risk of having if it's secondary prevention, a subsequent cardiovascular event, but if it's primary prevention, then hopefully prevent it all together.
I just know that's an area that we can do so much with our diet. Of course, as I mentioned, medications when needed. But the other group that I tend to work with a lot, and this isn't necessarily what I signed up for, but it found me is just the vegetarian, vegan population here in Vancouver. Many of them come to see me just to make sure that they're eating appropriately, making sure they're hitting their nutrient requirements, make sure they're supplementing appropriately.
Some of them raising kids. I want to make sure they're doing it right. For one, it's so great to see people wanting to make that shift and be able to help them with it. But second, when I see these patients, it's like, "I don't even have to do anything. They're so healthy already." That's something I've noticed because I always hear from others that, "Oh, my vegan patients, they're all unhealthy. That's not."
The people who are coming to see me who are vegan or vegetarian, and wanting to optimize their diet, if that's a thing, they're already eating so well and doing everything right most of the time. Maybe a few little tweaks here and there. But I really like working with that population just because it's just reinforcing a lot of the good habits they've already built, and especially seeing when they've got their super healthy kids there who are being raised this way as well.
Dr. Travis Cox (host):
Yeah. Totally. I can relate. I mean, I would think it would be a ... You geek out with these patients that are like, "I care so much about my health and I'm eating all these right things, but I always want to fine tune it." Then of course, if you can just, like you said, just tweak it a couple things it bridges the gap of there any concerns they have, but again, it's, like you said, they're pretty healthy. It's all pretty easy.
Dr. Matthew Nagra (guest):
Yeah. Yeah. For sure.
Dr. Travis Cox (host):
But getting back to the first demographic you mentioned with cardiovascular disease patients, and of course using certain dietary approaches, like the portfolio diet, do you find a lot of your patients need to dramatically change or take away or stop taking their medications?
Dr. Matthew Nagra (guest):
No. I think diet-wise, yes. Some have to make pretty significant changes. I actually get a lot of patients who unfortunately have fallen down the online rabbit hole of like keto and no saturated fats, not a problem. It's those pesky seed oils that are and all of those sorts of claims. I actually ... This is another thing I really like about it is I spend really long visits with the patient.
Initial visit being an hour long. I'll really explain these things to them and be like, "This is why those people you're following are saying this, and this is what the research actually suggestions." It's more of an educational piece. There are some patients like that where we have to drastically change the diet, but they're also ... Because they're so stuck in that mindset they're often hesitant to do so.
We take it really slowly. Like, "Okay. Let's just see if we can tweak these few things to start. Okay. You're not going to suffer because of it." Then once they do it for a few weeks, they feel good. Okay. Now we can take the next step. You have to slowly ease them into it.
Dr. Travis Cox (host):
Right.
Dr. Matthew Nagra (guest):
On the medication piece, as you mentioned, if anything, I usually encourage them to take their medication as prescribed, specifically if it is for cholesterol lowering and those sorts of things a lot, because of there's this idea that in naturopathic medicine where like anti-medicine, and that kind of thing, and that's just not the case at all.
I mean, sure. There might be a handful that are, and I mean, I'm sure you can find that in any profession, but I'm very much in favor of things like statin treatment and blood pressure lowering medications and things like that when indicated. In a lot of these cases, especially if it is something like secondary prevention, they're absolutely indicated.
Dr. Travis Cox (host):
Yes.
Dr. Matthew Nagra (guest):
For diabetes, for example, yeah, sometimes we'll get them right off their meds. If it's for primary prevention purposes, sometimes we'll get them off their cholesterol lowering meds or whatever, if I feel comfortable with where their values are at. But I'd say a lot of the time I'm actually encouraging them to stick with it.
Dr. Travis Cox (host):
Got it. Yeah. I just wasn't sure if you had such a dramatic change in their lab. It was like, "Well, yeah, you should be decreasing or modifying or eliminating some of those anti-hypertensives or ...
Dr. Matthew Nagra (guest):
Yeah.
Dr. Travis Cox (host):
Yeah. Like cholesterol drugs. Yeah.
Dr. Matthew Nagra (guest):
Oh, absolutely. For anti-hypertensives, absolutely. I've had that for again, diabetes medication, same deal. I've had that. For cholesterol lowering, again, it's like there isn't really ... if they're not experiencing any adverse effects there isn't really a risk to lowering your LDL even further.
Dr. Travis Cox (host):
Totally. Got it. That said, do you mind just sharing a success story with a patient that you worked with, ideally plant-based that they had some health issues, you helped them out, and what you had to do to make that positive outcome happen?
Dr. Matthew Nagra (guest):
Yeah. I had ... Oh, man, just trying to pick one. I think one of the big ones was actually ... This was a patient with high cholesterol, relatively young. We'll say 50s, early 50s, LBL cholesterol was around four and a half or so. He was recommended statins by his family physician. He said that he would take them if he wasn't able to address it with diet. But he wanted to work with me first to see if he could address it with his diet.
We went full on portfolio, everything, hitting every target, your soluble fiber, or the viscous fiber is your nuts, especially almonds focusing on that, soy and other plant proteins and really focusing on those cholesterol lowering foods and then obviously minimizing saturated fat and getting rid of the cholesterol. We dropped him down to about 2.25 or so.
Dr. Travis Cox (host):
Wow.
Dr. Matthew Nagra (guest):
It was ridiculous. That is not the type of results that everybody is going to get.
Dr. Travis Cox (host):
Of course.
Dr. Matthew Nagra (guest):
Now, even then I did suggest that look, "Lowering your values further with medication is ... could even more here for your cardiovascular risk." Ultimately, they chose not to. I informed them of why I recommended it. At the end of the day, that's their decision. But we were able to make a massive impact with just the dietary shift and mind you a pretty substantial dietary shift for that patient. He can only further be lowered with medication at that point, really. He was doing everything right.
Dr. Travis Cox (host):
Totally. That's amazing. Yeah. I mean, that's pretty ideal in that situation where he was putting a lot of weight on the emphasis of the dietary changes and hopes that he didn't have to go on medication or choose to go on medication. Sounds like you ... Yeah. Slam dunked that one. That's awesome.
Dr. Matthew Nagra (guest):
One of my most compliant patients. Let's put it that way that stuck with ...
Dr. Travis Cox (host):
Makes a lot of ways.
Dr. Matthew Nagra (guest):
Yeah. Every piece of advice. It was so funny.
Dr. Travis Cox (host):
Awesome.
Dr. Matthew Nagra (guest):
Yeah. I did really well.
Dr. Travis Cox (host):
In the inverse, what would you say, Matt, regarding a patient story that was not as successful and not so much like what happened, but just any clinical perils, any "aha" moments you had as a result of that?
Dr. Matthew Nagra (guest):
See, that's also a tricky one, because that does happen. There are absolutely cases that just stump you. I'm sure you've had that, too.
Dr. Travis Cox (host):
Totally.
Dr. Matthew Nagra (guest):
I had one who had high blood pressure, really healthy, athletic, otherwise ate, essentially, a whole foods plant based diet. We were able to tweak some things and help a little bit more and improve exercise in some ways. All the standard things you would do for someone with hypertension. She was taking ACE inhibitors. We got her from ... I can't remember what diastolic was, but systolic from 160 down to, I don't know, 145 or something. It wasn't a huge draw. I mean, it's a decent drop, but ...
Dr. Travis Cox (host):
Still a good direction to go into it. Yeah.
Dr. Matthew Nagra (guest):
Yeah. Yeah. Exactly. But it was one that there wasn't a lot more from a dire lifestyle perspective that could be done. At that point it was increasing dose medications and all of that, which again, I tend to get a lot of the patients who are hesitant to do that. I agree that, "Look, we can try the lifestyle approach for X amount of time if we don't get there. I think that this is a good idea. Eventually, you need to up the medication or add to whatever medications they're taking."
But that was one that ... I still don't know why it was, unless, some people just have higher baseline for a variety of reasons, genetics or otherwise.
Dr. Travis Cox (host):
Did you have any lessons learned from that experience as far as taking into future encounters of patients in that scenario?
Dr. Matthew Nagra (guest):
I think it's more about expectations. I think it's really ... This is something I try to do anyway, but I've become overtime more and more ... I guess, I've thought about it more and more and made sure to emphasize it is that spell out to your patients what your expectations are for a given therapy, realistic expectations of this is what I think we can do, might be less, might be more but roughly around that.
There are in ... I know in the plant-based space, I know in basically every nutrition camp, there are a lot of exaggerated claims. I don't want to give patients a false sense of where ... No. I don't think I did that with that patient anyway. But I said, "Yeah. I think we can try to tackle this with diet. Maybe we can get you there. We just weren't able to, because her baseline was already so good.
Everything she was already doing at the point that she saw me was quite good. There were a few things here and there that we could work on and ultimately this wasn't enough. I just obviously letting her know that from the outset, be like, "I think we might be the budget a little bit, but maybe not all that much." Can just prevent disappointment on their end.
Dr. Travis Cox (host):
Yeah. That's a good point because, of course, you want to provide hope so that someone's motivated and like committed to that strategy or rolling out for them. But at the same time, yeah, you don't want to have expectations so high and unrealistic that you fall short and they're disappointed, or maybe that they're delaying other types of treatments that might be helpful and ...
Dr. Matthew Nagra (guest):
Absolutely.
Dr. Travis Cox (host):
... expense of this one. That's a little bit tricky. I totally get that. Yeah. With some of your patients that come in and they have this perspective around what an ideal diet looks like, and it's not plant-based. It seems like they might be misinformed about some of the downsides of a plant-based diet. Do you want to just touch on some of the understandings of the literature on anti-nutrients or "anti-nutrients?"
Dr. Matthew Nagra (guest):
Yeah. Anti-nutrients and for actually those who follow me on social media, on Instagram, that I've made many posts about this topic.
Dr. Travis Cox (host):
Great post, on my side. Yeah.
Dr. Matthew Nagra (guest):
Yeah. Thanks. Basically anti-nutrients are a group of compounds that are thought to inhibit absorption of certain nutrients that supposedly lead to harmful effects in the body and whether that'd be nutrient deficiencies, or they might actually have other negative impacts on the body. This is something that I hear a lot, especially from the carnivore community, because they like to talk about how plants are toxic, or plants are ... consuming a plant-based diet it's going to lead to X, Y, and Z deficiency.
What we have to remember is that we can't just look at these compounds in isolation. We can't even look at individual nutrient profiles or anything like that in isolation. We have to look at what happens when you consume a given food and what happens to your health outcomes, what happens to nutrition status or nutrient status and all of that. The three big ones that I always hear about are lectins, phytates, and oxalates. Do you agree? Is there anything else I missing?
Dr. Travis Cox (host):
The probably ones, maybe PhytoEstrin, but those ones I think are the more common ones, for sure.
Dr. Matthew Nagra (guest):
Yeah. Yeah. I know we chatted about this before. There's a really good review that came out in 2020 called Is There Such a Thing as "Anti-Nutrients?" by Petroski, one of the authors. They do a really good job going through every one of these major anti-nutrients. But I think ... You want me to break them down one at a time?
Dr. Travis Cox (host):
Yeah, if you want to go to those three, that'd be great, yeah, those lectins, oxalates, and the phytates, for sure.
Dr. Matthew Nagra (guest):
Yeah. Lectins, let's start with that, because that's ... I've ... Oh, man, I've done articles on this. I've written about this a bunch, spoken about it many times.
Dr. Travis Cox (host):
[crosstalk 00:19:14] They made a little traumatized from it too, hey.
Dr. Matthew Nagra (guest):
Yeah. Yeah. This idea that lectins are toxic ... Actually, before I actually explain what lectins are. Lectins are proteins found in a bunch of plant foods, but especially in legumes and they were really popularized or became infamous is a better word when the book, The Plant Paradox came out. This book talks about how plants are toxic because they contain these lectins and those lectin poisoning and kill you and all those sorts of things.
Well, the primary focus to that book is that, yes, lectins can actually be toxic. Certain lectins can be toxic to you. But what happens is when we cook food, lectins are destroyed. If you are to have beans ... There's a study actually on red kidney beans. If you were to cook beans for just 15 minutes, which is not as long as you typically would, or if you're to cook them in a pressure cooker as well that really doesn't.
You actually destroy all the lectins. They aren't even detectable anymore. Yeah, if you were to eat a bunch of raw or undercooked kidney beans, perhaps you could have some issues. But if you were to cook them adequately and then eat your cooked legumes, it doesn't seem to be an issue anymore. This idea that they're toxic is really based on some cases of lectin poisoning and undercooked legumes, and on what we call mechanistic speculations, as far as lectins can be toxic compounds.
Therefore, if you consume them in any way, they end up in your bloodstream, that wreak havoc and all of that. But when we look at what happens in populations that eat a lot of legumes, there's super healthy. Legumes are one of the foods most consistently linked to longevity and excellent source of protein, various minerals, fiber, and all of that.
Food's a package deal. You can't boil it down to just the fact that, "Oh, it contains vitamins or something like that." Even if we want to go down the root of these effects by ... These specific effects of lectins can have, now, this is very low quality research. I'm not suggesting this to be necessarily the case, but there's actually some data on certain lectins from certain foods, like broad beans, potentially having anti-cancer effects and things like that.
Again, I'm not going to go down that route because again, we have to look at what happens when you eat these foods and when humans eat these foods. But it's just funny because you can apply the same logic in the opposite direction ...
Dr. Travis Cox (host):
Totally.
Dr. Matthew Nagra (guest):
... depending on what you want a cherry pick.
Dr. Travis Cox (host):
Right. I have a quick question there, because my understanding, too, is that wheat germ, glutenins, and gliadin, gluten are in the same category of lectins are those ...
Dr. Matthew Nagra (guest):
I believe so.
Dr. Travis Cox (host):
... also easily destroyed through that process of cooking or heat or pressure?
Dr. Matthew Nagra (guest):
Actually. That's a really good question. Because the studies I looked at where I came of gluten in particular, I would assume so.
Dr. Travis Cox (host):
Yeah. That'd be interesting.
Dr. Matthew Nagra (guest):
Yeah. Yeah.
Dr. Travis Cox (host):
Because of course most people have heard of gluten. Of course, I mean most people, I don't think would assume that those are lectins. But I think that those are of course not all lectins are created equal either in the sense of if it's gluten, of course, you see that disease then, yeah. I don't touch gluten. But in overall healthy populations or people that don't have celiac disease, then of course it shouldn't be as much of a concern. Especially if, like you said, with legumes you're cooking them. Of course, it's not an issue.
Dr. Matthew Nagra (guest):
Yeah. Yeah. Gluten issues are way overblown. Yeah. Celiac disease affects, let's say, roughly a percent or so of the population depending on which population you look at. Then non-celiac gluten sensitivity is maybe a little bit more.
Dr. Travis Cox (host):
Yeah. Let's say not to maybe 10%, that's ...
Dr. Matthew Nagra (guest):
Yeah. Exactly. I would say that is a very high ...
Dr. Travis Cox (host):
I think there's Alessio Fasano was like it's ball-parking it based on his research, right?
Dr. Matthew Nagra (guest):
Yeah.
Dr. Travis Cox (host):
Yeah.
Dr. Matthew Nagra (guest):
I would say that's a very high estimate, like very generous and even then it's still a minority.
Dr. Travis Cox (host):
Totally, 10% versus, yeah, the 90%, the other healthy population.
Dr. Matthew Nagra (guest):
Yeah.
Dr. Travis Cox (host):
Yeah. Got it.
Dr. Matthew Nagra (guest):
Yeah. I think that's really all we need to say about lectins. I don't know if there's too much else just, yeah, legumes seem to be very healthy so we should be eating more. Yeah. Now the next one, we'll go talk about phytates. Phytates are compounds again in a lot of different plants, nuts, seeds, legumes, grains, and that, and they bind to certain minerals.
Again, the thought ends up being, "Okay. Combined to minerals, maybe it prevents absorption of those minerals. Again, I'm going to pick on the carnivore community because they love talking about this how phytates block iron absorption and that. You're going to have iron deficient. Well, we actually have studies looking at various phytate levels in foods and how they affect absorption.
There's one study done on sorghum flour and they found it removing 90% of the phytates in sorghum flour, actually didn't affect the bioavailability of the iron.
Dr. Travis Cox (host):
Okay. Interesting.
Dr. Matthew Nagra (guest):
Yeah. That's one. Another study on young children, I found that 500 milligram per day increase in phytate consumption only reduced zinc absorption by 0.04 milligrams ...
Dr. Travis Cox (host):
That's huge.
Dr. Matthew Nagra (guest):
... per day.
Dr. Travis Cox (host):
That's such a small number.
Dr. Matthew Nagra (guest):
Exactly.
Dr. Travis Cox (host):
Minuscule, yeah.
Dr. Matthew Nagra (guest):
Exactly. It didn't really have anything. Then this is probably the one I love to cite the most.
Dr. Travis Cox (host):
Yeah.
Dr. Matthew Nagra (guest):
There was a study done on postmenopausal women and this found that on 180 postmenopausal women to be specific and they found that phytate levels ... Can't remember how they measured them actually. But their actual phytate levels or associated with better bone mineral density.
Dr. Travis Cox (host):
Oh wow.
Dr. Matthew Nagra (guest):
Eating more phytate rich foods actually were associated with a lower or ... Sorry, a higher bone mineral density, which may end up decreasing risk of fracture in that down the road. Again, there are a couple more studies in this same vein, but really we're seeing consistently that phytates don't seem to have that big of an effect. There are multiple reasons as to why. But one of the reasons that is populated is because as you regularly consume phytates, your gut microbes actually learn to break it down.
Dr. Travis Cox (host):
Okay.
Dr. Matthew Nagra (guest):
If you're regularly consuming these foods that are rich in phytates, they're going to have less of effect over time because your gut's just going to break it down for you.
Dr. Travis Cox (host):
Interesting.
Dr. Matthew Nagra (guest):
Or the microbes in your gut are just going to break it down for you. That's one of the theories. Again, there could be other theories. But when we look at the actual outcomes and whether you're absorbing these nutrients or not, we see that there isn't a very big effect.
Dr. Travis Cox (host):
Okay.
Dr. Matthew Nagra (guest):
Not a huge reason to be concerned about it.
Dr. Travis Cox (host):
Yeah. It was interesting. I mean, honestly I don't remember the research article entirely, but it was alluding to how sour dough, fermented wheat flour is able to help increase phytate activity and break down some more of the phytates. Whether or not that's a good thing, I guess it's questionable. But it sounds ... I think you alluded to other fermentable foods, too, can actually increase that ability.
It's interesting. The whole gut connection, like you said, with the gut microbiome changing over time, too, when you ingest more phytates can be a factor.
Dr. Matthew Nagra (guest):
Yeah. I wouldn't doubt that at all as far as that goes. I haven't read that specific study. But yeah, I wouldn't doubt at all.
Dr. Travis Cox (host):
Yeah. Interesting. Okay. What about oxalates?
Dr. Matthew Nagra (guest):
Oxalates. Okay. This is ... If anyone's heard of oxalates, they've probably heard of it in reference to kidney stones. That's usually where it comes up. There are a lot of claims online. I'll hear about spinach, because spinach is the high oxalate green causing kidney stones and that, or whether it does or doesn't, there's a lot of people claiming that eating spinach will.
Well, that's because the kidney stones are often made of calcium oxalate. They're often calcium oxalate stones. Oxalate being a key component there. However, we actually have research looking at oxalate consumption as well. There was one study on healthy individuals and had them consume 600 milligrams of oxalates per day as rhubarb juice.
Dr. Travis Cox (host):
Okay.
Dr. Matthew Nagra (guest):
This did lead to higher urinary oxalate levels. However, so that suggests that, okay, you can have more oxalates passing through urinary tract, but that doesn't really reflect typical consumption of oxalate. Now, if you were to just be having massive amounts of spinach or other high oxalate foods every day, then it's possible to reach those levels. But remember it was rhubarb juice.
Dr. Travis Cox (host):
Right.
Dr. Matthew Nagra (guest):
It was very concentrated. It is still possible to hit those levels. What we have to look at is do we find that those consuming more oxalates, higher intake of oxalates have higher risk of, say, kidney stones than those consuming less? We actually have data from the Nurses' Health Study, which did find a bit of an association between oxalate intake and kidney stone risk. But it was really just seen in those with lower calcium intake, calcium intake below 755 milligrams.
Dr. Travis Cox (host):
Okay. Got it.
Dr. Matthew Nagra (guest):
When you're looking at those with more calcium or consuming more calcium, the risk was either neutral or even suggested a possible decreased risk, particularly in men.
Dr. Travis Cox (host):
Okay.
Dr. Matthew Nagra (guest):
One of the thoughts there is that calcium can actually bind into oxalates. Maybe it prevents absorption having higher calcium intakes.
Dr. Travis Cox (host):
Okay.
Dr. Matthew Nagra (guest):
That would be suggestion from that. Now, if you were concerned about oxalate intake, you could still soap and boil these foods, a high oxalate foods ...
Dr. Travis Cox (host):
Got it.
Dr. Matthew Nagra (guest):
... and drain out the water and you can ...
Dr. Travis Cox (host):
Eliminate it.
Dr. Matthew Nagra (guest):
Yeah. Exactly. Well, soaking and/or boiling, depending on the food can help ... I wouldn't say completely eliminate, but help reduce ...
Dr. Travis Cox (host):
Reduce it. I got it.
Dr. Matthew Nagra (guest):
... oxalate level. If it was a concern, that's a possible prep method. Also we have to keep in mind that food is a package deal. Again, you're not just having oxalates on their own. We have potassium, magnesium, and that other compounds in these foods that might actually lower stone risk. We have to look at fruit and vegetable or ... Sorry. Vegetable, legume, other oxalate-containing food intake, certain nuts.
We don't see that there's really an association there. If anything, we see that there might actually be the opposite. I would definitely make sure that you're consuming enough calcium, but I wouldn't be overly concern about oxalates and that you're really having high, high amounts or possibly if you have a history of kidney stones and you want to just moderate your intake of it.
Dr. Travis Cox (host):
Right. Yeah. I think that's really appropriate to say is that it's not a one-size-fits-all. It's not you and I are just created the same or not, eating things, digesting things in the same way. Of course everyone has unique needs, unique physiology, but at the same time, like you said, a lot of this misinformation around these anti-nutrients is in this vacuum mindset of these nutrients in isolation.
Then of course it's just not how it works. Like you said, these foods, we are a packaged deal. That's really good to look at that way. Of course eliminate some of the research, too, and make sense of it rather than just reading some book or some blog article that says you shouldn't.
Dr. Matthew Nagra (guest):
Yeah. But again, if anyone wants to find a lot of this, they won't highlight every study I've talked about, but a good overview is, again, that review I mentioned on anti-nutrients which you should link in the description or whatever.
Dr. Travis Cox (host):
I'll definitely should. Yeah.
Dr. Matthew Nagra (guest):
Yeah. I think it's a super easy read for the most part and explains things really well. Definitely suggest that to the listeners.
Dr. Travis Cox (host):
That said, again, there's a lot of information out there, a lot of evidence to support it being a wise choice to be plant-based. But for someone just deciding to do that now, what would be your first bit of advice you'd get them in transitioning from going to a full-fledged plant-based diet?
Dr. Matthew Nagra (guest):
If they're transitioning from a very standard American standard, Canadian diet, I would probably suggest ... I do this with a lot of patients, too. I would suggest to start with one meal. Start with just breakfast. That's usually an easy one or whatever they think would be easiest lunch, dinner. I would start with just breakfast usually.
There are many options you've got, oatmeal, you got smoothies. You can make whole grain toast, tofu scrambles, breakfast wraps, all sorts of different things. Try out few of those sorts of recipes. Try to get in a habit for a couple weeks. Then once that feels like you've really nailed it, then you move on to the next meal, which would be, say, lunch. Do the same thing and then onto dinner and then onto snacks, if you still need to tackle that, too.
Just take it one at a time that way I think you can go all in. I think it's definitely possible to go ... You make the big switch overnight. I commend people who want to do that. But if that is a little overwhelming for some people then, making the slow transition, definitely a good way to go and helps build those habits little by little.
Dr. Travis Cox (host):
I like that. Yeah. Like building a repertoire of these different meals for a particular meal or time a day. I think that's really, really pertinent for sure. In addition to that, what would you advise someone to be aware of as far as any micronutrients they have concern or any specific foods that they should most definitely have in their diet when doing that transition?
Dr. Matthew Nagra (guest):
Yeah. Definitely B12 supplement, a hundred percent, depending on where you live in sun exposure, vitamin D might be a good consideration. Other than that, you might want to consider iodine intake. Again, if you use iodized salt in your cooking, then you could have that covered with as little as half a teaspoon or so. It depends again on the salt and how much is in there.
Those are a few of the main ones I go to. I often actually suggest multi. There are some multivitamins that contain all that. They contain the B12, vitamin D, iodine. They've also got decent amount of zinc, selenium, and a few other potential nutrients to focus. But those few that I mentioned right out the gate are definitely up there as far as ones that I would focus on. Omega-3, potentially, especially if you're not eating a lot of omega-3 sources like your flax, GL walnuts and all of that.
You can take an algae-based source, which is the long chain of omega-3s that you convert, the shorter chain omega-3s into. That's another thing to consider. But as far as foods to focus on, I think there are about five plant-based food groups really that you could try to pull from. I often suggest picking from each of these, trying to include each of these on a regular basis. Daily basis, ideally, that'd be your fruits, your vegetables, which can subsequently be broken down into leafy greens, cruciferous vegetables, and so on, whole grains, legumes, and nuts and seeds.
Those are the five food groups that I often I talk about. Then actually in the nuts and seeds, you can also have oils in there, too ...
Dr. Travis Cox (host):
Got it.
Dr. Matthew Nagra (guest):
... for those unsaturated fats.
Dr. Travis Cox (host):
Got. Go ahead.
Dr. Matthew Nagra (guest):
Go ahead.
Dr. Travis Cox (host):
I'll let you finish.
Dr. Matthew Nagra (guest):
No. I was going to say that's really about it as far as which ones to focus on. Also, a calcium-fortified plant milk, I think, is a really important one to try to include, too. You could get enough calcium from other food sources, but there's just nothing that's going to touch the level of calcium that you can get from a calcium-fortified.
Dr. Travis Cox (host):
100%. Is there any particular foods that are your favorite that you love to enjoy in your plant-based foods?
Dr. Matthew Nagra (guest):
I have oatmeal most mornings. I feel like that's such a common answer. Oatmeal, I do a lot of mornings. It's a good way to throw in a lot of the stuff I'm just talking about, yeah, throw in the flax.
Dr. Travis Cox (host):
Yeah. I do it, too. Yeah. Totally. It's like a smoothie, but like ...
Dr. Matthew Nagra (guest):
Flax, berries ... Yeah.
Dr. Travis Cox (host):
Awesome.
Dr. Matthew Nagra (guest):
Exactly. You can throw everything in there.
Dr. Travis Cox (host):
You do steel cut oats or just quick oats, whatever's easier?
Dr. Matthew Nagra (guest):
I have steel cut.
Dr. Travis Cox (host):
Yeah. Nice. Yeah.
Dr. Matthew Nagra (guest):
I do steel cut, but I mean, rolled is fine, too. I'm not super concerned about one over the other.
Dr. Travis Cox (host):
Yeah. I found these ... Because I often swear by overnight chia pudding kind of thing or steel cut oats. But sometimes I'm in a rush in the morning. I found these quick steel cut oats. I don't actually understand entirely how it's mildly process somehow, but still steel cut oats. But it cooks faster.
Dr. Matthew Nagra (guest):
See, I think I have those, too. I think I get them from Costco.
Dr. Travis Cox (host):
Yeah. Yeah. Exactly. Yeah. Yeah.
Dr. Matthew Nagra (guest):
I think they have the big bags. I think I have those, too.
Dr. Travis Cox (host):
Because it used to be an issue in the past was like steel cut outs like, "Oh, it's great." But it takes 45 minutes to cook. That always a given thing. But other than that, do you have any other foods that you like? I think you mentioned you love ... Or a big fan of tofu or ...
Dr. Matthew Nagra (guest):
Oh, yeah. I love tofu. I do. Yeah. I have tofu every day. Yeah. I have like a block every day.
Dr. Travis Cox (host):
Yeah. Nice.
Dr. Matthew Nagra (guest):
I mean, I do sandwiches often with tofu. I'll do stir fries things like that with tofu or soy curls, one or the other.
Dr. Travis Cox (host):
Soy curls? That's nice.
Dr. Matthew Nagra (guest):
Yeah. You don't know it's like ...
Dr. Travis Cox (host):
I mean, calorie is like an island for vegans. Yeah.
Dr. Matthew Nagra (guest):
Okay. No. Yeah. Soy, they're like these like little soy chunks.
Dr. Travis Cox (host):
Okay.
Dr. Matthew Nagra (guest):
But they're dry and weird in texture, but then you soak them and they plump up and they're very much like chicken and then you just cook them like you normally would. I use it as a meat substitute and it's just pure soy. That's all it is.
Dr. Travis Cox (host):
Okay.
Dr. Matthew Nagra (guest):
It's just like it ... Yeah. It is just soy. It's awesome. They're great. I often will just put them in a frying pan with even something simple, some barbecue sauce and just coat it. Coat them with the barbecue sauce and then put it on a sandwich. It's a sloppy whatever sandwiches. Super good.
Dr. Travis Cox (host):
Yeah. [inaudible 00:37:36] as living under rock, I've never heard of them, but I'll check them out for sure.
Dr. Matthew Nagra (guest):
You can order online.
Dr. Travis Cox (host):
Yeah.
Dr. Matthew Nagra (guest):
I think you can order online. I would highly recommend. I got Simon Hill hooked on him and I think you can order this massive box.
Dr. Travis Cox (host):
Nice. Well, I'll definitely have to give him a go for sure.
Dr. Matthew Nagra (guest):
Yeah.
Dr. Travis Cox (host):
Awesome. Before we wrap up, could you share with our listeners inspirational quote?
Dr. Matthew Nagra (guest):
Inspirational quote? I was not ready to ...
Dr. Travis Cox (host):
Okay. Well, just skip.
Dr. Matthew Nagra (guest):
Then can you tell me the next?
Dr. Travis Cox (host):
Well, maybe I didn't prep you, but any idiom or any mentality for people to go into the plant-based community with?
Dr. Matthew Nagra (guest):
Yeah. I was actually just thinking of a quote, but it doesn't really have anything to do with what we're talking about. Yeah. I often ... One of the things I can leave people with is I think you have to be somewhat forgiving of yourself. A lot of the time, what I'll find is that you'll have patients even who are starting to do really well and then they slip up, one way or another.
I don't even necessarily like the term of slipping up because there's room for everything in a healthy diet lifestyle. But to use that terminology, they'll slip up in one way or another and then they get discouraged and then they fall back on their old habits and so on. That's fine. If you feel like you had a hiccup in your progress, that's totally fine. Just get back up. Do it the next ... Get back to your plan the next day or whatever you're planning to do.
You don't need to be perfect all the time. I have my beyond burgers, too, and stuff. I mean, I've at least avoided the animal products, but I don't eat this super a hundred percent pure whole foods diet. Nobody has to. It's okay to have these other more processed. Not that process has to be a bad thing. But it's okay to have those sorts of foods in your diet.
Maybe you don't want to be smashing to beyond burgers a day every day. But if you want to have it on the weekend or something, or you're at a family gathering or ... I know I'm picking on beyond a bit. I don't mean to do that. But just like in general, it's okay to have your donuts. It's okay to have all that stuff. It's what you do day in and day out that really affects your overall long-term disease.
Dr. Travis Cox (host):
Definitely. No. I could agree more because often, especially if you're thinking about just the pure end of plant-based diets like veganism, it's like you get this sense of you cannot mess up. There's nothing that could be touched by an animal byproduct. That mentality, I think carries over to just not eating anything process, like you just mentioned.
Dr. Matthew Nagra (guest):
Yeah.
Dr. Travis Cox (host):
But it is about progress, not perfection. Yeah. On average, you should be heading in the right direction. But don't beat yourself up about it. I like that. That's a good ...
Dr. Matthew Nagra (guest):
Yeah. If every day needs to be better than the last, you're going to run out of space, then ...
Dr. Travis Cox (host):
That's true.
Dr. Matthew Nagra (guest):
... you can't go. You eventually can't get any more any further on that scale.
Dr. Travis Cox (host):
Definitely. No. That's perfect. Well, Hey, Dr. Matthew, thank you so much for joining us in the podcast today. I really appreciate you joining us today.
Dr. Matthew Nagra (guest):
No problem. Happy to be here and happy to chat about all this.
