Transcript of the No-Bullshit Vegan podcast, episode 50.

Karina: You're listening to the No-Bullshit Vegan podcast, episode 50. Dr. Sarina Pasricha joins me to talk about the gut microbiome. What is it and why is it important, what can we do to improve it, and how does veganism play into the picture?

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Well hello there and welcome to episode 50 of the show. Thank you so much for joining me. I am Karina (or coach K as my clients call me): your no-bullshit vegan fitness and nutrition coach. So, it's now the end of July 2019 and my coaching programs have been full for about a week or so and they're going to be closed for another few weeks at least. So, I'm not currently taking new clients, but do follow me on Instagram @karinainkster or on Facebook where I will post updates as soon as my programs open up again, in case you're interested. In the meantime, don't forget to download your free vegan resources at karinainkster.com so you can get a 350-item vegan grocery list, a 10-day how to go vegan course, an e-book on calories and macros on a vegan diet and a lot more all for free at karinainkster.com. Today's amazing guest is Dr. Sarina Pasricha, a nationally recognized gastroenterologist and speaker.

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Dr. Sarina focuses on the importance of good gut health and the gut-brain connection. She completed her undergraduate training in Biological Anthropology and Nutrition from Harvard University. She then attended Northwestern Feinberg School of Medicine for medical school and she subsequently completed her residency and fellowship at the University of North Carolina where she also received a Master's of Science in Clinical Research. She has published extensively in the most respected gastroenterology journals and has given more than a hundred national presentations. In addition to receiving numerous teaching awards, she has received prestigious awards from the Howard Hughes Medical Institute and the National Institute of Health. Dr. Sarina’s favorite vegan meal is tofu scramble. Now she and her family are actually in the process of making the long-term transition to a vegan diet. We discuss how they are making this work and why they started. We also discuss all things gut microbiome. What is it, why is it important, how does being vegan factor into the equation? Does exercise help and what do we do that is harmful to our gut health? Here's a little spoiler for you. Did you know that vegans may actually have more resilient gut microbiomes than non-vegans? Dr. Sarina is going to explain in our conversation, so let's get to it.

 

Karina: Dr. Sarina Pasricha, thank you so much for joining me today.

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Dr. Sarina: Thank you for having me.

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Karina: I'm super happy to have you here and we are discussing a topic that we actually haven't yet touched on in our show, which is gut health. So, I’m extra excited for some new info and some new insight which is going to be awesome. But before we get into that, actually before we started rolling, you mentioned that you're currently in transition toward a plant-based diet, which is great to hear. So, I'd love to hear how you came to that decision. Was there an event that kind of first made you consider this transition? Like where are you at in the vegan world basically?

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Dr. Sarina: So, I am an adult gastroenterologist and have spent a good amount of time studying nutrition. I studied nutrition when I was in college at Harvard and I've always had an interest in our gut and being healthy and trying to live a healthy lifestyle. But even though I was interested in that and I was studying, I was not living my best, healthiest lifestyle myself during medical training. I was working really crazy hours. We were working like 80 hours a week, day and night, and I was eating very unhealthily. I was eating a lot of meats, a lot of processed food, dairy, you know, whatever I could get my hands on when I was hungry, I would eat. I just never felt as energized as I feel like I should have. I know part of that is I was working long hours, but I think a large part was my diet.

 

During my fellowship training, I became pregnant. I have two girls now. One is three years old and one is five years old. When I became pregnant, I knew that I had to change my own eating habits. I also knew that I really wanted to give my kids a healthy diet and try and do everything I can to make them healthy. Probably a lot of moms can relate as we don't necessarily always take the best care of ourselves, but when it comes to taking care of somebody else, you want to give them everything that you can. So my passage into changing my diet and my lifestyle toward a whole food plant-based diet and a vegan diet really came from my kids because I started to do research and I started to try to understand what type of foods should I be introducing to my kids and when should I be introducing them and how should I be introducing them.

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All of that took me to the medical research. Every article that I could find was basically suggesting that a diet that was high in animal protein and in dairy was a pro- inflammatory diet and can potentially cause a lot of harmful diseases in the future. On the contrary, diets that were high in fruits and vegetables and low in dairy and animal products seem to give adults and kids the best lifestyle, longest mortality and lowest risk for developing chronic diseases. When I started to do that research, I am a scientist and a physician, so I always try to go to the research and the evidence and once you start seeing it and you just start reading article after article, you can't undo that. It changed my lifestyle and I wanted to make sure that I gave my kids a whole foods plant-based diet. So, in giving them a whole food plant-based diet, me and my husband we have to follow that as well.

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Karina: So where are you guys at now? When we were doing our chat before we started recording, it sounded like you’re currently in transition. Is that right?

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Dr. Sarina: That's right. I encourage all of my patients to follow a whole food plant-based diet. But for most people it takes time. It's not like a switch. Now for some people it is and that's wonderful, but for many people and myself included, it can take time for that kind of transition. What I tell my patients is start simple because I want you to have simple sustainable changes. This is not a fad diet or a short-term solution. The changes that I make and other people make really need to be a lifestyle change that you can live the rest of your life with. So, we started with simple things like Meatless Mondays or saying we're going to cut out meat and dairy for lunches and we're going to just start with one meal a day. So, where we're at now is I would say that 90% of the food that we eat is unprocessed whole foods and fruits and vegetables. 10% is still some dairy. We unfortunately have a lot of food allergies in my family, so I am allergic to nuts and coconut as are my kids, and my husband is allergic to chickpeas, peas and soy.

 

Karina: Oh, this sounds like my household, although it's all me. I just have a ton of allergies myself, so I can relate to that actually.

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Dr. Sarina: It is a little bit challenging when you're trying to do vegan diet. So, we often have to make different meals so that part has been a little bit of a challenge. I will say that we're 90% unprocessed and plant-based.

 

Karina: That's fantastic. I totally get the allergy thing. If you need ideas for no nuts, no chickpeas and no coconut, hit me up. I'm cool with coconut, but I'm allergic to every nut except for peanuts. So basically, all tree nuts because peanuts are actually legumes. And also raw fruits. So, I have to cook all of my fruit because I'm allergic to it raw. It's related to the pollen allergies that I have. It’s kind of interesting and I understand. I don't have kids, so you have the added challenge of feeding other small humans.

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Dr. Sarina: But it's good because sometimes it takes somebody else to point something out in your life that you're doing wrong and it can change your life. I actually tell people that I think I'm a better physician because of my kids and I think that my kids have kind of made me a healthier person and have changed how I practice medicine. So, it was a good relationship.

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Karina: Absolutely. A definition of a win-win right there. That's awesome. Very cool. Thank you so much for sharing. I'm certain even with the allergy situation and challenges that you guys have, I'm sure you guys can make it work. I like that you're coming at this from a very long-term approach. Obviously being a Scientist, you're not wanting to make all these changes overnight and then they don't stick. I think that's what a lot of people try doing. They want to do it super fast, but then they're not necessarily long-term. I think the important thing is that we're making changes that we can have for the rest of our lives. So why don't we get into our discussion points? We're going to talk about gut health and gut microbiome and things that affect it, things that are good for it, things that are aren't so great for it. Why don't we start with what is that gut microbiome and why is it important? I personally don't know a lot about this subject, so I feel like I'm going to be learning along with our listeners.

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Dr. Sarina: So, the gut microbiome is pretty much my favorite thing to talk about. I'm excited to educate you and your listeners. I'll tell you why I think it's so important. First off, what is the gut microbiome? This is a community of microorganisms and the microorganisms are made up of bacteria, fungi and viruses. These are all things that actually live on our skin and in our body. So the ones that live in our gastrointestinal system, in our stomach or small intestine, in our colon, that's part of the gut microbiome. What we have learned is that there over 100 trillion of these microorganisms in our gut. When we take it down to like a DNA level, the research has shown that we as humans are actually only 1% human and 99% of our DNA comes from these gut bacteria.

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It's so important that we take good care of our gut microbiome. This is something that we are learning more about in the last 10 years, but what we now realize is that the gut microbiome is really the key and the fundamental property that makes us healthy and contributes to our overall health. We all have good bacteria and bad bacteria. When there is a good number of good bacteria and a low number of bad bacteria, we live in harmony and we all are healthy. But if there is an imbalance and we have more bad bacteria than good bacteria, then research has shown that this can be linked to pretty much every chronic inflammatory condition that you and I can probably think about. It's called dysbiosis. So, the gut bacteria become imbalanced, and this has been shown to be linked to heart disease and heart attacks. It's been linked to cancer, diabetes, arthritis, and even obesity and cancers. All of these things are linked to our gut microbiome and gut health, which is why it's important that we understand what's going on in our GI system. It's not just that you simply eat food and then you get the nutrition and you poop it out of you. That's not exactly what's going on. There's a whole system within our gut that is constantly in play and it's affected by the food that we eat.

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Karina: That's amazing. So now that we have a better understanding of what it is in the first place, what can we all do to improve our gut microbiome? Does being vegan factor into the equation at all? Does exercise help? What are some of the things that we can do to optimize the situation there?

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Dr. Sarina: There is research by Dr. Rob Knight. He did a research project asking this question. He basically collected stool samples from people all across the country and he analyzed their stool samples and he also analyzed their eating patterns, their lifestyle patterns. His question was what is the single greatest predictor for having a good gut health and therefore having good health? He found that the single greatest predictor for good gut health is the diversity in the fruits and vegetables that we eat. Specifically, he found that eating at least 30 different types of fruits and vegetables is going to make our gut health be the healthiest.

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Karina: 30 different types, like just generally in your life or 30 different types within a certain time period?

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Dr. Sarina: That's a great question. 30 different types in a week. So, when you talk about a vegan diet, vegan diets are high in fruits and vegetables, that is the best diet that you can have for your gut. They've also done studies where they looked at people with the typical American diet that's like 60% processed food, 30% meat, dairy, and maybe 10% fruits and vegetables. They looked at people who followed the standard American diet. Then they looked at people who did not eat red meat and processed meat. Then they looked at people who didn't eat chicken and then they looked at pescatarians and then they looked at vegans. There was a spectrum of diets. The research found that as you keep cutting out the red meat, chicken, fish and go toward a vegan diet every single step of the way, you are more likely to live a healthy lifestyle and it's better for your gut health.

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Karina: So, do you know if there's a difference between, I really don't like the term, but let's just use it, junk food vegans and people who eat a standard American diet? Is there still a difference in gut microbiome between those types of diets? Like people who are vegan but eat 60% processed food?

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Dr. Sarina: Yes. So, there's two separate things. Eating processed foods is unhealthy and then eating meat products is unhealthy. In the standard American diet, you're eating both. If you're a junk food vegan, then you've at least cut down the animal products. So, even though you're eating a lot of highly processed foods, it's still healthier than the standard American diet. But you know, being somebody who follows more of a whole food plant-based diet, who is vegan but is not having all the oil, the sugar, the salt, that’s even better. So, it’s a spectrum. I try not to force people to go one way or another, but the research does show that the more unprocessed foods that you can eat and the lower amount of dairy and meat that you can eat, then you will have a healthier gut microbiome.

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Karina: That's fantastic. So, it seems like any step toward eating a more plant diet and a less animal product heavy diet is actually going to make a difference. Now, of course, ideally this would be mostly whole foods, but it's interesting to know that pretty much any transition in that direction is going to make it make a positive difference. So, is there anything else, like does exercise factor in at all? What else can we do here?

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Dr. Sarina: When we eat fruits and vegetables or when we exercise, we produce something called short-chain fatty acids like butyrate. Many people might have heard of that. These short-chain fatty acids actually help to increase the good bacteria that we have. So, diet is important, but also exercise is really important. We usually recommend that people exercise 30 to 40 minutes a day for at least four to five times a week. That's been shown to help with making sure that we have more of the good, healthy gut microbiome that we can produce.

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Karina: Interesting. I did not know that. So, exercising can actually help your gut microbiome? Fascinating.

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Dr. Sarina: As tough as it is to do, this is another reason to go out there and exercise. Just think about it, you're doing this for your gut microbiome, you're doing it for your gut health and you're going to feel better too. The other thing is that serotonin, the happy hormone that many of us have heard about, 95% of that is produced in our gut. So, when we exercise, we're actually making more serotonin as well. So that's making us not only live a healthier lifestyle, but it's also helping us to feel better, be happier and have a lower chance of having depression and anxiety.

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Karina: Amazing. On that depression and anxiety note, I've actually read that exercise can be as helpful as medication, which of course acts on serotonin and sometimes on other things as well for things like depression and anxiety. That's pretty fascinating actually.

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Dr. Sarina: Part of it is because it gets your gut moving and it helps the gut bacteria. Many people can actually avoid taking anti-depression pills if they exercise regularly and eat well. My goal as a physician, even though we're trained to treat diseases, my philosophy is I want to help prevent people from getting diseases and that's why eating healthy, exercising and living a stress-free life as much as possible is so important. I know that's tough and is easier said than done, but doing these types of simple changes can make a big difference and can prevent a lot of these chronic diseases.

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Karina: I love that you're a physician and you're so into the preventative model. I don't know if I'm opening a can of worms here or not, but do you feel like there's not enough of that in the medical field? Like it is a system that is built around dealing with symptoms and not preventing them?

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Dr. Sarina: I do think that a lot of the focus in my training was on the treatment of diseases and illness and really understanding the pathophysiology of why people get diseases and probably less of a focus on the prevention aspect. I hope that that's changing. I do read a lot more articles now and I feel like there's definitely more awareness about what we can do to try and prevent diseases. I am hoping that things are changing and I really do think it is. I know many of my colleagues are trying to focus on prevention. I think part of it is that we didn't even know anything about the gut microbiome and gut health 10 years ago. We knew about this starting in around 2006. So, the more we understand gut health and the gut microbiome and how this influences so many aspects, we're now starting to ask those same exact questions about what can we do to prevent disease and prevent illness? So, I think there's definitely becoming more of a focus on nutrition and lifestyle management and prevention.

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Karina: I would agree. I'm seeing more and more headlines like doctors are prescribing vegetables instead of medications now and things like that, which is great.

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Dr. Sarina: I often see a lot of patients with Irritable Bowel Syndrome which is stress-induced. One of the things that I do for that is I often write a prescription and I'll say you need to take 10 minutes a day for yourself and you need to relax and do something fun that makes you happy and distress.

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Karina: Are you actually writing this on a prescription pad?

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Dr. Sarina: Yes, for some people I have. Actually having that physical paper helps. It makes a difference and some people need more than just my saying, so yes.

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Karina:  I think that's a huge thing. There's some authority level and credibility aspect to getting something physical from your doctor. I think that's huge.

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Dr. Sarina: Yes, so I think we're going to see more of a wave in the future toward going toward prevention.

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Karina: I would agree. Going toward prevention and going toward the plant-based realm, I think.

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Dr. Sarina: Exactly. There's a conference I just attended called Plant-Based Expo and there's a conference that I'm going to next month called PCRM Physicians Committee for Responsible Medicine.  So, the conference I attended and the one I'm attending in the future, the whole premise is focused on a plant-based diet and lifestyle and how this affects gut health, heart disease, mood, depression and obesity. So, it'll be exciting to meet other physicians and health professionals who are thinking these same thoughts.

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Karina: Absolutely. There's a couple of people I know here in town. It's a very small town. I live in Powell River. It's only 13,000 people, but we've got an awesome vegan physician here. She's definitely going to that conference. You'll probably see her there. So, we've talked a little bit about what we can do to improve our gut microbiome. What are some things that are harmful to our gut health? It sounds like eating animal products is inflammatory and is not great for the gut microbiome. Is there anything else that we should try to avoid?

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Dr. Sarina: The biggest harm to our gut microbiome is the use of antibiotics and taking antibiotics. I recommend that people should take antibiotics when they need to take antibiotics. Antibiotics and the invention of antibiotics added years to our lives, like 10 years. So, it does serve a purpose and it is really important, but it is often being overused overprescribed. So, take antibiotics if and when you need to, but if you don't need to, try to avoid it because one course of antibiotics, for example, Ciprofloxacin, which is a common one that many people might have heard about, it's often used for urinary tract infections. One, 5-7-day course of antibiotics can change the gut microbiome for several years and potentially forever because now you’re selected for antibiotic resistant bacteria. That just creates this dysbiosis and this imbalance in the good healthy bacteria that we talked about. That can potentially put you at higher risk for developing chronic inflammatory diseases. So, try to avoid that if you can. One of the things we are realizing, and I know we talked about avoiding animal products and meat, but many meat products contain antibiotics because the animals are getting antibiotics. So, if you at least cut down the animal products, you're avoiding the antibiotics that way. Also just be judicious about when you take the prescription pills.

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Karina: So, as a non-doctor non-researcher, how do I know if these medications are actually necessary?

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Dr. Sarina: You just have to trust your physician and trust your doctor. I work at Christiana Care Hospital and we have a program where we are educating all the physicians about the proper use of antibiotics and we monitor it. I think that’s also true in other hospitals as well. We know that there are potential risks. Antibiotics are helpful for bacterial infections but they are not helpful for viral infections because that is one thing is that I do get patients and I know other physicians get patients who feel really ill and they ask for something to help them feel better. They sometimes get upset if you don't give them antibiotics because like you're not helping them, but the truth is we're not giving you antibiotics because antibiotics have a risk and they might not help in that certain condition. So, I think trusting your physician and you can always ask your physician to, if you want to make sure, just say, “is this absolutely necessary” and then they'll let you know because it's not necessary for viral issues.

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Karina: In that case it's probably detrimental overall it sounds like?

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Dr. Sarina: Exactly. Like I said, more people are now having an awareness of this. Both the public and physicians are having an awareness about some of the harmful effects.

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Karina:That's great. That's really cool that you're actually in the world of educating other physicians on this topic. I think that's very important.

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Dr. Sarina: We had an infectious disease conference at Christiana Hospital a few months ago and because we are now realizing the importance of gut health and these gut bacteria, they asked me to speak on this topic. So, it was a little bit unusual that I was a gastroenterologist talking to people in the infectious disease realm, but now we're knowing it's all inter-related.

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Karina: Interesting. This is really cool. This is all totally new information to me. I don't know why I haven't really looked into this in-depth. Is this because it's relatively new information? Most people don't know how important the gut microbiome is?

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Dr. Sarina: I think so. I think that you're going to continue to hear more about it and now that we've talked about it, you might even have more awareness when you're reading other things because the gut microbiome is a huge topic. It really is being considered an additional organ now, just like the liver, the brain, the muscles and the musculoskeletal system. I think you're going to hear more about it as we realize just how important this is.

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Karina: We've all heard the basics. I think most people know about the antibiotic thing, about how that can impact our gut microbiome and create resistance and that kind of stuff. Or just general gut health We all know people have issues like IBS or Crohn’s, but just overall that the fact that being vegan helps our gut microbiome, what we can do to avoid issues, what we can do to improve it,  I feel like not a lot of people in my world, which is very fitness related but still nutrition, not a lot of people are talking about this for some reason and it seems like it's very disproportionate to how important it is.

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Dr. Sarina: Well I have. I'm all about shouting it from the rooftop. I'm like “this is important.” When we talk about antibiotics and how that alters the gut microbiome, there was a research study that looked at vegans specifically and they found that the gut microbiome of a vegan is more resilient. So even after a course of antibiotics, their gut bacteria are more likely to normalize faster than a non-vegan. It's definitely important, what we're putting in our body and what we're doing. The other thing I see a lot of patients who have obesity and they want to try and lose weight. I'll tell you a really cool study there. There was a study done at Harvard about five years ago. They took a pair of identical twin adult females; one was obese and one was thin. They took the poop samples from those twins and they put the poop into mice. These mice lived in the exact same environment. They're called germ free mice. They ate the same food, same everything. They found that the twin that was obese turned those mice obese and fat, and the twin that was thin, the poop transplant turned those mice thin. Crazy! So, it's just an example that goes to show you. People come to me and they say they are eating healthy and then I have to delve into what are they eating, because the gut microbiome and those gut bacteria play a large role in if we are thin, lean, obese, muscular, it affects all of those things.

I know in the fitness world that's clearly very important. I tell people you have to take good care of your gut microbiome. We talked about the diversity in fruits and vegetables. Sometimes people come to me and they're like, I eat really healthy, but they're basically eating the same thing every day and they might have a kale salad. Even if they're eating healthy, they're having the same thing every day. I tell them that that's actually not the healthy as you want a lot of variety in your food, so there's a lot of changes that can made, they can change those gut bacteria to change your body shape even.

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Karina: That's amazing. I'm assuming that all the things we talked about to improve your gut microbiome, those are also going to affect just generally physique outcomes. Is that right? So, there's nothing we have to do specifically if we feel like gut microbiome issues might be leading to one body type or another. If we're supporting it in a way that is productive, it's going to help.

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Dr. Sarina: Yes, I think taking good care of your gut health and your gut microbiome is the first step. Of course, you can change your physique based on exercising and that's largely based on what type of strength training or cardiovascular training you're doing. But I see people who exercise regularly and still are unable to lose the weight and often it's because they might have had multiple rounds of antibiotics and they've kind of ruined their gut microbiome to some extent. And then we talk about eating fruits and vegetables. You can also increase your fermented foods. Fermented foods are great for gut health, so examples of that are sauerkraut or kombucha. These are really healthy for quickly turning over your gut microbiome. In some rare cases, some people even might have to take a probiotic, but the research on that seems to keep varying. So, I don't routinely recommend any supplement or probiotic in general. I just recommend fermented foods and fruits and vegetables.

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Karina: Nice. Well good to know. I'm on the right track because I eat sauerkraut literally every day.

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Dr. Sarina: That's so great. One thing I'll tell people, if you're not used to fermented foods, don't go from nothing to a lot all of a sudden because some people can get bloating and gas if they do that too fast. So, go slowly and work your way up. It sounds like if you've been doing it for a while, so you've probably worked your way up and are able to eat a lot, but for others, if they're not used to some of those fermented foods, go slow.

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Karina: Well that's good advice. I wouldn't have considered that because I'm so used to it at this point. I don't even really think about it. But that's a good point. Okay, so one more thing before I let you go. I'm very interested in how stress affects everything we're talking about. What is the role of stress in or on our gut health and what can we do to optimize the situation?

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Dr. Sarina: That's a great question because stress can negatively affect us in so many ways. Of course, when I talk to my patients, it's also the hardest thing to change. You know, we have more nerves in our GI system than in our spinal cord? In fact, there's five times more nerves in our GI system than our spinal cord. So, there are a lot of nerves in our gastrointestinal system. When we get stressed, anxious, worried, depressed, it affects our GI tract. This is why many people get irritable bowel syndrome. You can get abdominal bloating, cramping, diarrhea, constipation. Irritable bowel syndrome is actually the most commonly seen gastrointestinal disease that we see in the office. Most often it is stress-related. I write a prescription sometimes for people to take time for themselves because we have to all of us learn how to do yoga and meditate and relax and take time for ourselves in this hyper stressed out environment that we all live in because our gut will pick it up before any part of our brain does and any part of our body does and the gut is actually considered the second brain for that reason. So, that whole gut instinct concept is real and it has medical evidence to support that.

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Karina: That's super interesting. I think a lot of people will just inherently know the connection. When I'm stressed or anxious and I have anxiety, then my whole digestive system is off. I didn't eat for three weeks when I had a crazy, what I now call the anxiety shit storm recently, which was totally new to me. But it was basically high-level anxiety, panic attacks, et cetera. I just couldn't eat. I feel like there was such a connection between my gut and my brain. It really put it into perspective for me.

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Dr. Sarina: Yes, because the gut will sense that anxiety and sometimes that stress and anxiety starts in the brain first and then goes to the gut and sometimes it starts and gets sensed in the gut and then goes to the brain. But you're right, there is a brain-gut connection and we used to think there was a brain-gut connection, but what we have found is actually there is a brain-gut microbiome connection and all of these things are related. So, it's important to just make sure that you take good care of your health from what you eat and how you treat your body and how you think about things. It's all related.

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Karina: I think one of the main themes here is that all of these things are so related and if you're doing things like being vegan and mostly whole foods and managing stress and exercising and all the things we're supposed to be doing anyways, right.

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Dr. Sarina: Right. You probably heard your family tell you when you were growing up and it's all those really simple things that somehow has gotten lost as a lot of us got have gotten older that we just need to kind of go back to the basics. These are not crazy concepts and crazy ideas. These are really simple solutions that we just need to kind of go back to though living a healthy lifestyle.

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Karina: I also think that a lot of people get caught up in details like the fad diets, like all this detailed, what do I eat at what time and how many grams and how much protein do I need to get at breakfast, lunch, and dinner, and just all of these detailed things as opposed to thinking about things in broad terms and just eat as many plants as you can. It can be as simple as that. Right?

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Dr. Sarina: Totally. I actually see a lot of patients come to me and they're stressed out because they're trying to follow some sort of really rigorous, strict diet and they're trying to be healthy by following that diet. But the stress that they're placing on themselves is actually negatively harming them. There's a lot of bad diets out there, and that's why even when I talk to people now, I tell them to go toward a plant-based vegan diet. I tell them to go slowly because I don't want to stress them out and I don't want that to put unnecessary stress on themselves and everybody has to do it in their own journey. But once you know the science and once I talk to my patients about it, then I hope that they also see the medical evidence behind this and they feel that desire within themselves to make these small, simple changes so that they can live a happy and healthy life.

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Karina: Absolutely. That's fantastic. This is a super interesting concept. I feel like we could talk about this in multiple more podcasts episodes. But what you have told our listeners is a good place to start. We just talked about simplifying things, not over complicating things. What are some hands-on tips that you have for our listeners who just listened to our conversation, who want to make some changes but they don't really know what to start with?

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Dr. Sarina: One simple way is to eat 30 different fruits and vegetables in a week. So why don't you start by keeping a log of the fruits and vegetables you eat and just start counting and see how many you get. What I find is that if you start keeping a list of the fruits and vegetables you're eating, you'll soon realize, I'm only having 10 in a week, or let me up it and I'll go to 15 or 20. The first thing is just knowing where you are right now. If you don't actually know how many fruits and vegetables you're eating, it's tough to even reach a goal. So, eat fruits and vegetables and a variety of them too. I think that if you are able to do this with a friend, a loved one, a family member, I do think that makes it easier and it'll make it more likely to stay.

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I was on this journey toward going whole foods plant-based and I have a little bit of control over what my kids eat since they're young and I'm buying their food and making their food. I really also had to get my husband on board with this pathway too because if you have somebody who is a really heavy meat eater and somebody going plant-based, it's a little bit more challenging. So, if you can do it as a family unit or with other friends, that helps. I think the third thing is to incorporate fermented foods. That's something that's pretty easy to do. Just taking a spoon of kimchi or four ounces of kombucha in a day is an easy thing to add to your diet that can be low stress and help your gut health.

I think also just be mindful, that's my last piece of advice. I think being mindful of what you're eating, how much you're eating, how you are eating, if you're eating standing up, stressed out because you're running late and you're eating on the go, your body processes that and your gut health processes that in a very different way than when you are sitting down taking time to chew your food and you're eating in a more happier more happy or relaxed environment. So being mindful of what you're doing can actually go a long way.

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Karina: Absolutely. I think that goes for our lives in general too. Just being mindful all the time would be ideal, wouldn't it?

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Dr. Sarina: Yes, that's the ideal. That's something I'm working on too.

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Karina: It's my current project among many others.

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Dr. Sarina: Exactly. But we all can improve on that, I'm sure.

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Karina: Oh yes, absolutely. Well, it's been fantastic speaking with you Dr. Sarina. Thank you so much for coming on the show and sharing your expertise and your tips. We're going to have show notes that our listeners can go to and we'll have links to your social media there. Is there any sort of research that you could send over? We've talked about a lot of different studies, so if you're up for providing a couple of links, we can add those to the show notes. There was one that in particular where you're talking about the difference in gut microbiome between people who are vegan and people who aren't. There were a couple of studies you mentioned there, so that would be super awesome.

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Dr. Sarina: Yes, I think it's on mortality as well. I'll send over those links.

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Karina:  It was great speaking with you. Thank you so much. I'm so happy we got to have this discussion. Thank you so much for joining me on the show. Check out our show notes at Nobullshitvegan.com/050 to connect with Dr. Sarina and to access the research studies we mentioned in our discussion. Thank you so much for tuning in and I hope you join me for my next episode all about alcohol. Thanks for listening to the No-Bullshit Vegan podcast at Nobullshitvegan.com.

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