Karina Inkster: You're listening to the No-Bullshit Vegan Podcast, episode 156. Doctors Alona Pulde and Matthew Lederman join me to discuss their nine pillars of health and their new book, Wellness To Wonderful.

Hey, welcome to the show. I'm Karina, your go-to no-BS vegan fitness and nutrition coach. For new listeners or long-term listeners who haven't checked it out yet, make sure you go to karinainkster.com/resources to access our awesome and free selection of nine vegan resources, including a portion guide, protein calculator, and a vegan strength training starter kit. That's at karinainkster.com/resources.

My guests today, Doctors Alona Pulde and Matthew Lederman, combined conventional Western medicine, Chinese medicine, lifestyle medicine, nonviolent communication, polyvagal theory, and trauma-informed somatic principles and pain reprocessing to create their groundbreaking health paradigm. They've been successful corporate leaders, starred in the documentary Forks Over Knives, lectured for eCornell, and served as adjunct medical school professors and corporate medical advisors, and are New York Times bestselling authors.

Alona and Matt's new book, Wellness To Wonderful, is down to earth with relatable guidance and practical advice for a healthy and vibrant life. Doctors Pulde and Lederman bring the book's principles to life in We Heal, a virtual healthcare model built on their book's nine fundamental pillars of health: self, nutrition, activity, play, sleep, family and friends, work, spirituality, and the natural world. As evidence of the model's efficacy, the Florida-based physicians point to results showing reversal of chronic illnesses like type 2 diabetes and heart disease, weight loss, and increased overall well-being. Their favourite vegan meal is spinach lasagna or going out for Ethiopian, which reminds me of one of my favourite restaurants in Vancouver that I used to go to for Ethiopian meals that I really miss here living on the Sunshine Coast. Hope you enjoy our conversation.

Doctors Alona and Matt, thank you so much for coming on the show today and speaking with me. Great to have you here.

Dr. Alona Pulde: Aw, thanks so much for having us.

Dr. Matthew Lederman: Thank you.

Karina Inkster: Looking forward to our conversation, so let's jump right in. What I like to start with for folks who are in the vegan world, because not all of our guests are vegan but most of them are, but for those who are, I love to start with your vegan origin story. So how did you come to veganism in the first place? We're going to talk about the amazing work that you do within this field and how you're helping so many folks get onto a plant-based diet. But I'm interested what your own origin stories are, if they're the same, if they're different, if one of you started. What's the deal?

Dr. Matthew Lederman: I started being plant-based almost 20 years ago, maybe. I was reading a book and I remember halfway through the book I thought, "Oh my God, this book's going to tell me to be vegan." And I tried and I said, "They're saying how great you're going to feel. This is pretty amazing." At the time, I was on an Atkins diet thinking that was really healthy and I said, "Well, let me try it out and see what they're talking about." And I ate rice and beans for a week and I thought it was going to be miserable, but I actually felt great. And I said, "Oh boy, what's going on here?" I didn't want to be vegan.

So then I tried figuring out other ways to get out of being vegan even though I felt great because I wasn't ready to do it. And I tried to prove that I wouldn't get enough protein. I tried to prove that I wouldn't get enough calcium. And after reading about all that, I couldn't prove that. And then tried to prove that I couldn't get it to taste good and I got a vegan cookbook and took me five hours to make vegan French toast. And then I wound up loving the taste of that and I said, "Well, I can't think of any more excuses. I'll do it until I can find a reason not to." And I haven't found one yet and I've really enjoyed it. And then I realized, well, not only the health benefits but benefits in the environment and animals and just so many reasons to do it. And then I don't have a reason not to, so I'm just continuing on.

Karina Inkster: Brilliant. How about you, Alona?

Dr. Alona Pulde: I grew up on a Mediterranean diet. So it incorporated a lot of fruits and vegetables, but by no means was vegan and definitely had a tremendous amount of olive oil and then some animal products. And I struggled with stomach issues growing up and never quite correlated them to foods that I was eating. Maybe to some greasy fast foods and things like that, but not really that anything in that Mediterranean clean diet that was recommended.

And then in my second year of medical school, my father who was 55, also on a Mediterranean diet, he passed away from a heart attack. And it was a sudden death, something completely unexpected, personally absolutely devastating, and professionally. So as well, because I had had a Chinese medical background before and then I went to medical school, I was in my second year of medical school and I couldn't wrap my head around what had happened to my dad. He was on the recommended Mediterranean diet. He did have high cholesterol but was on a statin as was recommended. He maybe was a tad bit overweight but nothing significant, and very active in his life. And I couldn't piece together what it was that led him down that path.

And then I met Matt and Matt was already on the nutrition lifestyle, a vegan path. And the more I read and the more I looked into it, the more I realized what the missing piece was. And it really was going to a whole food plant-based diet.

Karina Inkster: Got it. I'm sorry to hear about your dad and how early that happened. It sounds like it was a catalyst for a lot of what you're doing now with your patients and your career in general. Still obviously a tough thing to deal with, but thank you for sharing. And I am looking forward to talking about the book that you have that just came out or is it coming out still? I can't remember if it's out yet.

Dr. Alona Pulde: Yep, it came out at that.

Karina Inkster: It did come out, okay. So Wellness To Wonderful - can you give our listeners a quick elevator description of what the book is and then we can go into a little more detail around nine pillars and the structure of it?

Dr. Matthew Lederman: It's about changing the definition of optimum health, so shifting it from checking boxes around how much you eat, what you eat, how much you've slept, how much exercise you get, to really defining it as getting to a state of life is wonderful. Not that life is always happy, but that you're connected in a way that you can walk around and say, when someone says, "How are you doing?" you say, "Life is pretty great. I have my ups and downs, but overall fantastic." And we teach people that that's the benchmark. Instead of conventional medical systems tend to get you back to your baseline, even if that's mediocre or awful, and we want to get you all the way up to, "Life is wonderful." And we found that there's nine pillars that can take you there and help you get back there when you get off the path. It's not that you get there and you're done. It's a lifelong journey tending to these pillars. And when you tend to them, you are much more likely to live in this state of, "Life is wonderful," and that's what we're striving for.

Karina Inkster: Got it. That's a little step ahead, a large step ahead, I should say, of what most folks are trying to do in the medical field of like you said, getting people back to the baseline, whatever that may be, what's different for a lot of individuals. So you mentioned nine pillars, and I know some of them are things like nutrition and activity and sleep and things that we might think are fairly clear and obvious, but there's other areas like the natural world and a whole bunch of other ones that are not usually talked about in this context. So what's the deal with the nine pillars? Why nine? What are they?

Dr. Alona Pulde: Matt and I are often driven by our passion and curiosity, and that's how we got into nutrition and the whole food plant-based diet and the lifestyle recommendations that we’ve made for decades. And it's a regular, it's taking personal inventory of where are we and how do we feel and have we achieved the health that we're desiring and are we servicing our clients and patients in the way that we would like? A couple of years ago, we did that whole inventory and there were things that were missing. We optimized our sleep, we optimized our activity, we optimized our diet, and still we couldn't quite come to that, "Yes, life is wonderful," state.

And so we started really taking a look at what's missing? And that's where the nine pillars arose from is what is missing and what would make it feel complete. And it really starts with our nine pillars are an infinity loop and the centre of which lies the self. And really the journey starts with self. It's a connection back to yourself to, for the first time, take that personal inventory.

So many of us are living in this state of survival mode, jumping from thing to thing, checking off boxes because that's what we need to do or should be doing, but never really correlating that to something that we want to be doing. And it could be as simple as, "I have to exercise so I need to go to the gym," whereas you can exercise and get movement in a whole lot of ways that don't involve the gym. "I need to eat kale or broccoli because that's what everyone is saying is the healthiest food." No, there are a ton of vegetables out there that could be more satisfying to you and equally healthy that you might actually enjoy and eat more of.

So really stepping into self saying, "What is it that resonates with me in these areas and in these pillars? And then how do I create strategies to do those activities or those behaviours?" So from the self comes, just like you said, things that we already recognize as things we can optimize on our own, like sleep, nutrition, activity. Play is another one that is really important, and we as adults have really forgotten how to play. But play contributes to health and well-being. And the most significant way is you can't be in a state of fight or flight, in survival mode and anxious, while playing. So it really takes down that state that so many of us are living in on a regular basis.

Now, once you can optimize that which we call our internal world, we can relate to our external world in a way that serves us and brings us more not only health longevity, but more joy. And so that's our family and friends because we feel more resourced. In that investment in our internal world, we resource ourselves and so we can show up for our family and friends differently. We can find the meaning and purpose in our work.

Spirituality is a really big pillar, recognizing that we are not alone and that there is something much bigger out there that connects us all. And then the natural world, which has huge health benefits and is such an important component to bring us that interconnectedness of it's us and the environment and the animals and the plants. And so bringing all of those things together and tending to them, having awareness around them as we go through our lives.

Dr. Matthew Lederman: And it's important I think to note that we talk about nutrition, lifestyle, and connection medicine. Connection, connecting to your external world, is so important for healing and for homeostasis, for our body to do what it's meant to do when it's not fighting a threat. It's connecting. That's how we feel safe, that's how we feel secure. We need those messages of safety for our nervous system which is constantly scanning the external world to say, "Oh, it's okay to digest now. It's okay to focus on rest now. It's okay to reproduce now." You need those messages of safety.

And if we're in this fight or flight or disconnected way of living, our body can't do those things anymore. And it also can't reverse, stop inflammation. Being disconnected, being in a state of fight or flight, high alert is a pro-inflammatory state. So whether you're eating a really unhealthy diet or having unhealthy habits or being disconnected, they all trigger the same physiological state that's pro-inflammatory, the same adrenaline and cortisol, the same pro-inflammatory cytokines. I think it's important that we get across that connection is not just a nice to have, it's an essential part of healing chronic disease.

Karina Inkster: That is a really good point. And I think there's a lot of research out there showing things like loneliness sometimes actually have a larger effect on mortality rates than some of the things we think do like smoking, not exercising, eating foods that aren't giving us good health outcomes. Something like loneliness can have similar, if not more, impact, which is definitely something that should be considered more I think in the medical field.

Dr. Matthew Lederman: Right. And loneliness can be, there's people that are, let's say, they're single or they're disconnected from their family and they're feeling really lonely and they just feel like, "If I could just have some more friends or more relationships, I would be better." But there's an even worse type of loneliness where you have those relationships where you're married and you still feel alone. Because a lot of people don't know how to really connect at that deep, authentic, we call it compassionate authenticity where you can really share what's true for you and do it in a way that keeps the connection cared for and nurtured versus either suppressing what's going on inside of you to maintain attachment or you're sharing what's inside of you and you don't care how it lands so there's almost a harshness to it.

So there's another thing that we've spent incorporating into our healing paradigm, which is nonviolent communication, and it's a really important process and tool for creating the connection that we're talking about, which is more than just going on more dates or going out to dinner with more friends. It's about that deep, authentic connection.

Dr. Alona Pulde: I was going to say one of the things that is also important and sometimes not recognized is in our society today, it really is about burning the candle at both ends. How can we be more productive, more efficient, do more? And we don't associate that to the toll that that takes on our health and wellbeing. And it's really important to consider that in that state of mobilization, in that state or fight or flight, we are creating an inflammatory state in our body that leads us down the road to disease, just like if we're eating an unhealthy diet or living a sedentary lifestyle.

Karina Inkster: Right. Yep, that's a good point. So when you're working with folks in your programs or one-on-one type patients, how does this look in practice? You've got a framework. You have a book that folks can check out. When you're working with someone, do you look at all these pillars at the same time? Do you focus on one and then the next and the next? How does it look when you're helping someone move through these different stages?

Dr. Matthew Lederman: We look at the nine pillars having nine, beautiful, sometimes rowdy children. It's not like there's one that's more important than the other. And it's not that we get them all taken care of and everything's going to be great from then on. It's a lifelong process of checking in and tending to them. And if one child is falling down the steps and the other child is needing help with their homework, I might start with a child falling down their steps. It doesn't mean they're more important. It just means they need my attention more right now. So it's this constant...

And the joy comes from the work. A lot of people think if I get my nine pillars in order, then life will be wonderful. And it's almost like saying, "Well, if I can get all my kids off to college, then life will be wonderful." And it's like, "No, it's a whole lifelong journey." And I make a joke that one way to avoid the work of raising children is to adopt 18-year-olds and then send them off to college. But then you lose all the joy of raising a child but it does get you out of the work. So to me, there's the joy in the work and it's all about tending and being in that present moment with them, not getting to some destination.

Dr. Alona Pulde: And the nice thing is that the pillars are interrelated, so giving one attention then ripples into the other ones. For example, if I am not getting enough sleep and I want to tend to my sleep pillar, but I also want to lose weight and I want to become more active and I want to have more time and I want to show up differently for my family and friends, it all comes together.

Getting enough sleep has been shown to reduce our cravings and our calorie intake during the day. We move toward more healthy foods versus more unhealthy choices. So we're more resourced to make those healthy decisions. We are feeling better and more resourced to actually get out and be active. We are, again, and I'm using the term resourcing because it's so important that again, to contradict that survival state of depletion and exhaustion, it's repletion and resourcing and it gives us the ability to show up differently. So when we sleep, we can eat better. We're more able to be active. We're willing to play. We have more patience and kindness with our family and friends, all of that. We can be more productive and efficient at work, so we're not so tired. So just tending to that one pillar also impacts positively all of these other ones.

Karina Inkster: Right, that's a really good point. With fitness and nutrition and being in that coaching world, we see this all the time where things like sleep are really underrated, actually. You scroll through Instagram or you're on TikTok or whatever and you see all these people doing crazy workouts and you feel like if you're not doing something that's half killing you, you're not working hard enough. And there's this idea out there about what fitness is supposed to be, and nobody ever talks about the basic stuff because it's boring, like sleeping enough, work-life balance to some degree, all these basic pieces, nutrition, which is a huge one. It's the foundation of everything. So I think there's a disconnect between what a lot of people are seeing in social media or even regular media and things that will actually have a measurable impact on their quality of life.

And so a lot of the things that you're talking about, the pillars of nutrition and sleep, they're things that are super important but I think a lot of folks aren't talking about enough. So is that part of what you want to do is to get this education piece out there that, "Hey, it's not just about working out all the time and eating plants. There's a little more to it than that."

Dr. Alona Pulde: Right. Because there is health, there is longevity, and there is joy. And it's just like you nailed it when you said they're not memorable experiences that impact in any significant way our quality of life. We're checking the boxes. Yes, we did that. We did that. We did that really hard workout. Maybe we feel pride. And a lot of times it's just like, "Oh, I was able to do that. I achieved that." And we're focused on achievement and doing, but we don't connect to the being. We don't connect to the joy that something is bringing us.

Dr. Matthew Lederman: A lot of people when they work out are feeling more relief from the guilt or judgment that they give themselves when they don't work out. They're so disconnected and washed. And in general, people are used to looking outside of themselves to know, "Hey, this is the right direction to go," external versus internal motivation. And we really want to cultivate internal motivation, our intrinsic motivation. And when you think that you're supposed to do something, it's not coming from within. It's coming from outside of you. And then if you don't do it, you think you're a bad this or you're unhealthy. You find some label, right? We knew we were good kids because our parents told us; we knew we were good students because our teachers told us; we knew we were good workers because our bosses told us. And we want to change that so that you're not looking outside but you're going to check inside.

What are your needs? "Oh, I have a need for movement." What would bring me joy? "Oh, say I have a need for rest." Okay, so you rest. Most people when they connect to their inner motivation, they're not going to want to just sit all day and do nothing. That's not how - they don't thrive. We have a natural need for movement. We have a natural need to contribute in life. We have a natural need to connect to other people. That is going to motivate us if we can start connecting to that and stop feeling the oppression from external values guiding us, and we can connect back to our internal values.

Karina Inkster: That's a good point. That reminds me of an interesting study that was done one time that looked at motivations for finishing what's on your plate. So they asked folks in North America, "How do you know that you're done eating?" And they said, "Oh, when my friends stop eating. When my plate is empty. When my show ends." And they asked folks in Europe, France specifically, they all said, "When I feel satiated. When my stomach tells me that I had enough food." It was all internal. So the difference between external and internal actually had a measurable difference in outcomes and health markers and things. So I think these things are pretty important.

Dr. Matthew Lederman: And I love that you point that out because it's so important and it's a skill. It's a muscle to develop, to be able to check inside and say, "Am I full or am I just feeling anxiety seeing my plate have food on it and I want to put it in my mouth? What's going on?" And taking it. And it takes a little bit of time, but we can rebuild these neural pathways that create these habits that are leading us towards being overweight or obese and towards having poor health. And your body will direct you if you can step aside and listen versus just be on autopilot and do, do, do.

Karina Inkster: Right. Well, our audience is very fitness and nutrition-focused. So can we do a little deep dive into the nutrition piece? When you're working with someone or if someone's going through your book and they're focusing on the nutrition pillar, what do they have in store for them?

Dr. Matthew Lederman: Well, we like to simplify nutrition. And a lot of people like to make it complicated. And there's a very small subset of extreme athletes that are burning a million calories an hour, but we're talking about the majority of people who are not in that category. There's five key food groups: fruits, vegetables, whole grains which includes your starchy vegetables, legumes, and nuts and seeds. Those are five food groups. And we tell people to eat as much from those five food groups until they're satisfied or eat dishes that you cook with ingredients that are from within those five food groups as much as possible. So either eat those foods directly or make foods using those foods. That's it. Do that until you're satisfied and then stop eating at that point. And if you're hungry twice tomorrow, eat two meals. If you're hungry four times tomorrow, eat four meals. If you're hungry earlier, eat earlier. If you're hungry later, eat later.

We'd really try to simplify and the key is getting as much of your calories from those five food groups as possible. And then the other key is learning all of the habits that you've created that you are now eating in a way that is no longer serving you. And then we have to undo those habits. So like we talked about, eating until your plate is empty versus eating until you're satisfied. When you're stressed, opening the fridge and going into the fridge to deal with that. If you're lonely, if you're sad and you immediately put food in your mouth, which makes sense because chewing and swallowing is actually regulating and calming to the nervous system. But you don't need to use food to calm the nervous system. There's other ways to do it without food. So it's not that we just take the food away. It's that we give them other ways to come and regulate the nervous system. So we try to meet all of your needs but do it in a way that's as healthy and life-serving as possible.

Karina Inkster: That's brilliant and very simplified and not 18 million steps that someone has to follow, and, “there's one right way of doing this,” which is I think a huge problem in the nutrition world, even in the vegan world like, "Here's one correct way of doing veganism, and if you're not doing it exactly like this, then you're doing it wrong," kind of thing. But I think there's a lot of room for individualization here, people's own preferences. And like Alona was saying at the beginning of our conversation, if you're not a kale and broccoli fan, there's lots of other options. It's not like a prescribed diet plan per se, right?

Dr. Alona Pulde: Yeah, that's actually key for success. For long-term success, it has to be palatable. It has to be something that you're enjoying. And if you're not enjoying, you're using willpower and the willpower will eventually give way to default behaviours. One thing that's really important to remember is that there are a variety of choices in those five categories, and there are so many combinations in those five categories. And now online and in books there's so many recipes available, and a lot of them range from super, super easy to the more complicated, depending on your skill and your culinary skills and finding the things that you actually enjoy and eating those. And if you don't like a dish, it's not because it's vegan; it's because you happen to not like that dish.

Karina Inkster: That's a really good point.

Dr. Matthew Lederman: And that's where if you can start connecting to what you like and just connect to what you like and assess that, I'll do that. I'll say, "Hey, you know what? I like this for two days but now I'm not really feeling it anymore," or, "I'm really craving lasagna," or, "Really there's this sweet tooth that's really hitting me right now." And then I try and I eat something and, "Did that meet that need?" Versus, "What am I supposed to eat right now?" A lot of people, "What should I eat? What's healthier?" And to me, it comes back again to those five food groups and figuring out what's working for you and what's healthy.

If you ask what's healthier, I've been asked, "Is it a red apple healthier than a green apple?" Something that I know makes you laugh, but some people, they're trying to figure that out. And to me it's like, "Well, it's healthiest is the one that you'll eat the most of." So if you eat green apples, those are healthier for you. And similarly, they'll say, "Well, what type of salt is healthiest?" And I'll say, "The most expensive one because you'll use the least amount of it."

Karina Inkster: Awesome.

Dr. Matthew Lederman: So I'm trying to increase the health-promoting foods and decrease the disease-promoting foods. But I'm not saying salt is wrong or salt is bad. There's nothing health-promoting about salt, added salt, added sodium. But hey, I'm working with people trying to make this. There's no sense telling them sodium is awful and the devil and then they just hide the sodium from me and don't tell me. I'm really trying to stay connected with them and help them meet their needs, not enforce my needs on top of them.

Karina Inkster: That's a really good point. And I'm going to assume that your approach to activity is the same. I assume the best workout is the one that you enjoy, A, and thus B, can stick to.

Dr. Matthew Lederman: Right. And there's also some information that says, "Hey, it's good to do something with resistance. It's good to do something with balance and flexibility and cardio." But there's lots of ways to do that. And I'll change it up myself. I'll say, "What am I really interested in?" And then if I can tell I'm using a lot of willpower to do this, and I'll sometimes bounce it off Alona and I'll say, "Well, is there something else we can do?" And I'll keep playing around with the workouts until I can say, "Oh, I really enjoy that." But I'm very connected internally to be aware of, "Hey, I'm using willpower," or I'm trying to tell myself, "Boy, I did a good job." If I have that sort of talk like, "I did a good job. I got an A plus for my workout today," that's external versus, "I feel really good and there's no judgment if I did something different but I'm working." Does that make sense? Where we're working together to figure out what is sustainable?

Karina Inkster: Yeah, absolutely. And I think this is another example of where the pillars are all connected, because something I feel is missing from the fitness professional world is we forget how important play is when it comes to activity. So I think we could combine those two along with what you've just said about thinking about internal motivations and continuously reassessing what is working and what you're enjoying and what you're going to stick to because that may change over time.

Dr. Matthew Lederman: Exactly.

Karina Inkster: So I think these are all examples of how the different pillars are connected, which is super interesting.

Dr. Matthew Lederman: Everything will change over time for most people. What I enjoy eating this week is going to be different in a month. Now, there's some basic dishes that I like, but after a couple of days of eating them, I might not want it again. There's some activity I've been doing for a couple of months and you know what? I'm getting a little bored with that. So it's really important to check in versus to clamp down and double down and force yourself to do something you think that's the right workout because somebody told you so.

Karina Inkster: Yeah, exactly. So along the lines of fitness and nutrition and the audience that we're speaking with, I like that you don't have a big focus on what we call outcomes like weight loss, number on the scale, things that we don't necessarily have direct control over. We're talking about actions that we decide to do like being active, choosing our foods. These are habits that we have agency over versus outcomes like whatever the scale happens to say. So at what point or does body weight factor into this at all? We have what we call a weight-neutral coaching practice. So we're working outside the confines of weight loss when it comes to health and fitness and things like this. But I'm curious what your audience or what your patients are coming to you for and what your stance is on BMI, body size, weight loss.

Dr. Alona Pulde: The wonderful part of practicing the way that we do is that those are natural outcomes that result from making the changes that we discuss and suggest and work with our clients on. And the difference though is that the focus is the need. The need is health. A strategy for achieving health is weight loss. You can achieve weight loss in a variety of ways. People can fast, they restrict, they portion control, they deprive themselves. Now, there's so many ways to get down to weight loss but how do you want to do it? In a way that's sustainable and enjoyable? And if we can connect to our need for health, if we can connect to our need for health-promoting nutrition, the weight loss will follow and it will follow in this joyful and satisfying way, not in this painful way that ends up often being just a short-term strategy.

Dr. Matthew Lederman: Right. And you can't trust the body if you're eating the Western diet. So you got to eat the food groups that we talked about, fruits, vegetables, starchy vegetables, whole grains, legumes, nuts and seeds. If you're not using that as the base of your diet, you can't trust your hunger signals that you can eat until you're satisfied and still be trim.

So then people depend on the scale because they have to stop eating before they say they're satisfied in order for the scale to then be the number they want. The only time you can forget about the scale is if you follow these food groups and you eat until you're satisfied and you learn how to connect to your feelings of satiation. And then the scale to me is more of a heads-up, a little check-in once in a while to be like, "Wow, I guess I'm getting a little loose." I'm playing a little fast and loose with going out to eat, let's say, and I'm letting in a little bit more of the foods that fall outside of those food groups. Because it's not that I'm eating 100% from those food groups, but I'm making that the majority of my diet. And sometimes that balance is a little off. So all that does, it doesn't tell me to restrict more as far as how much I eat. It tells me to change the balance of foods within those five food groups and all the other foods that we're faced with day in and day out.

Karina Inkster: Right. I like that because it's not labeling foods as necessarily good or bad. It's labeling foods that we should be eating more of because they're generally more in line with positive health outcomes.

Dr. Matthew Lederman: Correct.

Dr. Alona Pulde: Correct. And those health outcomes are - weight loss is one, but reversing and preventing chronic disease is another. Diseases like diabetes and autoimmune diseases, heart disease, high blood pressure, high cholesterol, so many, arthritis and inflammatory conditions. So many of those also benefit from making these changes.

Karina Inkster: Right. And I think those are probably better markers of health anyways. Just last month, the American Medical Association finally recognized, it took long enough, that BMI is not accurate and was based on a white population of males and actually doesn't apply and is misleading and really, really inaccurate in a lot of cases for people of colour, for example. So finally after decades, we've been railing against BMI for so long but there's now an official recognition that that by itself when you don't take other factors into account, is really not an accurate measure of health.

So what you've just mentioned around chronic disease prevention and other types of outcomes that are not body size, I think those are even more important. There's a lot of research that shows regardless of body size, if you're a sedentary person, your mortality rate is going to be super high compared to people who are active. And there's a study that came out a while ago, I think it was 2014, something like that, that found body size, whether you were supposedly normal, overweight, or obese, had zero effect on mortality rate if physical activity levels were controlled for. So focusing on things like being physically fit is actually more useful than looking at weight loss by itself if we're not taking other things into account. So I do like that there are other factors here. I think that's important.

Dr. Matthew Lederman: Right. I think that's important because I don't know the specific study that you're referring to to comment on that, but I want to do both. I want to say, "Hey, let's look internally. Let's look at our habits in general. But let's not also try and convince ourselves that being overweight can be healthy." I want to make sure that if-

Karina Inkster: Well, it can.

Dr. Matthew Lederman: What?

Karina Inkster: If you're a physically fit person.

Dr. Matthew Lederman: Well then, maybe we have a difference there because I think if you have 30 pounds of extra fat versus maybe you're talking about muscle, but if someone has 30 pounds of extra fat on their body, maybe compared to someone that has 30 pounds of extra fat and is active, there's a difference in disease outcome. But I don't think the person with 30 pounds of extra fat should say, "Oh, my health is fantastic. I don't have to do anything as long as I'm exercising." Because I worry that in order to keep 30 pounds of extra fat on the body, they have to eat certain things that might not be as health-promoting as some of the other things that you could eat where it would be hard to keep on 30 pounds of extra fat, for example.

So I'm not saying that the people that have the extra fat should judge themselves in any way or should label themselves as healthy or unhealthy because I think that doesn't do anybody any good. I think they should say, "Hey, is there a way that I can optimize my health even more than I am right now?" So when someone has 30 pounds of extra fat and they're saying, "I should at least move, and maybe it's really hard for me to change my diet right now," then hey, they're doing something that's contributing to their health. But I just want to make sure we're acknowledging both. They may not be ready to change their diet and there's probably something in their diet that they could change that would even improve their health that much more. Does that make sense?

Karina Inkster: I think so, yeah. I see what you're saying because very often, especially in North America, I'm in Canada, body size is correlated with what we're eating and how many calories we're taking in and how many processed foods we're eating, et cetera. But I do take issue with being trim as the default as the healthy. I don't think that's accurate. And again, because BMI was measured on only white people, it doesn't apply to a lot of areas of the world. So I think yes, I understand what you're saying around the correlation between on a population level, body size and what we're eating, for sure. But we also don't want to make people of a so-called normal weight feel like they're healthy by default, because that's not the case either if they're not active, if they're not eating whole foods, et cetera. So there's two sides, I would say.

Dr. Alona Pulde: Yes.

Dr. Matthew Lederman: And same thing with cholesterol. You could have a normal cholesterol, normal, and still have a high risk of heart attacks.

Karina Inkster: True.

Dr. Matthew Lederman: So to me, it's really about what you're doing for yourself and are you optimizing all of your pillars? Are you eating the healthiest foods you can? And even if some of those foods could be healthier but you're not ready to make that change, I think forcing that change on people is no healthier as either. Does that make... So I think it's really checking in each person, deciding what they can do and what works for them.

Dr. Alona Pulde: Yeah. And I think you're 100% right. A lot of times there are trim people who fool themselves into thinking they're super healthy even though their habits are not. And then that's the person that we hear the story of, "Oh, but they were a runner every day and they were so trim and thin," and all of a sudden they just had a heart attack or whatever it was. So absolutely, it's what we're putting into our body, whether or not we're active.

I talk about that a lot with heart disease. If you think about your body and your arteries as pipes, and we use pills and procedures like Drano to clear those pipes. But once the pipes are clear, if you're still eating the way you did that blocked them in the first place, they're going to get blocked again no matter what your weight is. And so it's really important to remember that. And that's the difference between focusing on weight and then focusing on health. When we focus on health, we can't eat the foods that we eat regardless of whether we're overweight or underweight and call ourselves healthy, but we could still call ourselves trim. Does that make sense?

Dr. Matthew Lederman: Right. And we don't care so much about a specific weight number other than the fact that it makes us investigate and ask some questions. Other than that, to me, the weight number is not that helpful. And even ongoing, the weight number is not that helpful other than getting you to check in once. So if someone's really thin, we're going to say often, I think to your point, they'll say, "Oh, I'm good. I'm thin." And we'll say, "I've seen what you eat and I've looked at everything here and they're not healthy at all." And you're going to be really shocked, to Alona's point, when you come into the emergency room with a heart attack. And then I've seen people that are 40, 50 pounds overweight and they're not healthy either. And then I've seen people that are overweight and they're really healthy and it's muscle and tone and big bones, and they're eating really clean and their labs look fantastic. So to me, weight is really something just to check in around and give you a little bit of information, but don't base a lot of your health on that alone.

Karina Inkster: For sure. I think that's a good construct. It's one piece of the puzzle. We always tell our clients, "Don't weigh yourself unless you're using other measures at the same time." For example, when I started strength training, seriously, I gained 20 pounds. So if all I was looking at the scale or if all I was looking at was the scale, I'd be like, "What the hell's going on here? It's going up." But if you're taking other pieces of info into account, like measurements or your lifts in the gym, your progress physically, photos, how you feel, your blood work, I think together it can form a picture of what's going on. But I do appreciate that it's not the be all, end all. That's the good way of looking at it.

Dr. Matthew Lederman: Right. We have people with cholesterol that will have high HDLs. They call it the good cholesterol. And they'll say, "I'm healthier because my cholesterol went up." But HDL is like the cleanup crew that cleans out and brings the cholesterol to liver and tries to clean out the bad cholesterol and help you out with that. So there's people that either change their diet and they get to a really health-promoting plant-based diet, and their HDL goes down, and then there'll be doctors say, "Oh my God, that's terrible because your good cholesterol went down." But to me, the reason HDL is good is because if you're on an unhealthy Western diet and your HDL reactively doesn't go up to try and clean that up, you're at a disadvantage. So a low HDL on an unhealthy diet, you're worse off than if you have a high HDL on an unhealthy diet. But the other option is to have a healthy diet.

Karina Inkster: Yeah, that's always an option.

Dr. Matthew Lederman: Do you see what I'm saying? So that's another example of where you look at a marker in itself in a vacuum, and it could be very misleading.

Karina Inkster: That's a great point, a marker in a vacuum. That's exactly what weight is usually, unless you're taking other things into account.

Dr. Matthew Lederman: Exactly.

Karina Inkster: So just as we finish up here, can you tell our listeners a little bit about your virtual healthcare model? So it's called WeHeal, and I would love to hear about it and how it works.

Dr. Alona Pulde: Yeah. WeHeal is our virtual model, and it's weheal.health. And we offer classes and courses. We're actually, Matt and I are leading a Wellness to Wonderful masterclass that starts in September. For anyone who wants to join, we'd be happy to have you. And it really is going to touch on the pillars and how to implement them into your lives. In addition to classes, we run classes on nutrition and lifestyle and really touch all of the pillars. There are offerings for individual coaching sessions. We have a nutrition and lifestyle coach and a trauma recovery coach. And then individual sessions with me and Matt are available as well. So lots of offerings, lots of free information and readings to enjoy as well. And delicious recipes from our nutrition lifestyle coach that are worth-

Dr. Matthew Lederman: Who's also a chef.

Dr. Alona Pulde: Yes, who was also a very talented chef, are worth looking at.

Karina Inkster: Amazing. Well, as always, we will have show notes where folks can go and link directly to that. Check it out. And Doctors Alona and Matt, thank you so much for coming on the show. It's fantastic speaking with you.

Dr. Alona Pulde: Oh, thank you so much for having us.

Dr. Matthew Lederman: Thanks for having us.

Karina Inkster: Thanks again, Matt and Alona, for joining me on the show. Access our show notes at nobullshitvegan.com/156. Thanks so much for tuning in.