Dr. Nadia Saleem discusses and debates the merits of the ketogenic, paleolithic and vegan diets. Learn about how a personalized approach can be used to find your “optimal” diet.
Episode 16: What is the best type of diet? Keto, paleo, vegan?
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[1:53] Dr. Paul Hrkal: Welcome back to Supplementing Health. I’m your host, Dr. Paul Hrkal, and I’m really pleased to be joined by a close colleague and friend of mine, Dr. Nadia Saleem. She’s a naturopathic doctor. We actually work at the same office together, and we’re going to talk all about what diets are the best for certain things.
[2:13] We’re going to talk about food allergies, and we’re going to break down the pros and cons of certain diets. If you have certain questions about what diet works for weight loss, if you have questions about what diet works for pain and arthritis or autoimmunity, that’s our goal about breaking down all these different diets and some of the information and a lot of misinformation. Dr. Saleem, welcome to the show.
[2:34] Dr. Nadia Saleem: Thank you for having me.
[2:35] Dr. Paul Hrkal: Yeah. It’s been something we’ve been talking about for a while, and we had a great conversation a couple of months ago about diets.
[2:41] Dr. Nadia Saleem: In a sauna.
[2:42] Dr. Paul Hrkal: Yeah. I know. We were doing some detox together at a clinic event, and it was just a great topic. I think a lot of people have tons of questions about it. We’re both active on social media. People are wondering: what is the best type of diet to eat. Maybe a good way to start off with is, tell me your approach with your patients because you’re a clinician, and then we’re going to go from there.
[3:05] Dr. Nadia Saleem: My approach is very specific to my patient populations, so my area of focus would be hormonally frustrated and mismanaged people. People are presenting with a lot of fatigue, a lot of digestive concerns, autoimmunity – that’s something we actually uncover with a lot of my patients.
[3:24] My dietary approaches – let’s really, while we’re working on all the other pieces of health, let’s take away one of the biggest sources of inflammation that we have in our body, and that is our input, so that would be our diet. I usually tell people as they start working with me, diet is non-negotiable, and that we are going to make some changes, and we have to do that to see the results that we want.
[3:48] What that means for everybody is very different. Generally, I am starting people with a hypoallergenic diet or an anti-inflammatory diet. The reason we start there is we want to understand what foods may or may not be working for people. People who are coming in to see me, they’re doing so because they don’t have perfect digestive health. Right?
[4:07] Dr. Paul Hrkal: Of course. Who does? There are very few people that do.
[4:09] Dr. Nadia Saleem: Absolutely. Over and over again that I’ve seen working with hundreds of people, there are certain foods that do tend to cause more inflammation for people, so there are certain things right off the bat that I do remove from a person’s diet. We do that for about three to six weeks, and then we start reintroducing the foods and see how people feel.
[4:31] If there is an element of autoimmunity, if we’re dealing with Hashimoto’s, which is something I see a lot of in my practice, there are certain things that we absolutely take out. So gluten and dairy would be big triggers there, and there’s a lot of research to show that gluten encasing proteins do have cross-reactivity with proteins in the thyroid, so our immune system starts attacking the thyroid as a result. So there are certain conditions where we are a little bit more specific with the diet, but outside of that, it’s moving to an anti-inflammatory diet for most people.
[5:06] Dr. Paul Hrkal: So you’re talking a lot about foods that cause inflammation, removing some of those foods. That sounds a lot like the elimination diet. Maybe a lot of our listeners have heard that before, and they’ve heard, “If I eat dairy, if I eat wheat, it causes inflammation.” But can you break that down more? Why does eating a food result in inflammation?
[5:30] Dr. Nadia Saleem: That’s a great question, and yes, the hypoallergenic diet is the elimination diet. When we look at foods and foods causing inflammation, it actually goes a few steps back to digestive function and digestive dysfunction. What I mean by that is, a lot of us over time have compromised our gut microbiome. Because of stress, because of medications, we may have taken, we now have a reduced capacity to break down and digest foods.
[6:04] We also live in a world where we are stressed out. We are eating on the go. We’re not taking our time to eat, and we’re not activating digestion. So, in that case, what’s happening is, there are foods that are getting in, and they’re irritating our intestinal lining. Those proteins are then getting into our bloodstream and creating these immune responses in our body that creates inflammation. It’s not that food is evil, it’s that there are other reasons why now foods have become triggers for us.
[6:33] Dr. Paul Hrkal: Right. Definitely, in my practice, I see the same thing. I have this conversation all the time with patients. There are some usual suspects that come up all the time. Wheat and wheat proteins such as gluten and gliadin, they are ones that are very common that we see in our practices.
[6:53] The research supports a lot of this. I was just at a conference where I saw one of the pioneers in gut permeability, Dr. Alessio Fasano, and he came up with this whole term of zonulin. You know zonulin.
[7:09] Dr. Nadia Saleem: Yeah, absolutely.
[7:10] Dr. Paul Hrkal: This is that little marker that when your gut becomes more permeable, aka leaky gut, it releases zonulin. He was talking that gluten is a big trigger.
[7:21] Dr. Nadia Saleem: It activates zonulin. Yeah, absolutely.
[7:24] Dr. Paul Hrkal: There is biochemical research that scientists are now coming out with more and more. Let’s talk about some of those usual suspects, the ones that you’re seeing all the time with patients, and unfortunately, they’re the ones that people eat most often.
[7:38] Dr. Nadia Saleem: Absolutely, and that’s probably a big part of the problem because we’re overeating, overconsuming these products. Now, gluten, for me, if anybody follows me, everybody knows I’m, yep, totally, we take away gluten. That is always a big suspect. But actually, I’m going to take a step back and, yes, for autoimmunity and for certain conditions, gluten is a big trigger.
[7:56] But for a lot of people, it’s not even necessarily the gluten. It’s what the wheats or what the grains are sprayed with. We know that there’s a ton of research now going into glyphosate and how glyphosate leads to leaky gut and inflammation in the gut. So, it may not just be a gluten problem, but it is a grain or wheat problem and what the wheat is sprayed with.
[8:16] That’s one of the usual suspects. Dairy is quite a usual suspect, especially in North America. I’m sure you also have a lot of patients who also say, “We go to Europe, and we’re perfectly fine. We come back here, and it’s back to the bloating, the gas, and all of those issues. So, those two, at least in North America, we do take away.
[8:36] Another one is corn. Corn is highly genetically modified. It’s highly inflammatory for people. That’s another one that goes. Outside of that, soy is another one we take away for a little bit, and we see how people deal with it. In addition to that, now we’re getting to more of the anti-inflammatory piece where these things may not be big triggers, but they are going to compromise our digestive function: things like rancid oils. We clean up the types of oils that people are using. We clean up the type of salt people are using.
[9:05] Dr. Paul Hrkal: Very little processed foods, basically. All the stuff that is just full of things that are highly refined, and therefore are making them more obnoxious to our gut lining and tissues in our body. Right?
[9:21] Dr. Nadia Saleem: Yeah, absolutely. That’s the premise behind the elimination or the hypoallergenic diet.
[9:25] Dr. Paul Hrkal: I think that a lot of people understand that, and then it’s hard for them to follow through. So, what are some key tips and tools that you tell your patients that, “I’ve just asked you to be gluten-free.” “How do I stick to this?”
[9:39] Dr. Nadia Saleem: The first thing is, nobody ever walks out of here with just saying, “You’re going gluten-free, and that’s it.” There is a lot of support with, “Okay, we’re taking this out, but these are the things that we need you to bring in” because never are these diets calorically restricted, and they’re meant to be nutrient-dense. So, there’s a lot of education that goes behind, “Don’t just take stuff out. This is what we need to bring in instead.” So, there’s always a focus on bringing in whole foods, and people do leave with that education.
[10:07] The biggest thing I would say, the one thing that either makes it or breaks it for people is having support. The more support you can have with your family, with your friends, get people on board to support you through the process because it’s never easy making these changes, and I totally respect that.
[10:24] I think you and I are in the round; we’re used to it. This is our lifestyle. We’ve seen this over and over again, but for the average person, it can be very challenging. So, the biggest thing I say is, “Yeah, bring in your spouse. Bring in your kids. Let’s have that conversation together about how we’re going to navigate the diet. Then we go from there.
[10:42] Dr. Paul Hrkal: Obviously, sticking to whatever the recommendations are, are challenging for some people. As you said, in our experience, once you understand the principles and then understand the food options, yes, the first couple of weeks there is some trial and error, and there’s some, “Ah, I didn’t realize that had gluten in it.”
[11:01] So, there’s a lot of label reading, and there’s a lot of exploring new recipes and seeing what recipes also fit with a family’s tastes. Also, people are worried about budget too, and people are concerned about food. There are solutions for each one of those. I think that’s why working with a naturopathic doctor is really helpful.
[11:24] But I think that there are a lot of resources out there that are available for people. Whether it’s a cookbook, or whether it’s some of the solutions with some of these programs. What would say some of the most common pitfalls are for people that are trying to stick to, let’s say, an anti-inflammatory diet and that derailed them?
[11:47] Dr. Nadia Saleem: The biggest things I see are, “I have a vacation coming up,” or “I have an event coming up.” People see it as an all or none. I think that’s a big issue that we need to navigate. We need to get out of the mindset of either I’m on it, or I’m not. We work with people to say, “Hey, that’s okay. You’re going to have times in your life where you’re not going to be able to stick with it, and that’s okay. We just move through that.” What are the best options we can find for you? It’s a lot of education.
[12:16] The other pitfall I see of people not being able to stick to it is, they now dove into the gluten-free world that’s chocked full of process foods, and they’re getting sicker and sicker. Then they think, “Well, this isn’t working,” so they come right off of it. It’s also a lot of education around what does it mean to go gluten-free or dairy-free or whatever the food group may be, and a lot of education around things to look out for and things to avoid.
[12:43] Dr. Paul Hrkal: Just because it’s gluten-free or whatever –
[12:46] Dr. Nadia Saleem: Does not mean it’s healthy.
[12:47] Dr. Paul Hrkal: Yeah. Does not mean it’s healthy.
[12:48] Dr. Nadia Saleem: A gluten-free cookie is still a cookie full of sugar.
[12:51] Dr. Paul Hrkal: It could definitely be that, and a lot of times, what is replacing the gluten is usually another refined grain, so starch and corn and those types of things. So, what you’re saying is the first step to health is identifying foods that you’re sensitive to, and you do that through the anti-inflammatory diet, through the hypoallergenic elimination approach.
[13:13] Some people are able to do it themselves; most will need some extra support. Since this show is Supplementing Health, we look at diet, but we also look at some of the nutrients that we have. During this process, during this time, is there something that people should be doing from a nutritional perspective over and above what they’re doing with their diet in terms of supplements to support this healing process?
[13:37] Dr. Nadia Saleem: One of the biggest things I recommend, and I do usually prescribe as we’re navigating diet is, bringing in digestive support in the form of either digestive enzymes, betaine hydrochloride and ways to support digestion. Then we focus on mindful eating because even if we’re eating very healthy foods if we’re eating in a rush, if we’re not supporting digestion, we’re not going to get the benefits even from the healthy foods.
[14:01] It is a lot of digestive support upfront that we bring in so that as we’re making these changes, we’re really going to support the integrity of the gut lining, we’re going to support breaking down the foods and activating digestion and all of those pieces.
[14:15] Dr. Paul Hrkal: Like you just said, there’s something so simple like mastication, meaning chewing is the first place you break your food down. Think about it. How many times are you chewing? A lot of people are just scarfing their food down, and the biggest macro way of breaking your food down is being missed. We’ve heard that you probably should chew your food 20-30 times each mouthful. Think about it next time.
[14:41] Dr. Nadia Saleem: Maybe three times.
[14:43] Dr. Paul Hrkal: Three to ten, maybe if it’s lucky.
[14:44] Dr. Nadia Saleem: One thing I get my patients to do is I tell them, “We need to activate digestion. I get it. Not everybody has half an hour, an hour to eat every time, but you know what? Even if you have five minutes to eat, eat without any distractions. Limit the time away from your computer, away from your phone, away from TV.
[15:03] Sit down, and it sounds silly, but look at your food, smell your food, and take a couple of deep breaths because you will notice you’re going to start to salivate, as you said. That is the first point of digestion. So, if we can just look at the food and start salivation, we actually tell our stomach that food is coming, and we start activating that digestive process. We start releasing the enzymes that are associated with it.
[15:26] Our stomach doesn’t have teeth, so it relies on that acid to break down the foods. So something as simple as upfront, just taking that time to set up digestion in that way. Take a couple of deep breaths and let’s go into our parasympathetic rest and digest mode and then start to eat your meal.
[15:42] Another thing I tell people is, start your food with something bitter. Bitter activates digestion, so if you have a little bit of arugula, or repine, or something like that, take a couple of bites of that first and then start the rest of the meal.
[15:55] Dr. Paul Hrkal: Any other options that you’d suggest? I know you mentioned digestive enzymes. Maybe arugula or repine may not be practical for everybody. Somebody’s having lunch at their workplace or a cafeteria, is there anything else that you can suggest as tips. I think this is just absolute golden information that people need to hear. I’ll throw one out there: apple cider vinegar.
[16:18] Dr. Nadia Saleem: I was just going to say, yeah, something as simple as apple cider vinegar. I think it’s very easy to keep in the cupboard or in your draw even at work. The way I get people to do it is taking a little shot of it – just one teaspoon in a little bit of water a couple of minutes before you eat.
[16:32] This is very different from – people are usually drinking like a massive glass of apple cider vinegar first thing in the morning. I can’t say I’ve ever had anyone do that. I usually say just do it a couple of minutes before you eat, and that creates an acidic environment, as well. That’s a great tip.
[16:47] Dr. Paul Hrkal: I think you just touched on another point. Don’t drink too much water with your food because it dilutes your digestive enzymes.
[16:55] Dr. Nadia Saleem: Yeah. We actually have a rule of no fluids with food. Eat or drink up until 30 minutes before and start an hour after. Then, in-between mealtime, load yourself up with liquid so that you’re not snacking. That’s the other piece: blood sugar balance. We’re in this world of one, eating constantly, which is not good for blood sugar. Then, we drink way too many liquids with our food.
[17:20] Dr. Paul Hrkal: Yeah. Obviously, the types of liquids, we stick to water, spring or filtered would be ideal. Yeah, I definitely don’t want to be drinking throughout, and definitely don’t need to be drinking fluids that are high sugar. That’s the first thing I tell my patients.
[17:34] Dr. Nadia Saleem: And caffeine.
[17:34] Dr. Paul Hrkal: And caffeine’s another big one, for sure.
[17:36] Dr. Nadia Saleem: Because that’s literally going to block the absorption of nutrients.
[17:41] Dr. Paul Hrkal: Totally. That information is just so important and understanding some of the roots of inflammation. Let’s say somebody presents with what you would consider leaky gut. We talked about that a little bit and foods can potentially cause this. What’s your approach to a leaky gut type of patient, and at what point are you starting to have that therapeutic conversation with them around that?
[18:09] Dr. Nadia Saleem: When it comes to digestive function, one of the things I started to focus on is testing and properly doing stool testing. There are a couple of tests that I really love in that regard, and that can help us discern, where are they in digestive dysfunction? Are we just dealing with, we need to support the stomach acid or the enzymes, or are we now dealing with are organs being compromised? Are we making bile? Are we secreting enzymes? Do we have inflammation in the stomach? All those pieces. Then the next step would be, are there pathogens involved?
[18:47] What we’re finding a lot is, people do have these infections – they have the wrong types of bacteria, potentially parasites, viruses, and that will absolutely contribute to leaky gut. I think one of the big things, at least in my practice is, understanding where we are, and then we can appropriately design that. However, if somebody is at the point where they cannot do the testing for whatever reason, there are still steps we take. Most importantly, let’s get the inflammatory foods out.
[19:13] Dr. Paul Hrkal: So we’ve got that checked?
[19:14] Dr. Nadia Saleem: Yeah. Absolutely. Then I do bring in very specific digestive support that would have certain nutrients like glutamine, aloe vera, a lot of demulcents to soothe the stomach lining, and I do rely on those. Even before I necessarily go to probiotics, I would utilize that approach for the first month or so, and then I would go to the probiotics because we also have to create a really nice lining for bacteria to even stick to. So, those would be some of my approaches.
[19:40] Dr. Paul Hrkal: Yeah. Those are all really, really great, sound, reasonable approaches. Sometimes, you can tell by symptoms. With my patients, not everyone has money to do the testing. If you can test, there are tests available for things like zonulin, which will see if you have permeability. There is research on certain things. You mentioned L-Glutamine. It’s the fuel for the lining of your gut.
[20:06] Dr. Nadia Saleem: And it’s something that most people tolerate really well.
[20:09] Dr. Paul Hrkal: It’s very well tolerated, for sure.
[20:10] Dr. Nadia Saleem: And we can use it in high dose. We can use it very therapeutically, very quickly, and people see results.
[20:16] Dr. Paul Hrkal: Yeah. I like your point about probiotics. This is probably a topic all of its own. Microbiome is huge, and probiotics are good bacteria that we are trying to create some sort of effect in the gut. What the research studies are now showing is that they don’t really change the gut long-term.
[20:39] They have a symptomatic effect, where a lot of people, that might throw them off because they think by taking probiotics they’re somehow changing dramatically the type of bacteria they have in the gut. The research shows very clearly that’s not happening. I’m interested in your approach with probiotics, in general, and how you fit in the whole big buzz on the microbiome are good, are a complete set of bacteria. So, what’s your approach, Dr. Saleem?
[21:06] Dr. Nadia Saleem: One of my biggest things going back to is testing and understanding what the microbiome looks like. My understanding or my take on it is if we’re not testing, we are guessing, and that’s okay. We just have to have that conversation with the patient, “Look. We might have to do a bit of trial and error if we’re not testing.” Even having said that, no test is perfect. Every test has to be taken with a grain of salt and put into perspective with the patient.
[21:32] My take on it is, I do work more on digestion first, work on the leaky gut first, and then I start to bring in probiotics. Most of my patients – I don’t know if this is the case with you, but most people have tried probiotics, and they’ve tried a lot of probiotics.
[21:46] Dr. Paul Hrkal: Yeah, they have, usually.
[21:47] Dr. Nadia Saleem: For a very few people, yes, they’ve worked, and now they’ve stopped working, but for most people, they don’t necessarily notice a big difference, and I think part of that is also that there are so many on the market. So you go to the health food store, you don’t know what you’re going to pick up. You’re going to pick up anything that they recommend to you, but it might not be the right strength for you, it might not be the right dosing. My take is, why don’t we try to do as much as we can through food, and let’s heal the gut first, and then bring in the really good probiotics.
[22:16] Dr. Paul Hrkal: Yeah. I think that’s a smart approach, and more and more clinicians that are up on the research are starting to realize this, that probiotics are not a cure-all for everybody, and they can be very specific for certain actions if I’m doing something to bring down a specific pathogenic bacteria like saccharomyces boulardii with diarrhea and gastroenteritis. But just giving somebody a probiotic is not a solution. You have to do the work.
[22:45] I love the fact that you brought up: start with the whole digestive process from chewing down to stomach acid. If you correct the stomach acid, usually, the stuff below will start correcting itself.
[22:57] Dr. Nadia Saleem: Then we can utilize food. We can utilize fermented foods that much more powerfully versus just relying on any probiotic on the shelf.
[23:06] Dr. Paul Hrkal: So we started off by talking about diets. Let’s get back on that track. Your patient goes through an anti-inflammatory diet. We’ve identified foods that they’re sensitive to. The approach is smart. That’s part of the naturopathic and therapeutic order.
[23:20] First, number one, remove the obstacles to the cure. I love that approach, and that’s my approach, as well, with my patients. Where do patients go after that in terms of the types of diets and foods that they should be eating?
[23:31] Dr. Nadia Saleem: Once we’ve identified what foods are their triggers, the first conversation – and some people actually choose to do the food sensitivity testing, and that helps us identify even in greater depth what the triggers are. The first thing I say to people, especially because their first question is, “Is this the rest of my life?” That conversation becomes, “Well, depending on what the foods are. If we’re dealing with autoimmunity, yes, there are certain foods that we will want to avoid; otherwise, you may have a relapse.”
[23:59] The goal is to heal the gut and get the gut functioning as optimal as we can so that you can get back to eating most of those foods. There really isn’t a good reason why we should be reacting to a lot of the fruits and vegetables and things that all of us are reacting to now. So, the goal is really – I say, “Let’s work on this for about three to six months. Yes, the goal is to getting you back to eating a lot of these foods.”
[24:22] But outside of that, I think there needs to be a mindset shift too. That’s where we have to do the work on educating our population, educating our patients because people assume breakfast should be a sugary cereal because that’s what marketing tells us. We assume that a lunch should be a sandwich because that’s what marketing tells us.
[24:44] So, part of it is a paradigm shift, and we have to help our patients navigate that. It’s a lot of education in that sense that “There’s a whole other way of eating that we need to explore, and clearly, what we’ve been doing up until now hasn’t worked, so let’s try a different approach. Let’s be open to shifting our lifestyle.”
[25:04] Dr. Paul Hrkal: Yeah. The mindset piece you just brought up is so huge. It seems like even in our conversation, that’s a big thing for you, and the patient is like, “What’s your thought process about food? What are your thought processes about breaking that food down and consuming it?” We could probably get in – and we’ll have to save this for another show about what’s the thought process around food and weight, and when somebody’s trying to be on a weight loss plan.
[25:29] Dr. Nadia Saleem: When people are just cutting out carbs, and they’re just cutting out calories, and it’s not working.
[25:34] Dr. Paul Hrkal: That’s right. You have to go through a more logical and more of a holistic approach because you’ll end up, just like, “I’m removing, and I’m creating what I’m removing without actually correcting underlying issues.
[25:45] Dr. Nadia Saleem: And typically, people will go right back, and they binge that much harder on the foods that they’ve removed.
[25:50] Dr. Paul Hrkal: I’ve had many patients that have had these hardcore Atkins-style diets where they have lost a lot of weight, and they’ve put it all back. I think slowly we erode our metabolism, our body’s ability to burn fat normally. Our bodies have this innate intelligence that we are not meant to be overweight. Some people are a little bit more; some people are a little bit less, thinner and thicker, but in general, we are not meant to have this mass adiposity. I think once you figure all this basic stuff out, and I’ve even seen taking off food allergies and sensitivities, weight comes off.
[26:33] Dr. Nadia Saleem: Our body is no longer holding onto water weight because of the inflammation that’s caused by these foods. Yeah.
[26:38] Dr. Paul Hrkal: Bingo. Wonderful. Let’s spend the last little bit here talking about some of the main diets out there.
[26:46] Dr. Nadia Saleem: The hot topics.
[26:47] Dr. Paul Hrkal: These are the hot topics. We’ll do a bit of a lightning round with this. Let’s talk Paleo and give me your notes about that.
[26:55] Dr. Nadia Saleem: Paleo diet is probably one that I utilize the most with my patient population because with autoimmunity, with hormonal issues, it seems to work quite well. One of the big concerns with the people I see is blood sugar management and insulin resistance. I think for that picture, the Paleo diet works very well.
[27:16] What I do love about the Paleo diet is we’re not concerned about counting carbohydrates from good quality vegetables, so that’s a diet that I do rely on because we’re able to bring in a ton of vegetables, some good quality meat, just really hypoallergenic, anti-inflammatory in that perspective.
[27:36] Dr. Paul Hrkal: Yeah. I think the key things for people that have heard about the Paleo are you have good quality meat, lots and lots of vegetables, a little bit of fruit –
[27:47] Dr. Nadia Saleem: I think our diet should be mostly plant-based, and with the Paleo diet, a little bit of good quality organic fruit, good quality meat, and we can’t stress that enough, good quality nuts and seeds, all of those are allowed on the Paleo diet.
[28:04] Dr. Paul Hrkal: That may mean that you have to look outside of what Costco offers in terms of like, organic chicken. There was even a case report with Costco showing that it was no better than anything else. I think this is about getting back to a bit of the roots. We’ve heard the term local, but getting to know where does your food come from. That is a fundamental thing, and we’ve totally advocated that responsibility as consumer of something that is so important.
[28:35] We do tons of research on like, “I want to know where my computer comes from.” Engineers put in, “What are the latest bells and whistles?” We spend more time researching our computer than the food that we’re eating, and that’s such a dysfunction about the way that we think about it.
[28:51] Dr. Nadia Saleem: The Paleo diet is heavier in animal products compared to, let’s say, a vegetarian diet. So, it’s even more important that we know where our food is coming from.
[29:00] Dr. Paul Hrkal: Of course, yeah. We’ve talked about this offline before, but animal products, just for the sake of where they are on the food chain, do have something called bio amplification meaning, if the animal is eating a ton of GMO foods and a ton of foods sprayed with glyphosate, they also are getting this into their system. So we want our vegetables to be organic. You should probably hope the food that you are eating is also organic. Right?
[29:30] Dr. Nadia Saleem: Yeah.
[29:31] Dr. Paul Hrkal: So let’s switch into Keto because that’s another one that’s really popular here. We’ll probably do a show on Keto at some point just all by itself. Again, for those people that haven’t tried it before, give them your notes on Keto.
[29:45] Dr. Nadia Saleem: Keto would be a higher fat, moderate protein, and lower carbohydrate diet. I think Keto diet is the buzz right now, and I’ve had quite a few people come in who have tried the Keto diet, and it may not have worked for them. I think it is an absolutely fantastic interventional diet. I think there’s a lot of therapeutic benefit to it.
[30:05] My concern with the Keto diet is for most people long-term is not sustainable. It’s not something I have my patients go through. When we are relying on a diet that is high-fat and the fats are usually typically coming from animal sources, I’m concerned about the source of our food.
[30:26] Dr. Paul Hrkal: It’s actually harder to find that. There are maybe only one or two butchers, for example, in our neighbourhood. We live in the Toronto area, so you have anything you want. You do have to take that extra step to go find that quality meat. We’ve talked about Keto before, and it’s hard to adhere to. It definitely switches the type of fuel that you use. The goal behind Keto is not that it’s high protein; it’s about high fats.
[30:55] Dr. Nadia Saleem: It’s high fat. Then, in addition to that, we also have to look at how well is this diet going to work in relation to, “What’s your stress level like? What’s your lifestyle like? What’s your sleep like?” If you’re not sleeping, you’re not healing. If your stress is high, even these diets may not work for you the way they’re intended to. So some people don’t thrive on some of these diets for that reason. That’s where we have to look at is this diet going to work for the person sitting in front of us versus this is a great diet for everybody.
[31:26] Dr. Paul Hrkal: And that’s not the case. I think we’ve seen that experience that some people don’t do well on a Ketogenic diet because –
[31:32] Dr. Nadia Saleem: People gain weight.
[31:33] Dr. Paul Hrkal: There’s that. I’ve seen that. I’ve seen people that are totally miserable because of their blood sugar being all over the place, and that has a lot to do with stress. That has a lot to do with insulin. This may help their insulin, but it may not. So there’s that personalization that has to occur.
[31:50] Dr. Nadia Saleem: I also think that’s where looking into genetics can be very helpful. I know AOR has a great genetic test.
[31:56] Dr. Paul Hrkal: Yeah. It’s called MyBlueprint™. Tell us a little bit about some of the key takeaways that you’ve put into your patients’ protocols and genetics.
[32:05] Dr. Nadia Saleem: From genetics, we can see that there are certain genetic variations that people actually won’t thrive on a Ketogenic diet or a high-fat diet because it will increase ghrelin, which is our hunger hormone, and it’s going to increase fat storage. So those people are actually getting more insulin resistance on a higher-fat diet. Without testing the genetics, we just don’t know what that profile looks like for somebody. That’s something where a Keto diet may not work.
[32:31] Going into the microbiome, if we have incorrect types of bacteria that are too high, Firmicutes is one of them in that family. Even then, a high-fat diet is actually going to go against us from a weight-loss perspective. So it really is about understanding what’s going on with the person and then customizing the diet to that.
[32:49] Dr. Paul Hrkal: It’s so fascinating. I was looking at some research recently that is right in line with what you just said. Our microbiome dictates a lot of our metabolism, and it dictates a lot of our propensity to be overweight. There are researchers now that are putting forward the theory that people’s obesity has to do with their microbiome as much as they do with the calories in and calories out and the types of fats. That’s such a fascinating topic that we’ve just had a chance to touch on, but it’s so important to understand that things that affect your microbiome like antibiotics, prescription medications, high stress, eating a really highly processed –
[33:39] Dr. Nadia Saleem: Sweeteners. We went through this whole craze of using NutraSweet and all these sweeteners, and we know now that they’ve destroyed our gut microbiome.
[33:49] Dr. Paul Hrkal: And we also used to think that it always had to do with their nerves, and that may not have anything to do with it more than like microbiome. I find that fascinating. So genetic testing is a tool that gives us a couple of clues on how to personalize. I can speak about mine quickly.
[34:04] For me, I’m one of those guys that I can tolerate carbs really well, and I do feel better when I eat a little bit more of a plant-based, balanced diet. I’ve tried the Keto, Paleo and haven’t felt as great. This is one of those things that it reaffirms.
[34:24] Let’s talk about a vegan-style approach because you get those people coming in. There is research out there that also shows eating a vegan diet has health benefits, especially in the cardiovascular world. I would say in the oncology world, it’s very popular with like the Gerson diet, and a lot of these more hardcore interventional diets. What is your take on a vegan approach?
[34:48] Dr. Nadia Saleem: For my patients, typically, a vegan diet doesn’t work, and the reason is, a lot of my patient population does tend to have insulin resistance. With insulin resistance, we really do need to be cognizant of carbohydrates. Not all carbohydrates are the same. However, a vegan diet typically – and again, it can be done very, very well.
[35:09] For the most part, a vegan diet will be higher in carbohydrates, so for my patient population, it doesn’t always work for that reason. Again, that’s a very specific population. Then, if somebody is on a vegan diet, we always make sure we are supplementing or optimizing their ability to digest iron, for example. We know the most available form of iron is through animal sources. However, you can get it through plant sources. We just have to have very good digestion and digestive functions to be able to absorb it.
[35:38] Dr. Paul Hrkal: In reality, it’s so hard.
[35:41] Dr. Nadia Saleem: It’s hard. Yeah.
[35:41] Dr. Paul Hrkal: I’m a bit biased because I’ve seen a lot of people that are on the sicker spectrum, but I think we’re talking in generalities, so definitely in a perfect world, there is a lot of merit to eating plants. There is definitely some merit to avoiding refined saturated fats and animal meats that are typically agro raised. A vegan diet does do that. But if you are sick, if you have chronic issues if you have autoimmune diseases –
[36:13] Dr. Nadia Saleem: Chronic digestive concerns.
[36:15] Dr. Paul Hrkal: You don’t do well on it.
[36:16] Dr. Nadia Saleem: No. Piling up like the legumes is not going to be friendly for our gut, especially if the gut is compromised. It really becomes specific. For my patient population, and it sounds like the same thing for you, it doesn’t tend to work.
[36:29] Dr. Paul Hrkal: Yeah. Not for the people that are really sick. The other thing to consider from a practical perspective if you want to look at it, vegan is one extreme, and Keto is the next extreme in terms of –
[36:40] Dr. Nadia Saleem: Like the carnivore.
[36:41] Dr. Paul Hrkal: Yeah. That’s another diet. There’s a carnivore diet. We’re not talking about it. I know some people swear by it, but it literally is just meat, and long-term, it’s preposterous to maintain that. I think if we’re looking at the carnivore and Keto on one side and vegan on the other, Paleo is somewhere in the middle, and it’s taking parts of eating lots of plants, and no sugar, no processing, and parts of the Keto of good quality meats. I feel like that’s probably just the easiest for people to adhere to.
[37:14] Dr. Nadia Saleem: For the most part, absolutely. If somebody tolerates greens, bringing in a little bit of quinoa, brown rice, can absolutely be fine for most people. None of these diets are perfect. I think we take them and run with them, but even in the Paleo world, we can get into, “Now, we’re having Paleo cookies, and Paleo desserts, and all that. I think a well-balanced Paleo diet is – we want to get away from the processed foods. Anything that’s processed, we want to eliminate.
[37:45] Dr. Paul Hrkal: Let’s finish off by talking about if a person is on one of these diets, and we want to try one of them. Let’s talk about how you would supplement each person. You’ve eluded to this a couple of times, but I want to clarify it. Let’s start with your favourite. We’ll start with the Paleo diet. What are the key things that people should be supplementing on over and above the types of food choices they make?
[38:09] Dr. Nadia Saleem: Definitely making sure we’re supporting digestion. My go-toes are digestive enzymes and hydrochloric acid. Then, from there, typically on a Paleo diet, we are able to get most nutrients, but fibre, I find people don’t have enough of because we are taking away the legumes and the grains. So, I do get people to do something like ground flax seeds or ensuring they’re getting a good-quality of well-rounded fibres from a lot of different areas because to feed our microbiome, we need lots of fibre.
[38:40] Dr. Paul Hrkal: That’s one of the knocks on both Paleo and Keto is that because you’re increasing animal meats and fats, they don’t have any fibre in them, and you can get deficient because, remember, this is something I’ve been watching closely in the literature, prebiotics and fibre are going to be the new probiotics. They’re already becoming that. We need to fuel our gut and fertilize it rather than just think, “We’ve got to give it probiotics for a period of time.” I love that you recommended fibre. I’m assuming for Keto that you probably would be doing the same thing?
[39:15] Dr. Nadia Saleem: Yeah. Keto, we definitely look at electrolyte balance, as well. That’s one of the areas. We’re making sure somebody is getting enough salt and electrolytes. But definitely, the fibre piece would be the big one.
[39:26] Dr. Paul Hrkal: Probably, I’d add in, as well, you mentioned hydrochloric acid, which helps break down protein, but I’d also probably add in some specific –
[39:33] Dr. Nadia Saleem: Carnitine.
[39:35] Dr. Paul Hrkal: Well, you can do carnitine to stimulate fat, absorption into the mitochondria. That’s a great option, especially if you’re looking for energy and fat loss. I was thinking more along the lines of bile support because of the high fat.
[39:50] Dr. Nadia Saleem: Digestive enzymes always have ox bile. The ones I utilize will always have more bile support.
[39:57] Dr. Paul Hrkal: I just wanted to point out that out so that people understood that. Lipase is the most important digestive enzyme there because it breaks down fat, and ox bile is adding in the substance that’s going to emulsify fat. So, that’s really important. Vegan: what should people be supplementing with?
[40:15] Dr. Nadia Saleem: Iron, B 12, carnitine. I think there are a lot of amino acids that people lose out on when they’re not having animal protein, and the other concern with the vegan diet is, you can get protein, but you have to eat a lot of varying sources of protein to get a complete protein.
[40:31] Dr. Paul Hrkal: Legumes, nuts, and seeds, but you have to eat a lot of them.
[40:33] Dr. Nadia Saleem: All in one meal. We can’t just have a little bit at a meal and consider it done. So with the vegan diet, it really becomes about – make sure we’re having a well-rounded protein, but adding in iron, and B 12, and carnitine, and some amino acids are pretty stable for my patients.
[40:51] Dr. Paul Hrkal: Yeah. For sure. I agree. I would probably add in some of the fat-soluble vitamins because they’re not getting a lot of them naturally. They’re getting a lot of fibre, definitely more than the two other diets, Keto and Paleo, but things like vitamin A, vitamin D, definitely be looking at. Then things like zinc because anything like you mentioned, the B family is going to be – things that you’re going to find in animal meats, but not in vegetables. And if they are in fruits and vegetables, they’re harder and the less bioavailable.
[41:22] Dr. Nadia Saleem: To assimilate.
[41:23] Dr. Paul Hrkal: They’re harder to assimilate. Again, that’s another reason you can do Vegan really, really well, but it takes a ton of preparation and a ton of commitment to be consistent. Hopefully, that gives everybody that’s listening, a really good overview of some of the diets that are available and some of the thought processes of someone like Dr. Saleem with her patients in terms of addressing some of the underlying issues, remove the obstacle of the cure, identify the food sensitivities, and then breaking down some of the pros and cons of each diet.
[41:55] I think the point that we’re trying to make is, if I can be so bold to conclude with Dr. Saleem saying is that there is validity and application to each form of diet. People are going to have to figure out what’s going to work for them in their lifestyle but work with someone that has the knowledge to be able to do some testing to address if this diet is right for you.
[42:19] Then, make sure that we are not blind to anything that we might be missing. That’s one thing that sometimes, we try our best, like, “Oh, yeah. I’m doing my vegan diet.” But, have you had your iron levels tested? Have you been tracking your B vitamins? Maybe you haven’t because you can get it all through diet, but that may not be the case.
[42:36] Dr. Nadia Saleem: Yeah, and I think with any of these diets, there’s such polarization that people really become blind to what some of those deficiencies can be. Yeah, it’s really looking at a well-rounded approach.
[42:49] Dr. Paul Hrkal: And it’s tough to know until you test. Thank you so much for joining us.
[42:53] Dr. Nadia Saleem: Thank you for having me.
[42:53] Dr. Paul Hrkal: This was such a great –
[42:56] Dr. Nadia Saleem: I feel like we can chat about this forever.
[42:57] Dr. Paul Hrkal: And, you know what? We did give it a bit of a superficial look, so we’ll have to, at some point, have you back on as a guest, and we’ll get into some more specifics.
[43:04] Dr. Nadia Saleem: Absolutely.
[43:05] Dr. Paul Hrkal: I’d love to hear more about what you do in your practice with females and women’s health. If people want to find out more about you, where can they find you?
[43:13] Dr. Nadia Saleem: They can find me on Instagram. That’s where I usually hang out the most: Dr. Nadia Saleem, ND. Besides that, you can find me. I’m working in pureBalance Wellness in Port Credit with Dr. Hrkal. I’m in Maple, as well, at the EBL Clinic. That’s usually where I’m hanging out.
[43:28] Dr. Paul Hrkal: Great. Google those two names: EBL Clinic or pureBalance Wellness in Port Credit to find out more about Dr. Saleem.
[43:35] Dr. Nadia Saleem: Or find me on Instagram.
[43:36] Dr. Paul Hrkal: Or check out her Instagram. Nowadays, all the info is there. Thank you so much for joining us. This was really fun. I enjoyed it. We’ll have you back. Thank you, everybody, for listening. This is a great show. Hopefully, you learned a lot, and we hope to have you back on the next episode of Supplementing Health.
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Thank you for listening today. For more information about our guests, past shows, and future topics, please visit AOR.ca/podcasts. Do you have a topic that you want us to cover? We invite you to engage with us on social media to request a future topic or email us at [email protected]. We hope you tune in again next week to learn more about supplementing your health.
[End of episode 44:36]
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