Episode 55: Diet & Disease
Andy De Santis explores ways to tailor our diet to aid in the prevention and management of chronic disease.
The content of this podcast has not been evaluated by Health Canada or the FDA. It is educational in nature and should not be taken as medical advice. Always consult a qualified medical professional to see if a diet, lifestyle change, or supplement is right for you. Any supplements mentioned are not intended to diagnose, treat, cure, or prevent any disease. Please note that the opinions of the guests or hosts are their own and may not reflect those of Advanced Orthomolecular Research, Inc.
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Welcome to Supplementing Health, a podcast presented by Advanced Orthomolecular Research. We are all about applying evidence based and effective dietary lifestyle and natural health product strategies for your optimal health. In each episode, we will feature very engaging clinicians and experts from the world of functional and naturopathic medicine to help achieve our mission to empower people to lead their best lives naturally.
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[01:35] Cassy Price: Hello and thank you for tuning in to another episode of Supplementing Health. Thomas Fuller once said that health is not valued until sickness comes which is likely true for many however, I like to believe that the narrative is starting to shift to one of prevention. So, today I am joined by Andy De Santis to discuss the management and prevention of chronic disease. Andy is a registered dietitian and public author from Toronto who has a deep-rooted passion for tapping into people’s natural motivation to achieve good health and believes strongly in utilizing the power of food to improve the health and wellbeing of those he treats. Welcome Andy. Thanks for joining me today.
[02:06] Andy De Santis: Thanks so much for having me. I am looking forward to it.
[02:10] Cassy Price: Okay, so chronic diseases are defined as conditions that last a year or more and require ongoing medical attention and or limit activities of your daily life. Now that does not sound like fun or something that I would want to strive for, and many would feel the same way yet approximately 45% of adults in North America are living with at least one chronic illness. So, in your opinion what are some of the key factors feeding this epidemic?
[02:36] Andy De Santis: Yeah. That is a great question. There is a lot going on, right? Obviously, what I am most interested in is the dietary component. Obviously, physical activity and the exposure to fresh air, all these things are important, stress levels, this stuff is all very important. What I am most interested in as you might have guessed is nutrition so I would say if I had to summarise, and I am sure we will elaborate on this as we go forward, if I had to summarise things in one sentence I think it is the variety especially as it related to protein that people get. All foods fit into a healthy routine but a lot of people I find trend in the direction of a lot of chicken and lot of beef, I have had a lot of that stuff and it fits into a healthy diet but there is a lot left on the table when it comes to plant and marine based protein sources. Your nuts and seeds, legumes and fish. I think the disparity between those two is probably the major driving dietary factor. Obviously, there is a lot more going on but for me the major driving factor with a lot of issues that people have.
[03:52] Cassy Price: So, what kind of proteins would you suggest people start incorporating because like you said most probably stick to the core ones that we see all over the grocery store and what not?
[04:03] Andy De Santis: Yeah, it is a great question. I am not trying to detract anyone from eating the foods that they love so let’s put that out there. Let’s use fish as an example. Fish is unique nutritionally because it has vitamin D and Omega 3s. These are nutrients that are not found in many other foods. Then you have things like legumes, so lentils, chickpeas and kidney beans which are also very unique because there is no food that has so much fibre and protein in the same place. Not to mention the fact that there is antioxidants, potassium, magnesium and iron. So, on the plant and marine based spectrum, nuts and seeds as well are very unique with the healthy fats that they have. There is a lot of things in these foods that are unique and can’t be found elsewhere so I would say go to fish, go to seafood, go to nuts and seeds, go to legumes. If we can have more of those foods in our routine, so many studies show that people who eat these foods more often live longer. That is as simple as that.
[05:03] Cassy Price: So, knowing that obviously diet impacts all chronic diseases do you think there are certain ones that are facing us today that are more impacted by diet than others?
[05:12] Andy De Santis: Yes. Absolutely. Let’s break that down a little bit. Let’s talk about cancers for a minute. Although the word cancer gets thrown around a lot, the word cancer is a set of very different conditions. For example, if you take something like lung cancer, we know that smoking is the major risk factor for lung cancer but then if we look to something like prostate cancer, liver cancer or colon cancer, especially colon cancer, the role of diet increases as we go. So, when It comes to colon cancer there is a massive role for fibre in terms of preventing it and there is a massive role for processed meats potentially raising your risk whereas compared with lung cancer a lot of it has to do with smoking. So, just in cancers alone which in North America are one of the top causes of death, just in cancers alone there is a range of how food plays a role.
[06:29] Cassy Price: So, why then is it so important that they get a variety of protein in particular compared to healthy carbs or healthy fats?
[06:40] Andy De Santis: It’s a good question. Well, look don’t get me wrong those are important too but what I try to do is have a novel message because otherwise what is the message going to be, okay yeah you need healthy fat, healthy carbs, healthy protein and vegetables. At that point is a bit diluted so I try and get something for people that hits home. That is part of the reason why I covered that message. Obviously, eating more vegetables and being exposed to more fibre and antioxidants, that is protective of any condition literally that has a dietary role. Eating more vegetables is going to play a big part in that, if you know what I mean. I personally based on my clients and the people that I see; I pick the protein message because I think it hits home the most and it distils all of the other messaging together. Even, let’s explore what you said further right, because you mentioned healthy carbs and healthy fats, well legumes or lentils and chickpeas, are starchy food that have very minimal impact on blood sugar levels so they can be used as the base of a meal not so differently than rice can. Then you talk about fats well nuts and seeds and fish are the main sources of what we would call ‘healthy fats’ so you can see how it really is all connected. All simply from that basic protein message. Hopefully, that was a decent answer to that one.
[08:00] Cassy Price: No absolutely. That totally makes sense. So, then you hear obviously, contradicting messages out in the media as always with anything in science but particularly when it comes to protein it seems that there are two camps where there is a camp that thinks you can really easily overdo it with the amount of protein that you take in and there are the others that seem to believe that most people aren’t getting anywhere near enough protein. Can you share what your views are on that and at what point you flip from not enough protein to potentially overloading your systems with it?
[08:38] Andy De Santis: Yeah. Okay, I would say the following. First of all, protein requirements vary depending, say if someone is otherwise a healthy person and they don’t have any unique conditions, protein requirements vary depending on activity levels. A relatively sedentary person, the requirement for that person would be 0.8 grams of protein per kg of body weight per day. That might sound fancy but that is just what it is. We can work out the math when we need to. Now, the more active you get the more energy you expend, like higher level athletes they need between 1.3 to 1.8 grams of protein per kg or in some cases maybe a bit more especially if they trend more to the resistance training, you know what I mean? Now, can you go to some websites and they give you some absurd numbers like 3 or 4 grams per kg which ends up being multiple hundreds of grams per day and not leaving enough calories to eat anything else? Yeah. That is problematic because protein is important and getting variety in protein is important but there are many healthy foods also that don’t contain protein. The risk of overvaluing protein, as I see it for the average person, is first of all if you don’t get enough variety of protein intake you are going to end up eating a whole lot of chicken and beef which again there is nothing wrong with that, but variety is important. The other thing is that you are going to displace other important foods if you overvalue protein. So, there are risks associated with that but not for some of the reasons that you might read online. It is more so from that perspective.
[10:08] Cassy Price: I can understand how that comes about. Now, obviously, with whatever we eat it affects our microbiome and the microbiome has been a huge hot topic over the last couple of years here. So, I’ve read a bunch of things about how plant-based proteins can help build up your butyrate and the different bugs within your gut that support the digestion and processing of that. Do you see a difference between those that have a healthy balance microbiome and those that don’t and how they tolerate the different nutrients?
[10:38] Andy De Santis: Yeah. There are definitely a few things. First of all, gut health and the microbiome, there is a massive degree of individuality that is associated with that. So, it can be hard to generalise because what some people tolerate other people might not. Then you throw into account IBS and IBD and things like that. On the whole, part of the reason why plant-based foods are associated with more microbiome diversity is because plant-based foods, guess what they are paired with? They are paired with antioxidants and fibre and what studies show is that certain types of antioxidants and certainly certain types of fibres act like prebiotics which means food essentially for your gut bacteria. When you feed your gut bacteria and you allow them to live in a healthy environment where they can metabolise the type of things that they like, which along with that is fibre, then you would expect that the gut microbiome would be more favourable in that case. So, the plant protein aspect is relevant in so much that it is paired with fibre and antioxidants because think about nuts, seeds and legumes and how much fibre and antioxidants they have compared to a piece of chicken which has neither, right? You can see the disparity there. Again, the point of this conversation and my message is not to speak badly about chicken and beef, it is just accepting the fact that most people eat that stuff already. There is iron and protein so those are good foods, but most people don’t need a nudge to eat more, if they are omnivores, right? But people do need a nudge in the plant-based direction. So, just to elaborate on my stance so people are clear, I am not trying to push one way or the other for personal interests.
[12:26] Cassy Price: Okay, So, one thing you were saying there that piqued my interest is obviously that there is a high degree to individuality here and so, foods that I tolerate you won’t and vice versa but overall eating healthier foods will lead to better health, so can you speak to how food sensitivities can influence a person’s risk for developing disease and maybe how it impacts how they tailor their diet?
[12:53] Andy De Santis: Yeah. I think one of the main considerations is IBS where you see how certain food components can aggravate it. Let’s just use legumes for example. There are some people who can sit down and have three cups of legumes as part of their meal with no digestive consequences, there are some people who can’t have more than half a cup without digestive consequences. So, that is where personalisation comes in on some level. Obviously, working with a health professional can help you get control of these things, but this is one of the most relevant examples. If you know yourself to be someone, this happens with my clients a lot, I have someone who says, “I can’t eat any lentils because I get gassy.” Well let’s look at how much are your having of them, what are you pairing them with, what if you had half the amount? It is very likely that modifying the amount and or what it was paired with, for example if they are having lentils with cauliflower, cauliflower could be for some people a gas causing food, there are these little nuances that make food more tolerable. That is where the individualisation comes in.
[13:53] Cassy Price: That is very cool. I don’t think people realise, at least I know I haven’t, always known the different ways that foods work together or work against each other when you are eating them together.
[14:04] Andy De Santis: Yeah. That is only tipping the surface. There are people who devote their whole life to the nuances of how foods interact with the gut. I have offered a basic example that I think with resonate with some people, but the levels go way higher than that, even beyond my own comprehension. There are people who have PHDs only in this type of area.
[14:26] Cassy Price: So, one of the things you have mentioned a few times is IBS which is Irritable Bowel Syndrome and is an inflammatory condition for those who aren’t aware. Inflammation has been touted as a major player in a variety of different diseases and health conditions, if it is left unaddressed and it becomes chronic. So, besides particular conditions like that, where it is obviously a specific trigger causing it, what other ways can your diet influence your inflammatory responses?
[14:58] Andy De Santis: Well, I mean, your immune system, for example, has a nodule to play in these responses. The health of your immune system is largely a reflection of your overall health and your overall health is then a reflection of your overall dietary pattern. For example, if we go down that path and think about Vitamin D for a moment. So, in Canada during the winter months specifically a significant percent of the population from the numbers I have seen up to 40% have inadequate circulating levels of Vitamin D, okay? Vitamin D as many people have seen is being increasingly associated with immune functionality and immune health, right? As a result, many conditions, whether it is an inflammatory condition, lets choose eczema for example, I was just doing some research on this and I found, this happens for many conditions but this is just one, that people with eczema are more likely than the average person to have inadequate Vitamin D status. That is one example of how things get tied together. Of course, you have the stereotypical anti-inflammatory Omega 3 fatty acids which are involved in anti-inflammatory messaging in the body and those are not found in many foods, right? Omega 3s are found really mostly in fish and flax and chia seeds and hemp seeds and walnuts. It is foods like that that have a role to play in modifying the response even if I think inflammation in immunity is much more complicated that people make it and certainly goes beyond our diet, but we cannot be sure that without a properly balanced diet that we are not facilitating the proper functioning of these systems, if that makes sense?
[16:49] Cassy Price: Yeah. For sure. Last week on Supplementing Health I was chatting with Saul Katz about the impact of sugar and carbs on your immune system and tying in some of those intricacies. So, from your perspective, if you increase sugar intake that is obviously outside of regular food sources like fruits and that sort of thing, do you see how that increase in intake in sugar that our population tends to have now is contributing in chronic disease that we are experiencing?
[17:23] Andy De Santis: Honestly, sugar is definitely an easy target for victimisation the way I see it. I think it depends on the context if you know what I mean because if we take someone, this is where individualisation comes in, if you take someone with otherwise strong dietary pattern and the fact that they have sweetened Greek yoghurt that is an irrelevant consideration. Now, if you take someone on the other hand whose diet is mostly consisting of sugar sweetened beverages and refined carbohydrates and baked goods, for that particular individual then yeah there could be a contribution there to a lower overall quality of health. For me I am not quick to say that little bit of sugar you have in your oatmeal is detracting from your health. It really depends on the bigger picture. I understand the question you are asking is more on a cooperation level. I think we have to be honest that stuff like pop and certain types of foods are not health foods and are not contributing to better health. Do they have a role to play in making people happy and the broader context? Yeah. Are they the main thing to blame for all of our health problems? That is harder to say.
[18:44] Cassy Price: Yeah. So, it is more like one of those assertoric questions I guess where it is a little more philosophical and what not. I definitely like you said has a role to play for sure, but I mean if you have to have a can here and there of Coca-Cola or something, then that is probably not the end of the world, right?
[19:03] Andy De Santis: 100%. As you can tell I try to be as diplomatic as possible because for me my philosophy is what makes you healthy is what you do and not what you don’t, if you know what I mean? Even if you look to the people, I read an article about the people in Okinawa Japan who live the longest, right? We highlight what they do. We don’t go there and talk about what they don’t because it is these positive actions and this inclusion which is much easier for us to wrap our head around and is much more positively oriented. I think that is important because as you know there is a lot of negative health messaging and I am not here to say that having candy and chocolate all of the time is the right choice for your health, but it also sucks if you are constantly being told that what you can’t eat. I would much rather be the person who tells you what you could be eating to feel better. That is much more my philosophy.
[20:01] Cassy Price: So, if one of your clients that you are working with comes to you and says “I know I am overeating sugar and I want to cut that habit, but I am not sure how to go about it and where to start” what are some of your tips for someone who is looking to make strides towards a healthier diet?
[20:18] Andy De Santis: Well, I would first of all make sure we have the same definition of what sugars are because for me a lot of the time because of all of the messaging that people encounter they overestimate their own intake, and they think that the choices that they are making a much more detrimental than they actually are. I use the point of sugar in yoghurt because a lot of people that I see just think that having a little bit of sweetened yoghurt is somehow the turning point for their health. I think that is furthest from the case especially when there is so much else to choose and look at if you know what I mean. I make sure that we are aligned in terms of what that means. Again, a lot of people think that eating a couple of pieces of fruit a day represents eating too much sugar. We have to establish a baseline. Obviously, if possible, I try to turn people to natural sources of sweetness. Obviously frozen fruit is very fun. Once you let it thaw for ten minutes it is a very fun thing to have as a sweet treat. I try to make sure that they are not being too harsh on themselves and kind of go from there. What you have to realise is when you emphasise, let’s say you talk to an individual who thinks they are eating too much sugar, perhaps by some objective measure they are when you emphasise what they could be eating instead that is natural that some of these choices will displaced just by virtue of the fact that they are thinking about eating other things. How that path carries out is so different from person to person so I can’t say there is one magical strategy. I encourage people to put to talk to someone in my type of profession to talk to someone about who they are how they operate which will allow you to come up with the best solution.
[21:58] Cassy Price: Do you think our diet culture that runs rampant in North America has played into a lot of these skewed perspectives of what is considered healthy and what is not?
[22:06] Andy De Santis: I mean look there is no question. One thing I always tell people is I think I am guilty of underestimating the effect of diet culture in my younger years. The more people I work with I cannot help but observe the effect it has. I can’t help it. I can’t help that the more people I talk with the more people I see have skewed views of foods which I think are so nutrient rich and so great and foods which they shouldn’t hesitate to enjoy which can be enjoyed as part of a healthy dietary pattern, so I mean absolutely. I can’t help but say that the more people I work with, the more I see it and the more I feel that it is playing a role.
[22:51] Cassy Price: One of the things I have heard people say and I have come across is that people feel the cost of eating healthy is a limiting factor for them especially now with the economy recovering from the pandemic and people don’t always see the longer term costs right, they are looking at their current day situation even though maybe eating healthier will give them higher quality of life at the age of 80 if they are 25 now that is probably outside of their purview at this point. So, do you have tips for listeners on ways that you suggest they eat healthy on a budget?
[23:32] Andy De Santis: I mean so let’s start with legumes as a starting point, right? Don’t underestimate the value of canned or frozen food, I think. That is a big one for me. Let’s start with the easiest to what requires more effort. I think right off the bat, don’t underestimate the value of canned and frozen food. Legumes for me, lentils, chickpeas and kidney beans, they are such valuable undervalued foods that are relatively economical as they can be purchased from cans if needed. They are also cheaper dry. I should also say that as well. So, some of these foods are very underrated. Legumes being number one. Then looking to frozen food, you know? It is hard to make a blanket statement because a lot of it depends on geography but a lot of times especially out of season a lot of people find value in frozen fruits and vegetables. I find that a lot of people misunderstand frozen fruits and vegetables, they think they are somehow less healthy which is not true.
[24:26] What I will say as well, this is also a trend I notice in people, some people feel that if they can’t have a whole tun of the vegetables it is almost as if they have let themselves down and it is not worth having any at all, right? I don’t blame anyone for thinking that, but it is the worst thing to think. Half a cup of vegetables a day is amazing. If that is what you are getting then cool, let’s run with that. That’s great. It is not unusual to run into clients who feel that they have to have four or six cups a day and if they don’t get that they are discouraged to the point where they don’t bother having any at all. Then beyond that you can look to, again speaking about cans, fish is expensive. Canned and frozen fish offers more value. So, not underestimating that and not thinking that those foods don’t play a role. Then you can get into looking for produce that understanding seasonality. What is seasonal in your area? Things like that is where you are going to find better prices. I think that is my best advice right off the top for those things and those considerations.
[25:27] Cassy Price: And in your professional opinion, are there supplements that everyone should be implanting in their diet to ensure that they are getting well rounded nutrients?
[25:37] Andy De Santis: That is an interesting question. If we take, let’s just stick to Canadian context where we face this reality where Vitamin D levels are too low, many Canadians don’t each much fish where fish is only really the main dietary choice with Vitamin D, there could be an argument made that would be hard to refute that most Canadians could benefit from supplementing Vitamin D, right? Now, Health Canada, this very specific but it is relevant, for the prevention of neural tube defects, Health Canada recommends anyone who can or could become pregnant take a prenatal multivitamin with folate because many pregnancies are unplanned and if there is inadequate folate in the diet it can increase the risk of neural tube defects, right? Technically Health Canada is asking a lot of people to be taking their multivitamin from that perspective. Beyond that it depends on the individual but those are two interesting ones to consider.
[26:40] Cassy Price: Now, this one is a little bit off topic, but I know that you value humour in your practice, so I was curious how do you find having a good sense of humour helps you when you are working with patients?
[26:52] Andy De Santis: I think first of all you have to have a sense of the clients and for whom humour maybe a tool and for whom it may not be, right? It is not like I am going to a meeting and getting a laugh is the goal but for myself my demeaner is baseline light-hearted and it does work its way in. I think people do appreciate that. For example, I have clients who felt uncomfortable talking about bowel movements, they had seen my post on Instagram on poo and all of a sudden, they realise that it is a perfectly acceptable discussion and actually quite an important part of good health and quality of life. Yeah, I mean, I think for the right person, and people know that about me just looking at my stuff so if they work with me on some level they may know already that I am very professional, as hopefully you can tell by how I discuss topics, but I do have that side to me especially given how rampant negativity around food is, I try to see the lighter side of things where I can and when appropriate.
[27:56] Cassy Price: Well, they do say that laughter is the best medicine so I can see how it can make, especially heavier topics, a little bit more digestible.
[28:06] Andy De Santis: Yes. 100%.
[28:07] Cassy Price: What are some of the steps that you help your patients with to manage their disease along their journey? So, if they have already gotten to the point where they have a diagnosis it is not just that they are not feeling their best, how do you help them manage that journey back to a better quality of life?
[28:25] Andy De Santis; It is very common that you will see people come in with for example prediabetes, elevated blood cholesterol, acid reflux, high blood pressure. These are some of the most common reasons why people are medicated in Canada and across North America. I think what people need to know is that it is within their power to change the course of their condition. Depending on the condition, obviously we don’t say this if it is not true, for many conditions the changes required to improve your status are well known and well-studied so there is no guess work. We know what you have to do. We just have to figure out how we can make it work for you. For example, cholesterol lowering, which again cholesterol medication is super common, cholesterol lowering, I have written a book on lowering cholesterol, and there are several steps that you take to lower cholesterol you just have to figure out how we can reconcile those steps with what a person is willing to do. For myself I have written a book on cholesterol and acid reflux so that gives me an extra point of leverage that can tell people “Look I am an expert in this subject. I help many people with it. We are going to help you. Here is what we going to do. What are you willing to do from these x amount of things? Let’s apply it and let’s let it work.” Of course, it depends on the condition but letting people know that it is within their control, that sense of empowerment and autonomy I think is very important.
[29:59] Cassy Price: So, if there was one common myth about chronic disease that you would want to debunk for our listeners what would that be?
[30:06] Andy De Santis: That is a good question. I can say a lot of things. Let’s just say that carbs aren’t to blame for everything. I pick that because I think it is the most misunderstood.
[30:21] Cassy Price: Fantastic. If any of our listeners would like to work with you what is the best way for them to get in touch?
[30:27] Andy De Santis: My branding or nickname is Andy the RD so andytherd.com. You can contact me through my website email@example.com. On Instagram @andytherd. Any of these platforms I am reachable at. My phone number is also on my website so you can give me a call anytime.
[30:51] Cassy Price: Awesome. Well thank you so much for taking the time to chat with me today. It’s been fantastic conversing with you, and I really appreciate it.
[30:57] Andy De Santis: Thanks for having me. It was a really awesome chat.
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Thank you for listening to Supplementing Health. For more information about our guests, past shows, and future topics, please visit AOR.ca/podcasts or AOR.us/podcasts. Do you have a topic you want us to cover? We invite you to engage with us on social media to request a future topic or email us at firstname.lastname@example.org. We hope you tune in again next week to learn more about supplementing your health.
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