How to Make Dieting Easy - And the Most Underrated Foods for Health | Shyla Cadogan

0:00Dr Karan: Shyla Cadogan, you are my go-to person for practical tips online. You're a registered dietitian. The online space these days is full of contrasting opinions. What to eat, what not to eat, what to cut out. This is toxic. That's toxic. People just want to eat healthy. They want something simple that they can stick to, not wellness influencer folklore and, you know, kind of like crunchy mum 12-step routines. What is one thing that people aren't doing that would make eating healthy easier? I feel like that is a question that is easy, but it's not necessarily simple or not the question itself, but the concept.

0:41People very much overcomplicate eating. And I wouldn't say it's always easy to do so, but it is simple. So I would just say simplify. And a way to do that is to focus on like, okay, what am I not doing right now that I could be doing? So not necessarily like, okay, everyone jumps to the gun to think, oh yeah, I'm going to just cut out all this stuff and then boom, I'm going to be healthier. Well, chances are those same people aren't doing things that they actually could be adding into their lifestyle, into their diet to be healthier. So it's like, okay, if you have a lunch that normally has no vegetables in it, add a vegetable.

1:17If you feel like your breakfast typically doesn't have a protein, add a protein. So like simple additions to your diet, exercise, sleep hygiene routine is a really good place to start for like trying to move forward in the right direction.

1:33Dr Karan: A lot of people get very caught up in meal prep and food logging apps and keeping food diaries basically. But I've always felt that that doesn't seem to be a very sustainable thing in the long run for a lot of people. Is there something that's like a very simple unlock for most people that goes beyond doing that, that, you know, just someone can go beyond food diaries and planning meals each week? What is that thing? So that's a really good question. I think food logging and food tracking and things like that helps people to learn the numbers, learn the logistics of healthy eating, but not necessarily learn how to eat.

2:12Those practices don't automatically teach you how to eat. So what I recommend doing is looking at the composition of your plate and use that as your guide for eating better. So like, okay, do I have a vegetable? Do I have a fiber rich carb? Do I have a protein? To me, that is a structure of what any meal that we could classify as healthy would be. And so if you don't have those things, organize it so, right? If you do have those things, that's how I would say that's nutrition. And so what that looks like can vary. Those foods all come in different categories, right? There's a ton of different fiber-rich carbs.

2:51You can have corn, you can have quinoa, you can have black beans, you can do all sorts of things, whole grain bread, vegetables could be any vegetable whatsoever, right, that you enjoy. And then protein, choose your lean poultry, your fish, your eggs, whatever it might be, your beans, your tofu. And so give yourself that flexibility within those specific parameters and you're on your way.

3:13Dr Karan: If someone takes a lot of their nutritional advice from content creators online, which is a bit of a, you know, a bit of a coin toss sometimes, right? Like you could land in the right part of the algorithm where you get some really good information, like from you, we could go somewhere else where maybe you go down like a carnivore or keto pipeline, which is a can of worms. But, you know, I don't like the term superfood because there's no thing, but there are like foods, which if you included on any diet, it would do what a superfood kind of would do. Right. So one of those things me would be like, you know, a food that doesn't get a lot of service or credit would be for me, something like green peas, right?

3:54Dr Karan: What are some underrated foods that could easily fit into most people's diets that people just do not talk about? I honestly would say, I made a video about this recently. One of the top ones right now, I think would be buckwheat. Interestingly enough, per serving, it really contains one of the highest amounts of magnesium in a plant-based food. And I would also say the same thing with pumpkin seeds. Those are also pretty easy to implement in your diet. A lot of people make, at least to go back to buckwheat, like overnight buckwheat, or they incorporate it into their baking to like, you know, use as a flour base or make pancakes out of it.

4:32Simple things that maybe people would already be making, but you could just swap out one simple ingredient and then you significantly boost the nutrition content. Also has a great amount of fiber in it per cup. And then for pumpkin seeds also easy to like put into salads, to put onto oatmeal, to mix into a dish or baking. So I would say those two foods are pretty high up there. Also, you know them, you love them, beans. All sorts of them, whether they're lentils, whether they're great northern beans, whether they're chickpeas, black beans, whatever bean that you like and can eat, I would say it's pretty dang far up there as something that we would consider is a superfood word I don't really like either but it's close enough and so I'm happy that beans now are getting talked about way more but I feel like it's a very recent thing and I think offline we have a lot more work that needs to be done and the PR for beans for lack of a term so

5:32Dr Karan: yeah I agree I think beans are beginning to get some of that PR but you know when you look at some of these longevity zones around the world, people focus on the wrong habits that people in those countries and cultures have. But actually, if you look at it, the beans is often a huge part of that dietary regime that most people have, whether it's in South America, in Asia, Africa, the beans, it seems to be the common denominator for a lot of these people. And that's backed up by the evidence as well. You obviously do a lot of, you know, what I eat in a day videos in terms of you show people what you like to eat, you know, which is interesting because they get a point of view of a dietitian who is an expert in nutrition and food talking about what they eat.

6:17Dr Karan: What would be something surprising that people would be kind of surprised to learn that a dietitian actually eats? So I, sometimes my What I Eat Today videos, I post like, I guess the concept of it is like What I Eat Today is a type B dietitian. And honestly, if you look very carefully. A lot of times the things that I'm eating aren't cooked or they're like random foods that I'm putting together or very minimal effort. And I think a lot of times when people hear, oh yeah, Shiloh, you're a dietician. So you must be in the kitchen meal prepping, doing all the things and all this crazy stuff. And it's like, no.

6:56Some of the healthiest meals that I eat involve nary a pot or pan. And I think a lot of people are surprised to see that. It doesn't take much energy for me to put together some random meal of like a slice of hard bread with Swiss cheese on it and black beans and kimchi and then some carrots and hummus.

7:18Dr Karan: And that's my lunch. I love that because I guess people are sometimes so, I don't know, religious about following certain, you know, very rigid dietary guidelines. Like it's got to be this wonderful whole food meal prep from scratch, baked, roasted and all these wonderful things, which in an ideal world, everyone had time, resources, money and ability to do that. Great. But actually, at the end of the day, can you just get enough nutrients, diet, like dietary fiber, protein, the easiest possible way? What is the lowest possible lever that you can pull to achieve that? And sometimes if you can do that without cooking or spending an hour in the kitchen every day, that is amazing, right?

8:04Yeah. Yeah. And it, when I tell people this sometimes, you know, some of my patients will be like, so like, what are you preparing this week? I'm like, I'm not meal prepping anything, girl. Like I'm not. And then I tell them some of the meals, some of the foods that I am eating. And it's like a light bulb goes off and they're surprised in a good way that their dietician is, you know, also looking for simplicity too.

8:27Dr Karan: I want to talk about something that's quite personal to me and about some medical conditions that I suffered from. I used to have high cholesterol and fatty liver disease, and that primarily stemmed from a severe lack of fiber in my diet. And on my quest for finding the perfect fiber supplement over the last few years that could help me add more fiber into my diet, I couldn't find one. That ticked all the boxes that I wanted and the high bar that I set for myself. So I built Loam Science. What I'm most proud of is not the product. I know that's great, but it's the fact that we've run two clinical trials on it, two randomized controlled trials, which is far more than the vast majority of supplements on the market will ever do.

9:02Dr Karan: And we've got even more coming because I'm a doctor first and foremost and a scientist. And I wanted to build something that I could actually stand behind with data and not just rely on good branding. So if you want to understand what's inside Loam Science and why, the science is all on the website and the link is in the show notes. Some of the things you mentioned there that you might have and some of the things I've seen as well, technically would be classed as ultra-processed. And nowadays, around 57 % of the average person's diet consists of ultra-processed food, which is just an umbrella term.

9:37Dr Karan: It carries no moral weight in itself. Where do you stand on ultra-processed foods and how can it be good for a person's diet, but also potentially bad? The term ultra-processed foods is just so loaded and it has become so weaponized on social media now. it's like for years now. You know, when we look at like research and the biggest classification system we have, which is the NOVA classification system that, you know, is behind that 57 % figure, right, that we use. We have to understand that when we look from class one through class four, class one being the most minimally processed foods and class four being what we would consider ultra processed foods, we have whole grain bread and we have Doritos in that category, right so it's like not to say that those are the same types of foods however you know when we talk about ultra processed foods we kind of have to keep that in mind it's like really it's a descriptor of how that food has been made right and if a food has been heavily processed and has added things to it's like canned beans with sauce would also be considered ultra processed i love canned beans with sauce, right?

10:47But what I would say is, you know, now when we talk about it, like the foods that I'm worried about, I guess, as it pertains to ultra processed foods would be the ones that are purposefully designed to be hyper palatable, right? So like, you know, your chips, your cakes, your cookies, your, you know, foods that have what food science calls the bliss point that has, you know, the right amount of sugar, right amount of salt, right amount of fat that makes you want to keep eating more of them, right? To kind of like bypass our biology a little bit to eat more of those, those are the ones I would say I'm like primarily concerned about.

11:19Those ones that are also usually low in protein and low in fiber. You can eat them mindlessly in large amounts. So, you know, that is a real pattern that has very real consequences that we see play out. So that's no denying. But I think if we just like widen our openness to nuance a little bit and, And, you know, can hopefully one day on a broader scale, more so distinguish those types of foods from like, you know, ultra processed foods, like certain milks and whole grain breads and beans and stuff like that and sort of distinguish that a little better. I hope we can get to that point, but right now we're not.

11:58But I feel like that's my stance.

12:00Dr Karan: I also feel that a lot of people need to appreciate the difference between something which is filling and satiating and something which is satisfying. Because sometimes something which is low calorie, high volume, which is quote unquote good for you, may not hit that satisfaction note, right? Sometimes you just may need that piece of chocolate, a bag of chips, something, right? And that gets us to the conversation of what is your dietary pattern over a long period of time? Exactly. All or nothing approach with just this one meal, which is demonized. And yeah, I think that's something I've learned in myself in that, okay, I know that berries are healthy.

12:41Dr Karan: They provide fiber, polyphenols, and, you know, a lot of these nutrients, and they're not going to make me hungry for a kilo of berries. Like I can get filled with a cup of berries and, you know, I'm filled with the fiber. But I'm not always satisfied with berries because in my mind, I have like, I want to have a bagel, right? Right. And one food cannot always be a replacement for something else as a form of restriction. Right. So I think there's some balance to be had there. And I guess you see a lot of that as a dietitian. 100 percent. I totally agree. And, you know, when I work with people who are working on their weight management, I always tell people I would rather you be there 80, 85 percent of the time and sustain that for years than be there 100 percent of the time for a month.

13:29Like, you know, if that means you have like a little piece of chocolate after lunch because that's fun and you look forward to that Great, right? We had a balanced meal beforehand. We're able to go into that a lot more mindfully, right? Like or, you know, if you're like out at your cousin's birthday party and you have cake like what? Okay, like you know Like that is not the end of the world and I think, you know In this culture that we've now curated in the wellness space online, it's very much okay If you eat that one thing everything's ruined and that does not help people it keeps people in this like endless loop of if i cannot do it perfectly it's not worth doing at all when that is just not true and satisfaction totally is like a part of life and like eating is like fun and it's enjoyment and it's culture and so like no like if you want chips like having kale chips probably isn't gonna cut it you know absolutely just go and have the chips normal

14:24Dr Karan: more chips, not vegetable chips. You know, a lot of the conversation that we've sort of talked about here so far, you know, is about that hunger filling and key to that conversation is fiber, which is a very filling macronutrients. And you're a big proponent of high fiber foods long before the conversation exploded online. So, you know, talking about fiber, we know that people are kind of saying that four out of five people, 96 % of people are not hitting enough fiber virtually, you know, everyone has baseline fiber intake is very low. But when it comes to actually eating fiber, and most people's preconceived notions about what fiber is, it tends to take them down the path of a big leafy salad, which is obviously the wrong way to think about things.

15:13Dr Karan: Do you think that is the number one challenge to people not eating enough fiber is because they don't know what fiber actually is? I would say so, at least in practice, and in my nutrition communications work too, I do see it a lot. There's a few reasons. One is the nutrition education piece, yes. If I ask the average person, what is fiber? They may give me one, a couple of foods that they think is fiber and maybe they're right, maybe they're not, right? So the education piece. But then also it's like people then, if I tell you all the fiber sources, that'll get me half the way. The other half the way is figuring out how to help you implement that into your diet?

15:55Because then I could tell you all these foods where you're like, great, I'm hardly eating them. How am I supposed to do that? And then in fact, how am I supposed to get 30 grams of that? Like, you know what I mean? Like it's very overwhelming to people. So yeah, the type and knowing what food sources are fiber, and then also knowing how can I actually like make that happen as many days as possible in my life to hit that 30 grams

16:19Dr Karan: plus whatever so one is actually knowing what foods are high in fiber the second is it's all well and good telling someone they need to eat beans and lentils for fiber but then how do you practically implement that because they've never had beans or lentils in their diet how do i cook it how do i actually incorporate it into my standard american diet which doesn't include beans or lentils that's not the culture i'm from and then i guess third would be they're coming from such a low baseline, they listen to, you know, all of us saying eat more fiber. They are very diligently adding fiber to their diet and then get the side effects, you know, and the sound effects as well.

16:56Dr Karan: And they're like, Hey, I can't do this. And that I think those three are pretty major obstacles for a lot of people. Right. And the third one also cannot be discounted too much because you're adding in a healthy food and it's making you initially feel worse. That's the other thing too. Cause yeah, then you start telling people, okay, hey, these are some fiber-rich foods. They start incorporating beans every day and then chia seed pudding for breakfast. And then they're like, oh, I can't go to the bathroom. And then you then have to talk through that layer of the conversation, which is, okay, yeah, we said fiber is super important and everyone should be increasing it.

17:30However, you should increase it slowly and you shouldn't not put all your fibers in one basket, right? Don't eat all the same types of fibers all the time fiber diversity. So like getting a range of fruits and vegetables and whole grains and legumes and nuts and seeds helps you to tolerate it better. And then, you know, going slowly, right? Increasing by a little bit, about five grams or so every few days and go from there to help you tolerate it better. And then people are like, okay, great. Now I have another extra layer, but then they start feeling better and it's worth it at the end. But fiber has a lot of layers and how to actually implement it in your life if you're not doing it already.

18:09It is a process.

18:10Dr Karan: So if you eat a salad of lettuce, cucumber, tomatoes, and thing that's going to get you fiber, it's not, right? What are some other foods like that that people are like just munching away thinking, yeah, I'm hitting my fiber goals, but they're nowhere close? I mean, I think you just mentioned them. Cucumbers are definitely huge. Same thing is like onions. I feel like people We're like, okay, I'm having some onions in my dish. This will give me some fiber. But it's like you'd have to eat a very uncomfortable amount of onions to get anything really. Some other foods that I would say are like that as well would be spinach.

18:51Spinach, it kind of goes into the leaves, but like spinach is one of those. And then like very high water fruits too. like watermelon is really not that high in fiber because it's essentially all water, but a lot of people will associate any type of fruit with fiber. So it's, you know, not that these foods are bad or anything like that at all. It's just, they provide you different things. They're better for hydration. They're better for some vitamins and minerals, but as far as fiber goes, we'd want to actually like throw in some heavy hitters.

19:22Dr Karan: So for someone looking to increase their fiber intake, what are some kind of like your go-to foods that you suggest to your clients, for example? So I'm going to take your example of a salad. So I love salads. I'm going to have salads multiple times a week, but I know that my base, my lettuce, tomatoes, onions, they're basically there for like fun, color, and water, not necessarily for fiber. So what I would add into a salad would definitely be like a half cup of beans. That's my heaviest hitter. I may also add a sprinkle of pumpkin seeds or hemp seeds to also add in some fiber from the seed category.

20:00I'm allergic to nuts, so that's not going to go into my salad, but think about that too. too. And then I would also, you know, perhaps consider in the beginning of the week, I like to roast a bunch of vegetables and just throw them into a lot of different things. So I may do that too. Some broccoli, some chopped up asparagus and throw that into meals, carrots to just beef up the fiber intake way more than just what a base, what we would define as a typical salad would be.

20:27Dr Karan: So, you know, taking the beans, for example, you know, that obviously packs protein, packs fiber, you know, magnesium, like a bunch of other, you know, important nutrients for the body. A lot of people don't know that you can just pour a can of beans into a salad and eat them. But what are some easy ways that someone can actually incorporate beans into their diet beyond that salad? And how do they get over the potential side effect of beans? Because they have that potential because of the fructan content that they can cause, you know, gas and bloating in some people. Totally. So outside of just a salad, a way that I have found is a nice intro for some people is if you're going to make like a taco meat situation, or if you're going to be making a meat sauce for a pasta, using beans to put into that meat sauce, or if you don't want to do that to like mix into the meat or mix into the taco meat, using the pasta example again, if you don't want to do that.

21:26We live in a really fun world now where we have bean-based pastas that don't taste that different than the regular pastas. So that could be a way where you can incorporate beans in a way that's really close to what you would be eating normally. It's just dried pasta that you would get from the store. So that could be a super approachable way. That said, monitoring how you're feeling if you're going to be starting to implement beans, right? So like some of my patients just go low and slow, not throwing it into meat mixtures or smoothies or salads right off the bat. But perhaps they're starting to just like incorporate maybe a couple of spoonfuls on the side of something, right?

22:11If they really want to go slow and boost up their tolerance a little bit. So then they ultimately get to a point where they can just seamlessly add it into something. Some people, they just take some digestive enzymes to help them break it down, right? Because they feel good, their markers are better, right? And they want to incorporate beans every day in a serving of like a half cup or more. However, they know their bodies, they know themselves. And so they may just incorporate digestive enzymes to help themselves break that down better and digest it and be able to incorporate it in a wide variety of foods that they're eating.

22:47Dr Karan: You mentioned bean-based pasta, like, you know, chickpea pasta, for example, which is great. You know, it's a food that you'd be reaching for every single day. And now it's just got more fiber in it as well, which is great. This obviously, this kind of awareness now that we're not eating enough fiber as a population, as a collective has opened up innovation in the food and beverage world where there's lots of better for you foods with additional protein, additional fiber, especially now in the last year there's lots of sodas which are now adding fiber as well i guess it's a way to meet someone where they're at trying to provide that bit of fiber what is your take on them because obviously people who historically are not eating enough fiber are likely to be those people who may have chronic gut conditions may have some pre-existing bloating because of another condition or just because they don't have enough fiber and then they add in maybe some sort of carbonated beverage, which has fiber, which is like an easy, tempting way and tasty way to have fiber.

23:48Dr Karan: What is that middle ground where like, yeah, it can be good, but also what's like the kind of downsides? So for those fiber sodas, personally, I drink them. I love them. Right. And I think, I mean, they work to, you know, add a few grams throughout your day, but I don't think for anyone, whether they can tolerate them well or not, that they should count as a means of like really getting you up there. Like they're complimentary. They're not a supplement for food to me, but they can absolutely help you to fill in some gaps. Now, the other side of this is that they typically are using types of fibers like chicory root, inulin.

24:29These are types of fibers that can make you a little gassy. If you already are having bloat, these likely will not help. So it could, you know, further worsen any discomfort that you're feeling. So if that is you, then I would advise like kind of easing off of those types of fibers because they're usually going to be in these beverages and foods that are having added fibers in them as an easy way to just incorporate them, but you may not tolerate them well.

24:58Dr Karan: Yeah, I think that's a really good point you raised, especially about the type of fibers used because just based on how it's formulated, and it's the same with gummies as well, the form factor of a beverage means that there's only a certain number of fibers which can even be considered for formulation. And it's usually inulin chicory root base, which is a fast fermenting fiber that can cause gas and bloating. And when you've got the carbonation and an inulin, and if you're glugging a couple of those a day, and you've got baseline gut problems, then it's like, hey, you know, you should be a whoopee cushion for the rest of the day.

25:33Dr Karan: But I guess it's the same for gummies. A lot of these viral gummies, fiber gummies that are online, pectin or inulin based, again, fast fermenting, not going to be great. Probably just an additive thing. If you were trying to make better choices, sugar reduction, and you were thinking, instead of this high sugar cola or a typical diet cola, can I go for this fiber enriched soda or this fiber gummy instead of the normal gummy in small portions. Maybe that's a good idea. I think the vast majority of probably reasons, it's the balance there. And another thing which people also like to use for getting in their fiber as like an all-in-one kitchen sink solution is greens powders.

26:16Dr Karan: What are your thoughts on greens powders? My thoughts on greens powders are pretty strong, but I think they are probably some of the most well-marketed supplements that I have ever seen in this industry. They are pushed as, you know, these cure your bloat and, you know, greens. So people associated with nice vegetables. Okay. I'm not eating many vegetables. Maybe I'll just have this. Then maybe I'll have more vegetables, right? Like maybe they're not marketing themselves as here's all your vegetables for the day. But if people see greens powder, they're going to associate that with vegetables and they're going to think, okay, I'm not really eating many vegetables.

26:51So let me go for this. Cause then I feel like I'm doing something. And these companies know that. So I think that they really don't provide you really any meaningful nutrition as it pertains to what you would get in actual whole foods. As far as fiber goes, on average, they may give you anywhere from one to two grams, which again is not very meaningful. And so I think when it comes to these green supplements, people should take the time to flip over the label, read what it's actually providing you, because it will say that clearly, right? Like, oh, I'm only getting one, two grams of fiber. Maybe someone would then think differently about those powders.

27:36On the back, most of these also have what's called proprietary blends on them, meaning that they may say, oh yeah, we have spirulina and we have wheatgrass powder, we have spinach powder and all these wonderful sounding green powders in them. But then they have them in one big amount of, let's say like 2000 milligrams or something, but all these different powders are listed under that. So what that means if it's a proprietary blend is that it may have all of these different types of things in them, but that company is not obligated to tell you how much of each individual ingredients actually in that 2000 milligrams.

28:09So you don't actually know how much you're actually getting of a specific ingredient. So, that means that you're kind of like not as good off as a consumer. And chances are those ingredients aren't going to be present in high enough amounts to really do anything. And definitely not as high of an amount as if you were just to eat the whole food.

28:27Dr Karan: It's, yeah, pixie dusting, not clinically dosed. And on top of that, yes to all the points you mentioned. And I think the last layer is like they usually taste horrendous. I was given a green's powder. Like they're gross. Awful. like I was given a like a kilo bag of greens powder by a company ages ago uh just as like a freebie and I was like okay I've got this now sure maybe it's got some nutrients let me just try taking it every day until it runs out I took it for a day and had to throw it away like it's not even fit like I wouldn't even give it to someone I think that would be offensive if I gave it to someone so yeah that I think we agree there quick one before we continue and something I've been genuinely nerding out on in my chief of science role at Throne Science is poop and pee.

29:13Dr Karan: You see, most of us are completely blind to what's happening in our guts and urinary health day to day. We often wait until something is wrong, but your body's actually constantly churning out data in your urine, in your bowel habits, in those patterns that most people never track. I'm proud to say that at Throne Science, we're building technology that captures exactly that. Passive, consistent biomarker monitoring of your gut health, your hydration status, your prostate health markers, without you even having to think about it. From a clinical standpoint, the shift from reactive to continuous monitoring is really important because that is where the early signal detection happens and that's when you can change your habits and hopefully outcomes as well.

29:52Dr Karan: I've been deeply involved from the science side because I think the research here is serious and with rising rates of colon cancer, poop talk is no laughing matter. So if you're curious about what that data could tell you, the links in the show notes. Something you talk about a lot online and you advocate for a lot online, and we've covered a lot on this podcast, is endometriosis. You're not only a dietitian, but you're an advocate for endometriosis. And I wanted to like pull on that thread between diet, nutrition, and endometriosis. How have you navigated that yourself as someone living through this chronic condition, but also an expert in food and nutrition and how you manage symptoms through diet.

30:33So as someone who, you know, I got diagnosed with endometriosis in May of 2024, but as with many of us that have it, the symptoms started far before that. And I tried everything, all the diets, all the supplements, everything. And I think a lot of people in my position also have been in that position where they're just trying everything and seeing what sticks. And I think now as a professional and learning about it from, you know, much more, you know, evidence science driven lens, I mean, and as more research just comes out about it, then even when I was diagnosed, we're just realizing that it is a like fully systemic inflammatory condition.

31:09Like it's not limited to being gynecological. So our approach to it from a nutrition perspective, from a, you know, medicine perspective, it has to take into account this multi-system approach to it. So when it comes to nutrition, at least on my lens, I really tried to focus on anti-inflammatory eating because it is inherently a chronic inflammatory condition. So, you know, if you are not eating salmon, if you are not eating many omega-3s, I'm making sure you're getting that in some way, even if we have to supplement with it. Or, you know, primarily focusing on sometimes do any foods trigger you?

31:45Do any foods make your pain worse? Because I do see that, right? Like for some of my patients, some months could be way worse than other months if they had a high added sugar month. So maybe we're particularly really focused on lowering foods that have high amounts of added sugar in them. And, you know, we're like increasing our consumption of as, you know, as many polyphenolic compounds as we can through fruits and vegetables and keeping things honestly as simple as we can, um, is typically my approach with this for myself and then for patients that I work with.

32:20Dr Karan: Yeah, there was a fascinating new study looking at the genetic markers associated with endometriosis. And there was so much overlap between endometriosis and various gut conditions. You know, it's significantly more likely that someone diagnosed with endometriosis will also be diagnosed with autoimmune conditions like IBS, sorry, inflammatory bowel disease, Crohn's, osteocolitis, but also irritable bowel syndrome as well as another chronic gut condition, celiac disease. And not only are endo patients more likely to have gut conditions, but even independent of the gut conditions, just the way endo spreads and occupies the body may predispose someone with endo to have gut symptoms, even if they don't have gut problems.

33:11Dr Karan: So then there's clearly like a massive door that we need to peek beyond and look at how diet can affect that. Because as you mentioned, it is a chronic inflammatory systemic condition. And you mentioned things like polyphenols and fiber, which are all beneficial. And we know from countless meta-analyses and studies that there are certain dietary patterns which can reduce inflammation. So it stands to reason by just those associations. If you have an anti-inflammatory diet, and by that I mean a predominance of foods in your diet or a dietary pattern that has lots of these anti-inflammatory, antioxidant-rich plant foods that should be able to, at least in some cases, help to reduce the inflammatory burden that endometriosis could provide.

34:02Exactly, exactly. And to go along that, Diet tends to be a pretty big part of the picture, but I also, at least when I'm working with patients, try to make sure that they are trying to lower that inflammatory burden, as you mentioned, across as many different fronts as we can. Stress management, right? Are you in pelvic physical therapy, right? Or if that's relevant to you. And exercising as well. All of these things together can just help with symptom management and just living a life with chronic illness, which is endometriosis. It takes a village as it relates to health-promoting habits to have a not-absolutely horrendous quality of life with endometriosis, and that's just the reality of it.

34:49Dr Karan: How often do people come to you as a dietician with undiagnosed endosymptoms? pretty often i would say on a monthly basis at least five to ten on a monthly basis to what to what obviously i'm a dietician so i can't diagnose it but what i would perceive as undiagnosed endometriosis and it's just like in our random initial workup right like they may talk about like how their gi symptoms are maybe like worse which you know is common you know perhaps over their menstrual cycle but then they'll be like yeah then in high school my peers were just really, really bad. Like I just always had to go to the nurse's office and like I had to be taken out of school and like all this stuff.

35:28And yeah, I don't know. My gyno didn't say much. And I'm like, okay, no. And that's, that's kind of like when my light bulbs go up and I'm like, have you ever even heard that, you know, this term endometriosis and has it ever been spoken to you, you know, from the lens of, Hey, maybe this could apply to your life. Right. And about half of them say no. Actually, I'd say 75 % of them say no, right? Or my gyno maybe talked about it a little bit, but then they didn't really say much else about it. Or they just said, okay, try this birth control. So I've been on birth control my whole life. That is just a very common way that I see it go.

36:12And it's been a really big part of my work, honestly, way bigger than I ever thought it would be to ultimately have some of my patients start to advocate for themselves more and ultimately get a diagnosis that they would have never gotten before if they hadn't seen me. And I don't say that to glaze myself like, oh yeah, like they didn't see me, but it's like, I'm the dietician. I actually don't even think that should be happening. Like all of the practitioners that you went through in our healthcare system and you ultimately got to me and then we found out you had endometriosis through me helping you advocate for yourself more?

36:49Like, why did everyone else miss this? You know what I mean? And that to me speaks to a way bigger systemic problem that I hope we can really start to bridge the gap with.

37:01Dr Karan: How do you see their symptoms change once you start working with them from a dietary perspective? Absolutely. So I would actually say that increasing fiber intake is huge. It helps a lot. specifically around the menstrual period, where I really encourage my patients to focus on that, maybe even a little bit more than they typically are. It can then help over the menstrual cycle. I've noticed with pain management, just my observation, but I've also noticed with like just bowel habits over the menstrual cycle that typically would be like not the best for them. And then I would also say as far as supplement interventions go, they are a pretty big part of my endo care work, I would say.

37:49We have some nice early research on NAC, like N-acetylcysteine supplementation. And I would say that has been a really helpful intervention as well in just the settling more so the inflammatory aspect of the condition. And it's been a really nice complement to dietary interventions that I make with patients.

38:08Dr Karan: Yeah, I think it's huge, especially that kind of fiber conversation and understanding why it could help because a huge part of endometriosis and the condition being exacerbated, it's an estrogen dominant condition. and if there's a way you could regulate the estrogen metabolism better we we have that tool via you know fiber and soluble fiber the fermentable fibers which feed that you know certain bacteria which are involved in estrogen metabolism and i think gaining some control over that through dietary interventions could be huge so yeah absolutely agree the philosophy i get from you is it's always more about adding rather than restricting.

38:51Dr Karan: I think, which is a very good philosophy generally, you know, in life, restrictive kind of mindsets are a struggle to keep adherence to long-term. But, you know, on the flip side, sometimes you do need to restrict certain things. What would you never do as a dietician? Things I would never do, to be honest, like when it comes to food, it's like what do they say never say never but i'm just someone that just i don't go out of my way to eat fast food like i i don't do it like you know especially nowadays i think i think some chains are doing better with having more options but it's just like it's not so much like oh yeah i'm like x off and i think about fast food all the time it's just like not a part of my lifestyle so i don't really do it like and you know i'm not really in situations where i have to do it gratefully.

39:43So I mean, I think it's just more so that's just my habit and that's my lifestyle at this point. As far as other things that I would say, like what, that I don't do, I would say this is more about how I am as a dietician. But I personally would never tell someone, like a patient, that their symptoms are like not real because their labs came back normal or something. And I feel like I see that a lot. And that I know that's a little bit different from what you asked, but I felt like it was worth sharing for this question because I just feel like I see that far too often. And so I don't do that. And I would never do.

40:26Dr Karan: yeah I I really liked that situational uh positioning of you know how you sort of deal with uh you know diet as well I mean I had a similar anecdote over the weekend where it was Saturday late morning and I was going to the gym and in the last hour before the gym closes on Saturday morning there's like a huge open calisthenics workout and they were all having like a PB day where they were all kind of like just doing different workouts when I hit their PBs and the kind of like lead instructor had loads of pizzas, loads of sodas out for everyone. And I was just like, oh man, I looked at everyone having pizza and then doing the calisthenics.

41:10Dr Karan: And I was just like, I want a pizza. Right. And I realized it's about the situation I put myself in, which can lead me to certain habits. You know, I don't go out clubbing. I don't put myself in situations that could lead to a negative consequence. Like I haven't had a drop of alcohol for eight years. I was never a big drinker, but you know, I was always a social drinker. Like if I went out with friends and they had a beer, I might have a beer as well, like just one beer. And I don't want to do any of that. Like I'm easily influenced by people. And so I just take myself out of the situation where I could be influenced.

41:45Dr Karan: And I think that's like a, that's something I would never do in terms of restriction. I would try to limit places and people I surround myself with, which would lead me down a path I don't want to go down. 100%. And that's a really good point that you brought up to like, alcohol, that has just never really been a part of my life. Like that is just not, and I'm not trying to start. And I, you know, as you mentioned, like, especially in my university days, where I was, you know, more social, I guess, because it's like, you don't want to be bored. And then everyone's having a drink. She's like, okay maybe so like every now and then sure but it's like especially now that like i'm out of university and i'm just kind of living my own life like i just i've never been the type to be like yeah let's go to happy hour yeah let's do like i'm just not that type of person and we don't vibe so that's i guess that is a never for me too no agreed um if you're speaking now to one person who is just feeling absolutely overwhelmed by nutrition advice online where should they start tomorrow morning?

42:47Tomorrow morning, I would say go into your kitchen and see what you have. Not from the lens of, okay, what can I throw out and put in the trash? But like, what do I have that maybe has just been in the back of the cabinet for a little bit too long? You know, do I have any random cans of like vegetables or beans that I just said I was going to buy when I was like in a healthy mood going to the grocery store, but I never did anything with it. Right. Or like, what kind of vegetables do I need to use up before the week ends, right? Take inventory of health-promoting foods that are in your kitchen right now.

43:24And then figure out, okay, what is like one meal that I eat all the time that maybe it makes sense for me to add this fruit that's about to go bad to? Or like, okay, I'm making this like these eggs or something like that. Maybe I can just throw in these greens that are in my fridge. That is the start of something that can then blossom into something that is like Ultimately bigger than where you started health does not all have to happen overnight I tell all my patients from the get-go if you're sitting here talking to me in our initial session Expecting you to like do a complete 180 by next session.

44:02You're in the wrong place Like I don't want things to happen for you that way But also I want you to build something sustainable and nothing worthwhile just came overnight. And it's the same thing with health. And so I would just say, like, figure out where you are right now. Take one small step forward and then let that snowball into something greater as time goes on. It's the same thing with exercise, you know, like, okay, do I have 15 minutes now? Can I just like go for a walk? Sure. Go for a walk. Great. That's 15 minutes of movement. That would have been zero minutes, you know, if you just didn't take that small little time out.

44:41So like, think small, eventually, it'll turn into something bigger. The more that you water it like a plant, you know, I you know, what I love about your

44:50Dr Karan: advice is that how simple and practical it is. And it comes from real education and working from real life people who don't have, you know, the same timelines as a wellness influencer, and who don't have unlimited resources. And it is grounded and just built on those simple principles that can meet someone who just has a normal life, maybe has like three kids working two jobs or, you know, working night shifts and they need something simple just to fix their diet. So they're working through chronic conditions and their lifestyle is compromised in certain ways. So they need simple things. So Shaila, thank you so much for joining me.

45:30This has been a pleasure. Thank you so much for having me.