Eat Everything
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Kara Wada, MD: Welcome back everyone, and welcome to our new listeners. This is the Becoming Immune Confident Podcast, and my name is Dr. Kara Wada. I'm a Board-certified Pediatric and Adult Allergy, Immunology, Lifestyle Medicine Physician, and today I am so excited to welcome one of my esteemed colleagues, Dr. Dawn Harris Sherling.
She's a board certified Internal Medicine physician. Who was also board-certified in obesity medicine. She began studying journalism before switching to pre-med studies at the University of Florida where she graduated with honors and as phi beta kappa. She earned her M.D. With honors from Yale and then completed her residency at Harvard's Brigham and Women's Hospital where she went on to serve as an attending physician, an Instructor in Medicine at Harvard University.
She moved back to her native Florida in 2008 and currently sees patients at a clinic for underserved populations and is an associate program director for the internal medicine residency at the Charles E. Schmidt College of Medicine at Florida Atlantic University. She most recently authored the book, Eat Everything: How to Ditch Additives and Emulsifiers, Heal Your Body, and Reclaim the Joy of Food.
She was inspired to write this book after an additive-free trip to Italy seemed to cure her IBS, so on. Dawn did a deep dive into the published literature on our microbiomes and how emulsifiers and other substances may be feeding the wrong bacteria in the wrong places and contributing to alarming rates of diet related diseases.
Dawn, I have to say I've been reading this book the last couple weeks. Thank you so much for sending me a copy. And this is totally up our alley here on the podcast. I'm so glad to have you here. Can you share a little bit more about your story and how you ended up here doing what you're doing?
Dr. Dawn Sherling's Life-changing Trip to Italy
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Dawn Sherling, MD, FACP, Dipl ABOM: Sure. So I was just going about my life when I started developing the symptoms of Irritable Bowel Syndrome, I thought I'm getting older, I had another child and I thought my body's just different now. Maybe I need to exercise more. I need to eat more vegetables. I need to de-stress all of these things that, that we tell people to do. I did the things I told patients to do. I cut out dairy, I cut out gluten, I tried the low FODMAP diet that a lot of folks with irritable bowel are told to do that I told patients to do for years and they would come back and say, "This isn't great. It's not really helping that much, and it's really hard to do".
And I was like, "Yeah, okay. That's it. That's what I got". And so I was trying all those things and it turns out my patients were a hundred percent right as they always are. And these were not effective treatments. I just would resign myself to having to spend a lot of time in the bathroom more than anyone should really spend in the bathroom.
And then I got to take a trip to Italy with my family. And within 24 hours of being in Italy, I was fine. After several years of struggling and trying to power through this stuff, thinking I was gonna be totally wrecked in Italy because pasta and pizza and gelato and all these things that people with IBS, onions and garlic and whatever else you can think of that we're not supposed to have.
I started slowly, but then rapidly increased my consumption of those things. Cause it's so good, right? Like how can you resist? And I was fine. I was absolutely fine. And I thought, oh you know what we say, we're on vacation, we're having less stress. It must be I'm walking more, it must be all of these things, and that's what I thought it was. I come back to the US, I vow to do better. I'm going to eat more salads, I'm going to walk more.
Within 24 hours then of being back in the us, boom. All my symptoms were back. And I was like, what is going on here? This doesn't make sense and the story's a little longer, but I won't bore everybody.
And so I decided at that time, I'm a little bit of a nerd and I like reading medical journals, so I said let me go and see what's going on with the food. So I did, I went into PubMed and started doing literature searches and I was very fortunate that at the time, in the 2015, 2016, 2017,
Articles started coming out more and more about our microbiomes, about these food additives. There were some researchers doing work in France and Brazil and some other places that were coming out with what these additives are doing, what these emulsifiers are doing, how our microbiome is being changed by them, and what happens when we eat less of a whole food based diet and more of an ultra processed one.
So I was like, "Oh my gosh. Is this what was going on when I was in Italy and was doing great? Let me cut these things out and see. And so I started eliminating. Instead of eliminating real food from my diet, I started eliminating these emulsifiers and additives from my diet and things went back to exactly as they had been in Italy.
So for lack of really any other good stuff to do for patients who were very frustrated, who had gone to see the gastroenterologist, who had gone to see other specialists and they were frustrated because they weren't really getting any better. And so I said, "Okay, try this". And they did. And it actually worked.
I said, okay, this is crazy. And then I have patients with diabetes. I see a lot of patients with diabetes.
Kara Wada, MD: Yeah. Unfortunately that's bread and butter, internal medicine.
Dawn Sherling, MD, FACP, Dipl ABOM: And the numbers have just been increasing. Cause I've been doing this for 20 years. And I'm seeing it and I said, "Okay, I'm seeing a population, as you mentioned, that doesn't have insurance, that can't afford a lot of these newer medications. And so we're left with, okay, we're either going to insulin or we have to make some dietary changes". And my patients by and large all say, "Yep, let's do the dietary changes".
Kara Wada, MD: Yeah. Better than needles. And we've heard about the cost of insulin being astronomical as well.
Dawn Sherling, MD, FACP, Dipl ABOM: So cost, inconvenience, a lot of my patients work outdoors, so it's not so easy to do injections. Not easy for anybody, but for, especially for my patients, it's not easy to check blood sugar and do injections and all of that. And certainly they can't afford the pumps, so that wasn't an option for them. Fast forward, they start cutting out the food with additives. And a lot of them, those of them who were a little bit older, and by a little bit older, I mean in their forties and fifties, who had come from countries where they grew up eating whole foods. It turns out that a lot of them, they were able to say, "Yeah, I know how to do that. I know how to eat real food. I know how to prepare food. I know how to cook. I grew up doing it. No problem". They did it and the rates of decrease in blood sugar in fatty liver, in all of these things that we, at least I, were I don't know what to do. This stuff is just going crazy. Fatty liver, that non-alcoholics, the hepatitis that we hadn't seen really in any great numbers 20 years ago that now seemingly everyone has.
Kara Wada, MD: And even kids sometimes we're seeing, yeah.
Eat Everything
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Dawn Sherling, MD, FACP, Dipl ABOM: Even kids. And it's awful. And I think now the evidence very strongly is pointing to what's causing it.
And the solution is to cut this stuff out, eat a more whole foods based diet, and it's not as hard as it might first appear. And so that's why I wrote this book, that's why I wrote Eat Everything. And that's why it's called Eat Everything. Because when I was in Italy, I could literally eat everything.
Everything because it was real food. And when my patients do that and they eat real food, they get better too. And I was like, okay, I have to write this book. I have to tell more people because it's crazy that this isn't getting more attention. It's actually starting to, because I think, if you've been looking at the newspapers recently and other news outlets, I feel like every week, something is coming out saying, "Hey, maybe don't eat this ultra processed product and eat Whole Foods instead. So that's, I think, been in the news lately and I'm really excited about that because we are talking about it more.
In Order to Eliminate it, We have to Identify it
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Kara Wada, MD: Yeah. What constitutes as alter process versus real food? Maybe you could share a little bit more about that with our listeners.
Dawn Sherling, MD, FACP, Dipl ABOM: That's a great question because in order to eliminate it, we have to identify it. So there's a group in Brazil which has done research into this and come up with something called the NOVA Classification System that the World Health Organization is now also embracing. And so I look to NOVA, is it perfect? No. Is it absolutely fantastic and better than what we're doing now?
Yes. It's super easy. Okay, so NOVA, real quick.
So category one, NOVA Foods. Basically those are whole foods. Those are foods that look like how they look when they come out of the ground. So an apple looks like an apple. If you're a meat eater, then you know, a piece of chicken looks like a piece of chicken, right? And so those are whole foods.
When we look at category two foods in the NOVA classification system, culinary ingredients, that's the stuff we use to prepare foods. So butter and oil and salt and spices, and we're not meant to use that much of them. They're accompaniments, they are, a sprinkle of this, a little of that. We shouldn't spend too much of wasting our time. I know a lot of people are talking about should I use this oil or that oil or this butter? Or not use butter or not use coconut, just use a little bit. And then, keep it moving. Try not to deep fat fry stuff too often. Try not to pour a ton of salt onto stuff, but you know enough to make it taste good so that you don't have to use the ultra processed stuff and eat even more salt. So we learn to season our food. That'll go a long way. Okay, category two.
Category three, the traditionally processed foods. So yogurt, that's just milk and the bacterial cultures that make yogurt. That is a processed food 'cause you're turning milk into yogurt. But it's traditionally processed. So category three foods are the traditionally processed foods.
Category four are those ultra processed foods that we all wanna know, what is that? And that's basically food that has been so altered from its original state that our bodies don't really know what to do with it anymore unfortunately. And that's leading to the fatty liver and the metabolic syndrome and all of these other conditions that we're talking about.
Don't be fooled by Fancy Packaging
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Dawn Sherling, MD, FACP, Dipl ABOM: So those foods can be identified. When you turn over a package and you look at the ingredients, don't look at the front of the package. I tell people ignore the advertising words. Ignore organic, ignore natural, ignore whole grain, because those aren't meaningful. What's meaningful is turn it around, look at the ingredients. If there are ingredients in there that you can't picture in nature, how it would might be growing, don't eat it. And the thing of it is people say, " How can I know that maybe there's a vitamin listed or maybe there's something else that isn't bad for me?". And what's really cool about that is we live in the age of Google and so you can look it up if you know you have the time. We can't do this with every single thing we're buying in the supermarket or we'll be there for three hours. Just pick a couple of items and say, "I'm gonna look at these items when I go to the grocery store and see if I'm buying an ultra processed product". So talking about yogurt, turn the yogurt over if it says, supports gut health. If it says all natural, ignore those words. Turn it over, look at the ingredients and if there's stuff that you don't know what it is, you might wanna Google it. In my book, I do list 25 additives to avoid. My teenage son, who is a computer programmer might this summer be making an app for me to help people.
Kara Wada, MD: That would be so awesome.
Dawn Sherling, MD, FACP, Dipl ABOM: It would be so awesome. Teenagers, so we'll see. He's actually really good, but we'll see what he comes up with. I'm excited for him to try. But hopefully, I'll have that for people. I'm not making any promises. But if I don't have that, we can still turn around the package, look at the ingredients and Google them, worst case scenario. So do that. Fewer ingredients are better, generally speaking as a general rule. And I think we have to use general principles and general rules are we gonna be right a hundred percent of the time? No, but progress over perfection. We have to try and this idea that we can't identify ultra processed foods, please, let's not listen to that.
I think that's something that benefits the ultra processed food industry. If we're all throwing up our hands and saying we can't do it. We can't possibly figure this out.
Yes, we can. Yes we can. We can figure this out. We can start getting rid of the ultra processed stuff. And that is the first step into improving our health.
Kara Wada, MD: So what do you say 'cause the thing that I hear so often from my patients when we talk about making a big shift with lifestyle, especially with cooking and food, is I'm too busy.
Time for a beverage makeover
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Dawn Sherling, MD, FACP, Dipl ABOM: We all are. So we're overstressed, we're overworked, we're overburdened and there isn't a lot of extra time to do things. And noting that and being mindful of that it's like small steps, right? What can we do today? Is there anything that you can do today to make a small change, to get rid of something ultra processed? And what I find in my patients, that's the easiest change to make as a first step, and it makes a huge difference, is in beverages.
Yes. Because you're gonna drink something and water is a great beverage or fizzy water if you like the bubbles, right? So fizzy water's fine. Water's fine, coffee's fine, tea is fine. Unless for some reason it bothers you, then obviously not, but, and also be mindful of what we're putting into those beverages.
We can cut out the juices, the sodas, the sports drinks as a first step. That's actually huge. Huge. And that's something most people can do, 'cause that actually doesn't take any more time and it might even save you a little bit of money. 'cause you're not buying all of these things 'cause water, if you get it from your fridge or your tap, hopefully you can do that is free or almost free. That's a really good thing to be able to do and then just make a small change. Say, is there something this week that you can change?
Cooking: Turn your kitchen Into a Stress-free Zone
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Dawn Sherling, MD, FACP, Dipl ABOM: The other thing that gets really important is being able to cook. And being able to do a little bit of food prep and having some ideas for that.
So there's some ideas in my book for that and how to do things really simply and easily. But also, again, in the internet age, there's a ton of stuff on all these things, right? Yeah. I'm always getting ideas. There's some people that I follow on Instagram who are always posting really wonderful whole food based ideas that are fast and easy, right? If someone is posting like a 16 step recipe, No. That's not happening. I don't have time for that. And then, cooking in bulk. I love cooking in bulk, right? Cause I'm making something that's gonna take me the same amount of time to make it last for two nights or even three nights as it would for one. And then I don't have cleanup on left overnights. Really? Which, yay.
Kara Wada, MD: Yes. That has really changed, I think, how we approach things. And it's evolved in changes. Our family has grown but the weeks we do best are the weeks that I have thought ahead. Okay. What's coming up? Anticipated kind of some of those sticky spots on busy nights or what have you, and then gotten things ready on Sunday. Did a couple hours of meal prep. It cuts down on my costs, it cuts down on the dishes, which as you mentioned is huge. And it really helps overall cut down on our stress levels because we're not wondering like at 4:45 as we're going to pick up, okay, what's for dinner? Are we gonna swing through Wendy's or get BB Bob or, what have you.
We have a plan in place and can just quickly execute it.
Dawn Sherling, MD, FACP, Dipl ABOM: It's so important. That is so key that you mentioned that it's like making the plan on the weekend for the rest of the week. Yes, because same deal. If I don't have a plan and I'm scrambling, that's when the wheels come off. And that is really stressful.
And so having a plan for the week I plan it out, we grocery shop based on that plan. And then there's less waste also. Because I know exactly what I need to buy. I go to the grocery store or my husband goes, and then he gets a bunch of extra stuff that I'm like, now what do I do? But that's okay. And so we get the food that we are going use that week. And I have the plan ready to go. Now, do things always go according to plan? Absolutely not. Ordering the pizza, absolutely, yes. And that's okay. Perfect being the enemy of the good, like I'm not trying to be perfect.
I am just trying to actually make things easier and for people who are struggling with IBS or other health issues and I saw a survey recently and I'm trying to remember where, but even for people without IBS, something like 50% of Americans complain about their stomachs and that takes a lot of time. If your stomach is bothering you and you can't do other things because you're concentrating on, "Oh my gosh, my stomach", that's time. That's taking our time. And so if we can instead just take a few of those minutes that are invading our week and put it in our weekend. Like you're talking about having a plan, let's do it. Let's figure out how we're gonna make dinner this week. And I'm not cooking more than two or three nights in the week, probably not more than two, right? But I'm using my slow cooker. I'm throwing stuff in there. I'm just having the plan. And that's really important.
There's a sample plan in my book too, actually. For what to do for a week. But again, everyone's so different, so I didn't wanna make it too prescriptive. Because we all have different tastes, we all have different skill levels, we all have different amounts of time that we can spend. And so making it personal and figuring out what we can do is key not to have something not a strict rule thing that we have to follow because that may not work for us.
Kara Wada, MD: Yeah, I think that's helpful as we think about rejecting some of the diet culture that we have been immersed in our entire lives of just what can we add that is going to help support and nourish us in place of those additives.
Unleash the Power of Grandma's recipes
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Dawn Sherling, MD, FACP, Dipl ABOM: Yeah, and that's the thing, and that's where I say talk to a grandmother, right? If it's not your grandmother, talk to someone's grandmother because they'll know. And so I talk about, in my book, one of the recipes is Japchae, which is a korean dish. And so my husband's roommate in med school, he's a physician too he met in med school. His roommate is Canadian Korean American. And his family came to visit us one year. We're down in Florida. And the Canadians really like Florida in the winter, we're a great spot for tourism. Yes. And so we invited his whole family to stay with us one winter. And they came, his brother with his brother's wife and his parents came and they all stayed with us. And it was really a lot of fun. And I had a new baby at the time and the mother and sister-in-law, so grandmother took over the kitchen and they started making all these dishes and my husband said, "Can I watch? Will you teach me?" And so that's really key, right? Because I don't come from a family of not my immediate family, my grandmother, unfortunately, I didn't get her recipes when she was around. My parents weren't really cooks, right? Not that generation. I think in this country, that generation was already doing the TV dinners and all of that. And my husband's family, the same thing.
He doesn't come from a family of cooks either. So we've relied on other people, other friends who come from more cooking cultures, cooking with whole food cultures to teach us. And so that's been really good. And cooks are generous people in general. And if you ask someone who can cook, if you have a friend who can cook or they have a parent or grandparent who can cook, Ask them, "Hey, will you teach me?"
And usually that person will say yes. And home cooks are the best because they're trying to go quick and they're trying to be efficient and not cook with expensive stuff. I did a podcast recently and the host said there are no weird ingredients in your book, there's nothing that I have to go to six grocery stores for, right?
Because that's not practical. That's not how home cooks cook. So learning from home cooks is the best.
Kara Wada, MD: Absolutely. And is so timely because I've been having conversations, my children go to the same childcare center and have been since my oldest was like three months old. And so they are essentially our family in where we live because we don't have family nearby. And their staff, there are several young women in probably their early to mid twenties who, I was talking with them about cooking and food. And food is medicine and things and some have come over to help sit for us while I meal prep when my husband's at the hospital and the game plan is actually they're gonna come over on Sunday afternoons. They're gonna help me take some footage for the social media stuff, and I'm gonna teach them how to do some of this home cooking. Because they haven't learned. They're making the boxed mac and cheese or the grilled cheese sandwiches, or, those things that we learned in college to keep us fed. But they're wanting to also learn some of those skills. And it's a joy to share that knowledge. And I think there's something for us that those of us who do like to cook at home that, this food is love, and and Passing on that education is similar.
Dawn Sherling, MD, FACP, Dipl ABOM: Yeah. And people have asked me too, will you teach me how to make this? And absolutely. I love that, right? Yes, I wanna teach you, I wanna teach you how to make it. And I wanna teach my kids too. So I mentioned to you before we started that my son is gonna be going off to college in a year.
And I'm like, you are not leaving this house until you know how to make five things. You need to learn how, and he does know how to make a few things already, but none of them will sustain life for long. He knows how to make brownies, but he's gonna learn and he's gonna leave my house knowing how to cook.
And the thing of it is this is knowledge that we all used to have. And then we were told, "Oh, you don't need this anymore. You don't need this 'cause we have all these ultra processed things that are, it's gonna make your life so easy". And I think my mother was probably from that generation where you just get everything from a box or a package and this is gonna just be great for you. And the thing of it is, it was a lot of marketing. So I mentioned my son knows how to make brownies, and he asked me, "Mom, why do people make it from a box? It's just as easy to make it with just flour and cocoa and sugar and eggs and whatever". And for a teenager to say that, that's pretty amazing.
But yeah it actually isn't much harder at all. Like two more minutes and a couple measuring cups to make it from scratch to make it yourself. And the problem is that we've been advertised to so much to make us think " Oh, we can't do that. That's too hard". And unfortunately, I feel like a lot of us have bought into it, right?
Yeah. And so we think, "Oh, I can't possibly make salad dressing. That's too hard". When it's super easy.
Kara Wada, MD: We made one this past weekend. I joked and did a little video. It's so easy. A four-year-old can do it. But she was able to put all the ingredients in the little shaker. We have a little dressing shaker and she had a great time shaking it up and. Now, did she eat much of it? It's questionable, but yeah, she tried a little.
Hard-coding Healthy Habits in your kids
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Dawn Sherling, MD, FACP, Dipl ABOM: Yeah, she tried it. That's amazing. I recently read that 70% of what our kids are eating is ultra processed on average in this country and it's a scary number because our kids, they pick up so much, right? They just see everything that we do and they pick up their habits from us. And so this idea that like what you're doing is so cool involving your kids at a really early age making food, they see, "Okay, this is a healthy way to live. This is a good example to live by". And again, my patients, they don't have a lot of money at all and they don't have a lot of time either. The ones who have been able to make this change are the ones who saw it when they were kids, who saw Whole Foods being prepared and they understand how to do it. And it comes very naturally because when you grow up seeing something, it's like hard-coded And so I think it's like another benefit of eating more whole foods based and getting your kids involved is that it gets hard-coded for them and so they know, "Okay, this is how I do this". Even if they, like my son probably go off to college and don't do it, it's in there somewhere. And if at some point he decides, "Hey, I wanna do this", then it'll be in there. They'll know how to do it. And so it's so great that you're teaching your kids and for those of us who are trying to engage teenagers, that's a little harder.
Response of Residents
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Kara Wada, MD: I'm curious how your residents, what their response is because that's an even, in between that generation, between your teens and certainly I'm an elder millennial, but they're in that other generation.
Dawn Sherling, MD, FACP, Dipl ABOM: Yeah, so that's actually been really interesting. And I've lectured on this topic to the residents.
And a resident actually came up to me the other day and this was so cool. And he said to me, "After your lecture, I totally decided to make these changes and I'm so much healthier now and I'm doing all this stuff". So I was very excited that on a personal level that they were listening. Yay, but residents, right? Talking about people who don't have time. Yeah. They work 80 hours a week. Yeah. Hopefully not quite 80, in hard weeks they're working 80 hours a week. They are not as well paid as they should be. That's a whole other issue.
So they don't have a lot of money, they have big student debt, and they don't have time. And so really they're in the hardest spot to make these changes. And the thing of it is too, when you're in the hospital, they're serving so much ultra processed food in the hospital and they're trapped in the hospital for sometimes 16 plus hours and that's it. That's all they have access to. So it's really hard for residents. Acknowledging that and acknowledging that we need to make radical change in the food we're serving our patients and our staff in hospitals because that's really bad. But that's maybe a topic for another day.
The residents have, I think been listening and been saying like, "Okay, wait a minute. This isn't good for us". And I love working with the younger generation because I think they're already primed for this. So I'm Gen X, I'm a little bit older than you and, Gen X, we just grew up with this stuff and we didn't question it and the breakfast cereals and all of this stuff that we were told was good. This is a good breakfast. This is a nutritious breakfast. And we didn't question it. I think this younger generation that's coming up, they're like, "Wait a hot minute". First of all, they're really good at questioning everything which is awesome, which I think is awesome. They're like, "How do you know that? Like, how are you so sure about that?" And so that's great that they do that. And I think they're doing that with the food. And so we're seeing it and I love the enthusiasm from the younger millennials, the older millennials too, and the Gen Zers who are just like, "Yeah, we're not into this stuff. Like we definitely wanna go more Whole Foods". And so I'm seeing that from the gen Zers being more conscious of that. And that's really cool.
Kara Wada, MD: Yeah. I've been talking to a few, there's a resident who's been with me the last few weeks and he had mentioned that he's been making some changes with his diet and cutting out some of the crap, so to speak, and he's, "I feel so much better".
Self-Reinforcement: Cutting on the Additives
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Dawn Sherling, MD, FACP, Dipl ABOM: It makes a huge difference. That's the thing that's so amazing to me. When people start cutting out these additives, when people start eating more whole foods based and they're like, "Oh wow. I feel amazing". And that's self-reinforcing. So talking about how change can be challenging. When you feel better the next day after making some changes, you're like,
"Okay, wow. That was awesome".
And so it's just like your resident, it's self-reinforcing because you do feel so much better doing it. And this kind of goes back to so many people over the years have been saying, and now everybody comes to tell me their story, right? Because after writing this book people are like, wait a minute because I do tell patient stories in Eat Everything and the patient stories are very recognizable. So I didn't pick really obscure stories. I picked stories that were pretty common. And people will come to me and say, "Oh my gosh, this patient you talked about that's exactly my story".
And the thing of it is that when people travel, and they go to countries that things are more whole foods based, and they say, "Why? Why do I feel fine? Why did I eat all this stuff and not gain any weight? Why did this happen?" And for years we were telling them, oh, you were less stressed, you were walking more, you were whatever.
And it turns out, it's the food. It's actually the food. It's been the food this whole time and now it's just reaching these epidemic proportions where 25% of the adult population is struggling with diabetes in the us, struggling with blood sugars. 25% and that number doesn't scare the heck out of us.
The Health Mystery
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Dawn Sherling, MD, FACP, Dipl ABOM: We should be like, "Oh my God, what do we do? Why do a third of my patients have fatty liver?" Which is gonna be the leading cause of cirrhosis it's gonna bypass, the viral hepatitis. It's gonna bypass alcoholic hepatitis and it's gonna be this Non-alcoholic Steatohepatitis, this fatty liver disease. Where did it come from? We didn't even define it until the 1980s. And now a third of people have it. Like what? Huh? It's not because, and lemme tell you this, okay. This is the thing that working with the patients I work with opened my eyes to also. So yes, my own travels like, yes, that opened my eyes to the additives and the IBS issues that the rest of the world doesn't suffer with at the numbers that we're suffering with it, like at all.
In Italy and Spain, not even close, but taking care of my patients who are just hardworking people. They are the folks who are doing the roofing and the tile laying, and the landscaping, and these folks are doing the house cleaning. These folks are doing physical labor. So this idea that we're unhealthy 'cause we're not moving enough. Okay. For some of us that's true. Okay. I'm not gonna say I could also stand to exercise a little bit more. But for my patients, that is absolutely false. They're working six days a week, sometimes 12 hour days, and they don't stop moving. Why do they have diabetes? Why do they have fatty liver? That is the part that doesn't add up. And they have it in huge numbers, right? In huge proportions. And they're young. They're in their thirties, sometimes even in their twenties, coming in with this stuff and it's like physical activity wise, they are getting more than all of these gym rats, right? So that's not it, that's not the explanation.
Kara Wada, MD: Now we just need some, just thinking of things from the system level to support these changes in thinking about how, I mean from the big picture, how our food subsidized all the things, like all, you can just start going down the not necessarily the rabbit hole, but the list of ways that, okay, how then can we support these changes?
Because it really is going to take a village, but starting small.
We can change what's on our plates today
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Dawn Sherling, MD, FACP, Dipl ABOM: The whole system is definitely not making it easier for us to do this and we do need system change for sure. And there are, I think there's some politicians that are working on, I think Cory Booker comes to mind as someone who's really trying to change food policy in this country. And that's huge 'cause that's not like a sexy sell, right? That's what I realized once I started, talking about my book, which is even though I gave it a cool title, like Eat Everything, everyone's oh, that's such a cool title. But it's like the stuff is not, we're talking about poop and we're talking about blood sugar and we're talking about learning how to cook and that's not sexy.
And so I think the same thing with farm policy and other stuff , it's vitally important. But it's not as sexy as some of these hot button issues that people are getting a lot of attention for. And it's too bad, right? Cause it's our health. That's the most important thing but unfortunately it's not getting a lot of attention. So I think you doing this podcast is awesome. Trying to get attention, right? Because if voters are interested in it, if people are interested in it then and we demand change, then our politicians and the people who make policy, they're gonna do it because they want us to elect them.
But in large numbers, we have to start speaking out and we have to start saying, "Hey this isn't working" and physicians too, and other people in healthcare as well, we have to start leading the charge 'cause we see it every day. We see all of this diet related disease every day. And if we're not speaking up about it, it's really hard to ask our patients who are, again, overburdened and overworked and they're sick on top of everything.
So when you don't feel well, you don't need more stuff to do. So I think it's hard. I do talk about in my book how we can start to make change and voting with our dollars actually is a big place to make change because government moves really slow usually. So I was a political science major as an undergrad. And so we learned that unless there's a big, major crisis that happens, government moves really slow. Private industry moves faster, much, much faster. And so if people decide, "Hey, we're not buying this stuff. We're not buying this stuff with the emulsifiers and other additives in it", they will pivot fast and start getting this stuff out of our food.
So if we as the consumers decide, "Hey, you know what? I don't want this. I don't want this in my diet. I don't want this in my kid's diet. No". And we don't buy it. The industry will get the message real quick and pivot much faster than policy change can ever happen. The crazy thing is, the tough thing is that policy change, if it does happen, which I hope it does, is years and years and maybe decades into the future.
And my patients and your patients, they don't have decades. Their bodies are struggling now.
Every small improvement adds up to better outcomes
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Dawn Sherling, MD, FACP, Dipl ABOM: And so that's why I concentrate so much in my book on making change at the individual level, even though it would be much easier if we had it on the, system level, that would be great and make all our lives easier. But that's a far way off.
Kara Wada, MD: Yeah. And at the end of the day, the only actions we can control are our own.
Dawn Sherling, MD, FACP, Dipl ABOM: Yeah, that's true. And so the thing is I get upset, I get like really upset when people are defeatist about the whole thing and they say we can't do this. We can't do this because the industry is against us and there's no policy support and there's no, all of those are true. And all of those are true, unfortunately for a lot of things. And if we just throw up our hands and we say, "We're not able to affect change. I think that's hard and that's disempowering. I think we have to acknowledge that people are facing real struggles and that the systems aren't in place to support them. So acknowledging that a hundred percent, but also saying, "Okay, all of that is true, but we can't give up. We can't just throw up our hands and say there's nothing we can do".
Because again, making those small changes that you're talking to your patients about, that I'm talking about in Eat everything, making those small changes are really what leads us to better and better outcomes until such a time as we can get high level change, which unfortunately is gonna be a long time incoming.
Kara Wada, MD: Those 1% improvements. They sure do add up.
Dawn Sherling, MD, FACP, Dipl ABOM: They do. They really add up. And I think that's what's cool about seeing patients is that you can make change, you can make small changes that make big differences and sometimes it takes a little more time and sometimes it takes people a few more times to make change, a few more attempts to make change, right? Change doesn't always come so easily, and that's okay. And that's why I love primary care, because primary care is that continuity or hopefully, in an idealized primary care world, right? We don't live in an idealized primary care world, unfortunately.
Our Microbiome's Fast Response
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Dawn Sherling, MD, FACP, Dipl ABOM: But in an idealized primary care world where we have continuity with patients, it's okay, didn't work this time, or, okay, you know what? You made those changes and then there was a little bit of a setback because something happened in your life because there was a stressor, or you just, you fell back on old habits for whatever reason. But we can go back. We can start doing those things again".
We haven't talked too much about the microbiome and our guts but the cool thing about those bacteria and the other organisms that make up our microbiome is they are multiplying and turning over and changing based on what we feed them constantly. And just the time we've had this conversation, our tens of thousands of organisms. Tens of thousands of organisms have changed. And all right. Didn't work out this month make the change and boom fast, right? It happens. For the most part, we haven't done anything that we can't undo.
Kara Wada, MD: Yes and I recall one study, I can't recall if I, it was during my lifestyle medicine training or maybe it was in another book that I enjoy, The Fiber Fueled C ookbook too, but our microbiome can change within 30 hours. If you go from like a standard American diet to a whole food, plant-based diet, you see those changes in a day.
Dawn Sherling, MD, FACP, Dipl ABOM: Yeah. So really fast, right? Yes. And so I heard this phrase actually recently called plant slant, and I like plant slant. Yeah, I think that maybe comes the blue zones maybe. But that's the Plant Slant and so I like that because there are a bunch of people, and I'll throw myself in there who are like, "I like chicken sometimes and I like a hamburger sometimes, and I like", and that's fine actually. But you're right in so far as like we want to lean in on the plants. Yes. On the Whole Foods. On those whole plant based or plant slant stuff. Because that does nourish our microbiome.
Our Microbiome and What we feed it
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Dawn Sherling, MD, FACP, Dipl ABOM: And if we're gonna talk about that then there's a group out in California that has done some research on the microbiome and what we feed it, and they've done stuff on fermented foods as well and how fermented foods can impact the microbiome. So yes, eating that whole food, lots of plants, lots of fiber from plants as opposed to the fiber that's extracted from the plants, and then put into ultra processed foods, which does not behave the same way in our body as when we are ingesting it from those whole foods, right? So when I tell my patients like, "Please, when you see a package that says fiber enriched, or lots of fiber, if it's written on a package, that's not the fiber that has really good data behind it".
For the Microbiome: Fruits, Vegetables and Fermented Foods
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Dawn Sherling, MD, FACP, Dipl ABOM: The fiber that has really good data behind it is the stuff you're getting from whole fruits and vegetables, right? And whole grains and all of that.
Kara Wada, MD: An apple, a carrot, an apple.
Dawn Sherling, MD, FACP, Dipl ABOM: Right? So simple, right? But unfortunately on an apple or a carrot, it doesn't say high fiber, but I just want people to know if it's a fruit or a vegetable, it is high in fiber for the most part.
Again, perfect being the enemy of the good. Run with that. Just run with, "You are nourishing your microbiome if you are eating whole fruits and vegetables, period. Hard stop, right?" And then if you wanna get into the details, that's cool. I love details, but just for starters, just for a floor, let's say whole fruits and vegetables, lots of fiber and the good fiber that you want, right? Okay, that. And then the other gut nurturing stuff are those fermented foods, right? The traditionally fermented foods, which yogurt is, kombucha, we talked about korean food, kimchi, right? And all the other pickled stuff. So that actually really diversifies our microbiome in a way that unfortunately just eating fruits and vegetables can't do. This group in California has published data on that, but when we eat the fermented foods, we get a diverse microbiome. And I know you talk about this less inflammatory microbiome, which turns out to probably be really important.
Kara Wada, MD: Yeah. Even at our most recent national meeting, the American Academy of Allergy Asthma Immunology, there was a lot of discussion on the role of these additives and other substances, chemicals that we encounter through our modern existence that really are contributing to these same sorts of injury that we're seeing with the additives.
Dawn Sherling, MD, FACP, Dipl ABOM: Yeah. Yeah. So that's
Kara Wada, MD: all contributing to the allergies, the autoimmunity, and then the metabolic diseases that you were talking about that are just rampant.
Dawn Sherling, MD, FACP, Dipl ABOM: What's been really interesting is that, I have a friend who's an oncologist and she went to, I think it was ASCO that was the recent oncology conference.
And so she went there and they were discussing how changes in the microbiome are leading potentially to cancers and not just colon cancer, which has been well documented, but other cancers. And we're starting to have this conversation, which is good.
And there's some things that we can control and there's some things that it's harder to control.
So you told me about the smoke that you're having where you are from those forest fires. Canada. And that's not good for us. But unfortunately besides staying indoors and putting on masks and doing that sort of thing, I cannot control the air quality outside talk about needing big system level change.
But I can go control what I'm gonna eat for lunch. So to me going down these rabbit holes and getting so overwhelmed with everything that's wrong and everything that's not great for our bodies. But I'm like, okay. Exactly what you said. "What can I control? What can I change today?" Okay. Can't control the air quality, unfortunately. But I can make sure my lunch is not ultra processed, doesn't have these 25 emulsifiers and other additives that I've gotten rid of. I can do that. And I can feel much better for it. Not even a little bit better for it. And again, if you talk to people who travel to places where they're eating whole foods or you talk to people who have been able to eliminate this stuff from their diet and eat more whole food space, just like you're saying, you feel really good.
And that's the whole point, right? We can't change everything all at once, unfortunately, we can try, we can vote, we can write our congressperson, we can do all these things and try to have big system change. That's hard, but changing what we buy when we go to the grocery store and by comparison, cooking a little more, that's easy.
Kara Wada, MD: I think it's in Frozen 2 just do the next best thing or the next right thing. If I'm not totally misquoting it.
Dawn Sherling, MD, FACP, Dipl ABOM: Yeah, I did see that. It was a few years ago. Yeah, I did. We were big frozen people.
Kara Wada, MD: Yeah. With a seven-year-old and a four-year-old, it's still quite popular.
Dawn Sherling, MD, FACP, Dipl ABOM: Yeah.
Kara Wada, MD: Dr. Dawn, can you share with us where folks can connect and how they can get a copy of your book, Eat Everything.
Where to buy Eat Everything
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Dawn Sherling, MD, FACP, Dipl ABOM: Yeah, so Eat everything is available everywhere books are sold. I'm distributed by Penguin Random House wherever they distribute, which is everywhere. Your library your local bookstore, Barnes and Noble, Amazon, anywhere books are sold, you can get a copy of my book. It's on audio book too. It's on Kindle, so it's everywhere. And then to connect, I am on social. I am Dr. Dawn Sherling on social and awnsherlingmd.com on my website where there's more information. I have a blog so people can get way more information than they probably wanna know about their microbiome and whole foods, diets and emulsifiers and additives.
Kara Wada, MD: Perfect. We'll make sure to link to all of those in the show notes and we'll have the link to pick up the book as well. Thank you so much for taking time out of your busy schedule for sharing all of this awesome information and just the lovely conversation this morning.
Dawn Sherling, MD, FACP, Dipl ABOM: Thank you for having me. This was so fun.
Kara Wada, MD: We'll have to do it again soon.
Dawn Sherling, MD, FACP, Dipl ABOM: Yes, sounds great.
Kara Wada, MD: Hey, everyone. I am going to ask you once again to go into Apple podcasts and submit a review of the podcast for me.
But first I'm going to share a review from Dr Lex RX.
"Dr Wada's unique perspective is amazing considering she's both an auto-immune patient and physician. Her experience, expertise and insight make this podcast so valuable. Keep them coming."
One other from Amanda Katherine.
"Wow. So informative. Thank you for bringing more attention to autoimmune diseases. Each podcast is so informative and well thought out. Very impressed with all that you do."
Thank you so much, Dr Lex Rx and Amanda Katherine. I really appreciate the feedback and the review.
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