A Conversation on Immune Health and Food with Kim Shapira M.S., R.D.
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Kara Wada, MD: Welcome back everyone to this episode of the Becoming Immune Confident Podcast. My name is Dr. Kara Wada, board certified allergy immunology, lifestyle medicine physician and systemic Sjogren's patient. And this is episode 101. I can't believe it. We celebrated our monumental 100th episode last week, and I am absolutely thrilled to welcome one of our original guests back to the podcast. We are going to catch up with Kim Shapira today. She is an amazing dietitian, nutrition expert extraordinaire, who is really paving the way of ditching diet culture and really just reframing our look at nourishment, which I love, love, love. And we always have such a blast chatting.
So we thought we'd switch things up a little bit today. And we are going to just have a conversation. We don't really have anything in particular planned. So we've got 30 minutes on our schedules and we're just gonna see what comes up. So welcome back, Kim. I'll let you introduce yourself a little bit more for those who maybe haven't listened to your prior episode.
Kim Shapira, MS., RD: Hi, everyone. I'm Kim Shapira. I'm so happy to be here and have this fun conversation with you. I am a registered dietitian. I've been in practice for 27 years. I see clients privately and in group session. And my first book came out last year, which is called "This Is What You're Really Hungry For."
And if you're listening to this, I would love for you to tell me what you think the answer is and then I'm going to give you the answer, which is really peace around food and nutrition and your health. And my goal is to always make it easier for people to get on the journey and then to stay on the journey.
Discussion on Semaglutides
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Kim Shapira, MS., RD: And as you're talking, I'm actually was thinking, God, I wonder what your take is on the semaglutides. And. and health in general.
Kara Wada, MD: I think for a lot of folks it is a game changer in regards to helping them get on this journey. I do certainly worry about those that are using it that maybe, I don't want to say don't need it, that are on the cusp, but they really do help people get their physiology back on track.
I know my colleagues who are much more well versed in obesity medicine, one of, my best friends, she just certified in obesity medicine really has found great benefit in helping her patients really move the dial on how their metabolism is essentially malfunctioning and helping right the ship.
I think the biggest worry I have honestly deals with our broken system and these are medications that are needed to be used for the long term. They are a long term commitment when you come off of them, you will regain at least a portion of the weight that you've lost and it really I think it's really sad seeing some of the limitations that payers and insurance companies are putting on the medications that are really making it very challenging for those that need it to get it.
I also worry just about the safety for some of the compounded versions that have popped up.
Kim Shapira, MS., RD: Can we say in that space really quickly? About the, I agree with you that I think it's a lifeline for many, many people. And what I'm always talking about is sustainability and long term health. And from my perspective as a dietician, I think almost every, every disease is related back to food and diet and how our body is able to handle it, right? And so when we look at these medications, I'm thrilled that people are losing weight because that's decreasing the risk of these metabolic diseases like cholesterol, diabetes, high blood pressure, but I do worry about because they're getting full faster, there are limitations on getting a well rounded diet, number one.
And number two, I think people are so focused on weight loss on this scale, but they're not focused on body fat percentage. Really, I wanna scream it from the rooftops, we need to focus on our body fat, and you need to be in a lean body mass, in order to really know that you can sustain this.
So that's what I'm seeing is a little bit of worrisome is that we're not getting to that lean body mass because we're not losing weight necessarily the right way. And it's not that the medication's not causing people to lose weight the right way, it's that they're not changing their life. So they're just relying on the medication and they're not building in exercise and water and different types of living.
Importance of Lifestyle Changes
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Kara Wada, MD: No, I think that, and that's where it comes to this space where I feel so passionate about bringing together, yes, let's use what modern medicine has, but that has to go hand and step with the lifestyle changes for the longterm. It's really harnessing the power of healing from our habit. And really getting those habits ingrained into our everyday doing that's really vitally important.
Kim Shapira, MS., RD: Yeah. I guess that would be the message, right? Like I'm excited for everybody who has done this and had success losing weight, but really to focus on the balance of their diet because it's really dietary patterns, right? What is your overall pattern look like for quality of health and thinking longterm?
Inflammation Markers
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Kim Shapira, MS., RD: And I'm curious, as far as inflammation markers, because I know that some people are feeling that they have less depression and their mood is improved, but what about inflammatory markers?
Kara Wada, MD: That is actually on my list of things that I need to look up and I'm curious how much it's been evaluated because I do have a fair number of my patients who have really significant asthma, a condition that we know can be made worse by excess weight, especially abdominal obesity.
I'm going to be curious to see if it moves the dial on how often they're flaring, how often they're needing their prednisone for a big flare up of their asthma and exacerbation and were there a need for other biologic medications of these other injectable medications that really have been incredibly helpful at getting that excess inflammation, but will they continue to need those or will there be at some point, a tipping point where we're able to wean off of those as well? So those are questions that I have that I don't think we have the answer to at this point, but...
Kim Shapira, MS., RD: Yeah. It's interesting. That's my only question about it. I was just curious what you
thought.
You Are What You Eat
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Kara Wada, MD: My kind of question for you. So, it is the new year and the whole New Year's resolution, but one of my New Year's resolutions, I turn 40 this spring and I really want to, I want to be strong. Like, I want some more muscle. I want to work on building that lean body mass.
And so what I've been watching, like many people, this most recent Netflix documentary that is out. The name is escaping me, so I'm going to pull it up on my phone real quick. I think it's You Are What You Eat. But what they did was they took about 21 or so groups of identical twins.
They put one on a diet that was included meat. It was an omnivore diet. And they put the other twin on a whole food plant based diet. They provided the food for the first four weeks. The second four weeks they had to fend for themselves, but they were supposed to stick with their diet. And one of the things that I still have a little bit of the last episode to watch.
And I'll try not to spoil, I have too many spoilers, but one of the things that came up with being more plant based was it was a little more challenging for that twin to keep or put on lean muscle mass.
Kim Shapira, MS., RD: Yeah.
Kara Wada, MD: So I'm curious, we have pretty good data that eating a pretty plant forward diet is helpful and important.
Some would advocate for totally plant based diet, but if we are trying to put on some muscle,
Kim Shapira, MS., RD: Yeah.
Is a plant-based diet the way to go?
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Kara Wada, MD: Love to hear your thoughts.
Kim Shapira, MS., RD: Yeah. It's interesting. I love the idea of a whole plant-based, but I don't necessarily agree that that is what our human body needs all the time. So again, when we look at dietary patterns. And are we getting all the amino acids, which are the building blocks? And I don't think that we can get them all in plants all the time.
So it's really tricky because I think overall having a diet higher in plants or fruits and vegetables, let's say, overall will probably reduce your risk of almost every disease unless you're sensitive to the food, right? Like blueberries I'm sensitive to and so this causes an inflammatory response.
But as we're aging and we all are aging every single day and we want to maintain our muscle mass. Because that's going to be how we save, protect our bones and our balance and how we age well. We do still need 8 grams per kilogram of protein. And so what that looks like is anywhere from 40 to 60 grams in a day.
And you can get them, every single vegetable has about 2 grams, but it doesn't have all the amino acids. I am curious. I have not watched this movie, but from my own education and what I know, I do think that we need some lean animal protein, but not as much as everyone else thinks. What I think this documentary is going to do is it's going to quiet the high protein diets of the
world. Yeah, so I'm not even sure what your original question
was.
Kara Wada, MD: Just thinking about, as we, over this next week, for instance, I'm out of town tomorrow. So I was trying to do some meal prepping today. It's not my usual meal prepping, making a whole bunch of beans and I'm like, okay, what else can we do? And so part of it is, is thinking about those patterns of like, how can we, you incorporate some plant based proteins and yet also find that happy medium of finding some sustainable leaner proteins too.
Kim Shapira, MS., RD: Yeah.
So I guess it depends like, are you somebody who wants to eat animal
protein?
Kara Wada, MD: I typically always have, like I grew up in a house where my dad hunted. So often growing up, we were eating venison maybe a couple of times a week or chicken or what have you. I will say for a period of time after I had Charlotte, she's my oldest, we did experiment with being more plant based for several months probably and in part because she didn't want to eat meat at the time.
She really liked picking up beans when she was about a year old, like that was a fun food for her. So we were eating a lot of pinto beans and black beans and and then at some point we slid away from that probably because at the time it wasn't sustainable.
As I think about kind of those long term eating patterns and what some of those smaller shifts that have really, we've been able to keep with for the long term.
Kim Shapira, MS., RD: Yeah, I think it becomes complicated when we start putting a label on the type of eater or the type of diet we have, and I love the idea of looking at diet as lifestyle rather than something that I do as a restriction, but more "this is who I am". And I'm more into not labeling the fact that I'm having a vegetarian meal right now or I'm having chicken right now, but overall, again, back to the dietary patterns of the majority of my diet is full of vitamins and minerals, and I'm still able to eat what I love in that spectrum of whatever fruit and vegetable I like. I just got back from Costa Rica with my family, and I ate papaya every morning for breakfast. But out of the five of us, I was the only one who did that, right?
And so they were choosing mango and guava. I wasn't interested in that. Again, I don't want to label or call one person one thing or another, but have the freedom to eat what I love. And have the spectrum to choose anything. And so, every one of us has our own factors going on in our own bodies.
And I am not, I'm not somebody who eats, I actually went to In N Out Burger for the first time, which is a huge like thing in California here. And I've grown up here my whole life, I'm 50, and I've never, I don't eat hamburgers because I've just never eaten a hamburger. I do love a turkey burger, but, so In N Out Burgers has never had a turkey burger, and I've just never been.
But when we flew home from Costa Rica, we arrived at 1:30 in the morning, and that's what we ended up going to get, and I had a grilled cheese, and it was great. Do I normally order grilled cheese? No. But overall, my pattern of eating is whatever it is, and I don't worry about having one meal like that or anything.
So I think focusing on like long term health, it is, I think, am I getting enough fruits and vegetables in my diet? And I do think that we should spend time not fearing it, but being interested and curious. How many times can I add fruits and vegetables into my diet? And the recommendations truly are between five and seven servings a day.
That's what we need, and we're not getting them. And that would ensure that we're getting all the antioxidants and the fiber and such great things that our body really needs every single day.
Kara Wada, MD: And one of the things I bring to my patients often, and I hope that I'm not overwhelming them, but is this idea of the diversity too. If you are really aiming for that 30 or more different types of plants in a week that we know is associated with lower rates of diabetes and heart disease and improved gut function and likely immune function too you're going to have to eat that many different servings a day in order to get that variety.
If you're working the math, most likely, and in really thinking about that and getting curious about, okay, what are some of the, can I try something we haven't tried before this week? We ordered a rutabaga at our vegetable box. My kids were like, okay, let's try that that might, that sounds interesting.
So I think next week we'll try making like a vegetable shepherd's pie and maybe put that as the mash on top. And we'll see if they eat it or not. I don't know.
Kim Shapira, MS., RD: I love that and I love that you also empowered them to make the choice. I really think that's the key is that, somebody needs to see the food at least ten times before they're even willing to try it and when they cook with it, they're empowered to actually eat it. So if anyone is dealing with kids who are afraid of or, I'm putting "picky" in quotes because I don't want to label anyone.
But, like, if somebody is on the pickier side, let's say, if you empower them by getting them in the kitchen, they're more likely to take, like, ownership of it and eat it. And I
love it.
Kara Wada, MD: I have a recent success story I have to share. So Josie is my middle, she's five, and she is in a stage where she is more particular. And if this kiddo could eat a refined carbohydrate plus a processed cheese in any form, she would eat it. Like today, she came home from school. "Josie, what do you feel like for dinner ?"And like, I should've made a bet because I would've made my money back, but she wanted mac and cheese like the kid would live off of it. A couple weeks ago we're home on break and I have been making a veggie soup about once every other week or so and I got her to help me make the veggie lentil soup this time so I had chopped up the veggies cause she's too little to use the sharp knife, but she was able to get her little stepstool with the instant pot.
She had her little spatula and she helped me put everything in, saute it. We added the lentils in, she poured in the broth, and as she was doing it, she also, like, she's the cutest little thing. Obviously I'm biased, but she is very sweet. She's blowing kisses into the soup because she's adding love because that's gonna make it taste better.
Kim Shapira, MS., RD: You know, it does.
Kara Wada, MD: It was delicious. It was just last week we did this because I had leftovers this week and she actually ate that soup at dinner, which is amazing because normally she'd pick at it, "Oh, I don't like it." But I'm like Josie, "This is the soup that you put your extra special love into so it tastes extra delicious" and she's like, "Oh, this does. It's so good.
Kim Shapira, MS., RD: So funny.
Kara Wada, MD: And she got her siblings to eat it too. Yeah.
Kim Shapira, MS., RD: Oh my God, look at her. Now she's like a role model. I love it. Did you ever see the movie Chocolat?
Kara Wada, MD: Long time ago.
Kim Shapira, MS., RD: Yeah. So if you remember, like when the chef was like in love, everybody started feeling love. And when the chef was angry, they started recognizing that they were angry. And like, we could go to the same restaurant 10 times in a row. And generally it's, it's the same, but if the chef has an off day, we probably don't like the food as much. So when we're even cooking, if we can blow kisses, and I love this idea, then you're going to be giving everybody like an emotional kind of like boost. I love that.
Kara Wada, MD: It's almost like the idea of like Reiki, right? Like some people will kind use Reiki in their, in their everyday lives.
Kim Shapira, MS., RD: Oh, my God. I love it. It's the sweetest thing ever.
Kara Wada, MD: I think she was trying to compete a little bit. So Charlotte, her eight year old sister, a few weeks prior, learned how to use the sharp knife for the first time. So she chopped up the veggies for that round of veggie soup. And so I think they were kind seeing who could make the tastier version because every batch turns out a little different. We essentially
clean out the fridge for veggie soup night.
Kim Shapira, MS., RD: Yeah. Okay. And now I have another question for you.
Plans for 2024 and Conclusion
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Kim Shapira, MS., RD: So what is your plan this year in 2024 to motivate people to have, to deal with, how do I put this, to help themselves with inflammation? What are you going to do In 2024?
Kara Wada, MD: I have my goal setting, like right in front of me on my whiteboard. We talked about my my personal goal, which is to get fit and get strong. Professionally, I am going to actually sit down and write the book that I have been noodling on for the last several years. I think I'm finally to a point where I kind have a outline and a game plan. What I wrote is I'm going to write my book with authenticity, with courage and with curiosity. Because what feeds me is connecting with other humans who are suffering, mentoring and sharing knowledge and understanding of our human humanity intersecting with our immune system health.
So, you were kind talking before we hit record, I made a shift this past week on my social media identity to kind rebrand of sorts from The Crunchy Allergist, which is what I've been known as, to immune confident. And really, I see that as this intersection between the science and the strategy.
But also kind of this aspect you get from life coaching. So the humanity, the vulnerability, the, the right side of our brain that is really, really important when we think about true healing and, and really learning how to take care of ourselves and our whole being.
Kim Shapira, MS., RD: How do you stay immune confident? How do you, what do you need to do? What are three things that somebody could do right now to become immune confident?
How to stay immune confident
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Kara Wada, MD: Hard to narrow it to three, but I have my five must-have habits.
Kim Shapira, MS., RD: Okay.
Kara Wada, MD: For healthy living for healing, which are meal management. So planning ahead, using our prefrontal cortex in order to think about what we're going to eat, because we know that when we get under stress, we are going to go towards those sugar, salt, and fat.
We've talked about it a lot on our prior episode.
Kim Shapira, MS., RD: And not to cut you off, but the truth is we can't predict the
stress. We cannot predict in the day when we would feel stressed. And so I love this idea of having a plan.
Kara Wada, MD: And that may be planning to get takeout. It may be meal prepping. You can vary for each of us.
Moving our body. So that's where my getting strong is, however that feels good to you. I've realized been pushing myself a little bit in my workouts this last couple of weeks. My sleep is so much better.
I monitor my sleep on one of the little wearable rings and am, I'm gonna brag a little bit. I got a sleep score of 98 last night, which is the best I've
ever gotten.
Kim Shapira, MS., RD: Oh my god. Congratulations. That's I
Kara Wada, MD: it really is from working out and I've been really consistent and this is a segue into number three, but to mindfulness.
So mind time, taking 10 to 20 minutes a day to let your brain be and work on exercising that right side of our brain.
Fourth is meaningful moments with those that you love. So having that human to human connection with your kids, with your partner, with yourself.
And then mandatory me time.
So whether that is taking an afternoon off, making time for therapy, whatever that may look like, just making sure that you're making dates and keeping them with yourself.
Kim Shapira, MS., RD: Yeah. I love it. That's a nice little roadmap
Kara Wada, MD: Yeah, and kind covers like all most of those aspects of really lifestyle medicine pillars.
Kim Shapira, MS., RD: Are you sensitive to certain foods or are you not really?
Kara Wada, MD: Not too bad anymore, I think earlier in my journey I definitely had lots of issues with onion, some of the FODMAP FODMAP tomato tomato foods. Oddly enough, raspberries for a while, I did not digest well, and now I've realized I can digest those a little bit better. I had actually a whole handful last weekend and didn't have any tummy trouble. And I had this really interesting situation after I had Charlotte. I was still an allergy fellow, where I could not tolerate eggs. So I could eat egg in like a baked good, but if it were over easy or French toast, something that was more lightly cooked, it was game over. And actually in, at the time course I'm a fellow, kind of start wondering, okay, what's going on?
Could it be this type of reaction, that reaction? Doctoring myself, skin tested myself, so I knew it wasn't an anaphylactic type reaction but in hindsight with information that now has come out in the literature, I'm pretty sure I was having what's called FPIES reaction. So essentially it is a non antibody mediated reaction.
So it's not an anaphylactic reaction. It's solely GI symptoms. Can result in really severe cramping, throwing up repeatedly, diarrhea, feeling totally wiped out for a period of time. And typically will take a little longer to occur. So it will occur maybe an hour or so after you eat.
Whereas a true food allergy happens sooner. There's no test to confirm it. And so what is really interesting is that that ended up going away, eventually but yeah, so I share that little TMI, but I think it goes to show that even when you are immersed in the information and the data you still can be perplexed by how your body's responding to things and also to share that the data continues to evolve and FPIES in adults has not been well described and even now, like, we're just getting some more science behind it.
This was a condition that really wasn't known of 20 years ago.
Kim Shapira, MS., RD: Well, I think like leaky gut and food sensitivities is, these are hot topics right now. And to, to know that, again, dietary patterns and the way that we even deal with stress is impacting the way that we are breaking down and digesting food. And there's a slew of symptoms, even more than the ones that you listed, like headaches, clearing your throat, tearing eyes, runny nose, heartburn, bloating, smelly gas, that's usually a symptom. It can be diarrhea, it can be constipation, it can be joint pain, it could be psoriasis or eczema, right? Like, really seeing this. But what's interesting is that, like what you said, it's not a true allergy, and when you heal your gut, when the lining of your gut is repaired, most of these sensitivities go away which makes our body magical.
Kara Wada, MD: Yeah, it's interesting to just think, "Okay, well, what moved the dial?" And I don't know that it was one thing I think it really has been an amalgam of being really diligent about my sleep, making sure we're eating a lot more variety in the plants, you know that we're eating, cutting out not fully but you know minimizing some of the emulsifiers and additives, you know within reason. Within the last nine months or so, pretty much cut out alcohol.
And movement, we know exercise is really important to regulate our microbiome and gut motility. Then stress, goodness, that's huge game changer.
Impact of Microbiome on Health: Probiotics and Prebiotics
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Kim Shapira, MS., RD: Yeah, I think we don't know enough about our microbiome. It's very interesting. I was reading that we're 50 percent bacteria, so that makes us like aliens.
Kara Wada, MD: Well, and now I love that we're thinking about it as its own organ system and how then are we going to best take care of it? I'm hopeful. I'm putting this out into the universe, so hopefully we can make it happen. I would love to invite Dr. Will Bulsiewicz back on. He's been doing a lot of work in the realm of prebiotics.
We know that there is a lot more data to support prebiotics compared to probiotics, so prebiotics being the fiber, probiotics being the bacteria themselves. And so I'd love to have an update with him, see what's new.
Kim Shapira, MS., RD: Yeah. I like what you said, it's more about what you can add. So it's the exercise, the lifestyle, the mindfulness, and it would even as far as like your diet goes adding Omega 3s in either the form of like flax seed, chia seed, or hemp seed, and again, back to these fruits and vegetables.
Are you getting 30 servings at least a week? And what about fiber? And it's interesting, I think you knowing that onions was affecting you, which is a prebiotic, could be like, "Hey, something might be off with my bacteria.
Could be interesting. Like, I don't think your research is there
even.
Kara Wada, MD: college student in, you know, 2004
Kim Shapira, MS., RD: Somebody said to me 18 years ago something about probiotics, and I was like, come on. Come on. Seriously? What are you talking about?
Kim Shapira's class on The Kim Shapira Method
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Kara Wada, MD: You have some really exciting things going on that you were telling me about beforehand with a class you're running and some group programming.
Kim Shapira, MS., RD: I'm super excited. Yeah. I am super excited about this class. I call it a masterclass, but it's not the masterclass. It's just a class on The Kim Shapira Method and my six simple rules. And it's something you can do in the privacy of your home and really go deeper and figure out your relationship you have with your body and food and diet.
And there is a private Facebook class, so, group actually. And so it's interactive and I think it's gonna help a lot of people. I'm super
excited about that.
Kara Wada, MD: Where can people find information on it?
Kim Shapira, MS., RD: I think they can find it on my Instagram and also in my website, which is kimshapiramethod. com.
Kara Wada, MD: Will make sure that we have the links to both of those in the show notes, so you can click on them and get right over. And we're also going to link back to our first episode. So you can learn even more about The Kim Shapira method and those six simple rules. Get a little preview from old quote unquote studio.
The Demystifying Inflammation Summit Encore
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Kara Wada, MD: All about it there. And then the other place you can tune in to see Kim is Kim was one of our featured speakers at the Demystifying Inflammation Summit, and so we have the encore coming up in a couple of weeks, so you can make sure to get registered for that. It's free to attend. There is an All Access Pass that you are able to upgrade to if you so choose but that is another great place to hear some amazing information, take home messages, and really ditching diet culture and really focusing on these sustainable ways and approaches to nourishing our brains, our bodies, and our souls.
Kim Shapira, MS., RD: Yeah. By the way, your demystifying program, honestly, I think everybody should send it to everybody and watch it because there's so much amazing information.
Kara Wada, MD: Thank you. It was a lot of work, but I think it was well worth it. And just the collection of amazing speakers and the topics that we covered are really incredible. And I can't wait till we get to do it again. I'm thinking January 2025 so mark your calendar,
Kim.
Kim Shapira, MS., RD: Sounds good to me.
Kara Wada, MD: Awesome. Well, thank you so much for joining me today and for having this conversation and cheers to 2024.
Kim Shapira, MS., RD: Cheers to 2024.
Kara Wada, MD: Thank you. Take care.
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