In this episode, Lisa Jones interviews Annamarie Rodriguez, RDN, LD, FAND, and Abbie Gellman, MS, RD, CDN, on the impact of plant-based nutrition on health, misconceptions about plant-based eating, and what is on the horizon for plant-based eating dietary interventions.
Additional Resources:
Abbie Gellman, MS, RD, CDN, is a spokesperson, recipe and product developer, author, and educator. Shes also a member of the Science Advisory Board for Nutraceutical.
Annamarie Rodriguez, RDN, LD, FAND, is a renal clinician retention specialist at Pentec Health, a member of the Academy of Nutrition and Dietetics Quality Management Committee, the State Coordinator for Vegetarian Nutrition Dietetic Practice Group in WI, MI, IN, and northern CA, a board member of Plant-Based Prevention of Disease Inc., SE WI Region Representative-elect for WAND, and owner of Nutrition Directions LLC.
Lisa Jones, MA, RDN, LDN, FAND,is a registered dietitian nutritionist, speaker, and author based in Philadelphia, Pennsylvania.
TRANSCRIPTION:
Moderator: Hello, and welcome to Nutrition411: The Podcast, a special series led by registered dietician and nutritionist Lisa Jones. The views of the speakers are their own and do not reflect the views of their respective institutions.
Lisa Jones, MA, RDN, LDN, FAND: Hello, and welcome to Nutrition411: The Podcast, where we communicate the information you need to know now about the science, psychology and strategies behind the practice of dietetics. I am Lisa Jones and excited to have two fantastic guests joining me today. Annamarie Rodriguez and Abbie Gellman. Today, we'll be discussing plant-based nutrition in a world of opportunities.
First, I will start by introducing Annamarie. Annamarie has worked as a renal dietician for almost 25 years in a variety of settings from clinical to pharmaceutical, including clinical sales, education, and renal medical affairs. She is on the Academy's Quality Management Committee, the State Coordinator for Vegetarian Nutrition Dietetic Practice Group for several states, a board member of the Plant-based Prevention of Disease organization, the Vegetarian DPG chair-elect and the Wisconsin and Southeast region representative-elect. Welcome, Annamarie.
Annamarie Rodriguez, RDN, LD, FAND: Thank you, so glad to be here.
Lisa Jones: Yay. Next, I will introduce Abbie. Chef Abbie Gellman is a spokesperson recipe and product developer, author and educator. She creates, produces and hosts cooking and nutrition videos, and works with a wide variety of food companies, brands, commodity boards, food service operators, health professionals, and private clients. Welcome, Abbie.
Abbie Gellman, MS, RD, CDN: Thank you.
Lisa Jones:So, glad that you're both here. First, I want to start with Annamarie, if you can just give a little background about your expertise.
Annamarie Rodriguez: My background has been a severe deep dive in CKD and ESKD, which is chronic kidney disease and end-stage kidney disease. And because of that, I've had a wide variety of roles that range from clinical to educator, sales, medical affairs, and I've been acclimated to every aspect of patient care surrounding these specific roles in the care of CKD patients.
Currently, though, my focus is on the prevention of chronic disease in general, but namely on CKD. It is my passion and I want to focus on this through nutrition. And, the main component is delaying the progression of CKD to ESKD. I am on a mission. And as I'm a plant-based dietician, my degree plan is on health and wellness. My focus is on a more holistic approach and this is where food plays a vital role. I've also worked with hospice, wound care, diabetes and weight management. So, I kind of wear a lot of different hats, which makes my life very exciting.
Lisa Jones: Very exciting. And I love that you are on a mission. Missions are amazing and I like your mission. It's a good one. So, I will go over to Abbie. If you want to tell us about your expertise and background. Although, the chef kind of gives it away a little bit.
Abbie Gellman:
So, the short version is that I went to culinary school about 20 years ago and I worked in corporate America for a really long time consulting and some other things. Eventually, I left corporate America and left restaurants to get my nutrition degree and that's when I learned that most dieticians don't cook. Which was shocking, to me, at the time. Fast forward to now, where I have a culinary degree, worked in restaurants, did all those things, plus now I'm a dietician. So, I've spent the last 10 plus years doing what I call culinary nutrition.
So, a lot of the work I do now is teaching health professionals. Mostly dieticians, but also diet techs and physicians and any health professional I get in front of, how to cook, how to get that base of culinary skills that we need. And then also, culinary nutrition for our clients and our patients. So, disease states like diabetes and heart disease or nutrition issues like aging and that kind of thing. So, I spend a lot of time doing cooking demos, speaking, and presentations. And, I have an online course to get you culinary nutrition certified and a bunch of other things. And then, do some work with consumers and such, as well.
Lisa Jones: Thank you, Abbie. That's fantastic. I took her course over the summer and highly recommended it. I'm your target market. I am the dietician that's not cooking, and that's fine.
Abbie Gellman: And, you get 53 CEUs, if you take the basic and advanced-
Annamarie Rodriguez: Oh, my gosh.
Abbie Gellman: Program.
Annamarie Rodriguez: I would love to take this course.
Abbie Gellman: Come over.
Annamarie Rodriguez: I'm so sorry. I interrupted.
Abbie Gellman: No, go to culinary nutrition studio.com. I'm sure that it'll be in the show notes.
Lisa Jones: We'll put it in the show notes. But you're filling a gap that is much needed. So thank you, Abbie.
Abbie Gellman: Thanks.
Lisa Jones: All right, so let's begin. I'm going to ask you a couple of questions. The first one is, how does following a plant-based diet impact your health? Annamarie, do you want to start with that one?
Annamarie Rodriguez: Yeah, sure. I want to mention about Abbie's response. I'm so sorry. One of the first things my grandma said to me, when I was going to school to become a dietician, she said, please be sure to know how to cook. So, I kind of took that with heart, and I love cooking since I was a child. So, it was easy for me.
But, following a plant-based diet affects health in so many different ways. Plant-based nutrition improves the gut microbiome, making it healthier, overall. Nutrients are absorbed much more efficiently. Immunity is enhanced. Inflammation is reduced. Plant-based nutrition, it's high in fiber. That's just the natural fact of plants. And, it's beneficial in lowering cholesterol, stabilizing blood sugar, reducing intake from protein, also from animal sources by increasing plant-based eating reduces gut toxins, such as p-Cresyl sulfate, indoxyl sulfate, TMAO, which is Trimethylamine N-oxide. Which, is known to favor the growth of proteolytic bacteria in a gut microbiome.
And historically, we've thought of this in regards to cardiovascular disease. But now, we know it's also very, very heavily regarded with CKD. These toxins are known as key uremic toxins. And interestingly now, TMAO is also known simply as a renal toxin.
Plant-based nutrition lowers BMI, blood pressure, blood sugar control, favors lipid management. And, we identify the positive effects with CKD because, plant-based nutrition is effective because of the less acidity of it. It favors a more alkaline approach. We know that metabolic acidosis is not only a contributor to kidney disease, but it's a consequence of kidney disease. So, this is a strong tactic in reducing in the progression of CKD. So, plant-based nutrition has really come a long way. Historically, this CKD diet has always been adverse to using fruits and vegetables. Where now, it is just now starting to be embraced, because we now recognize the fact that this is kidney saving.
Lisa Jones:Thank you, Annamarie. You know what I love about what you decided? It's like the beginning part when we were talking about the TMAO was more the questions that dietician want to know. So, they want to know the 'why' behind it. But, if you're flipping it to think about, what do our patients and clients want to know, and they really want to know the benefits. And, that's what you just so nicely explained. So, thank you for that.
Annamarie Rodriguez: You're welcome.
Lisa Jones: Abbie, how about your take?
Abbie Gellman: I mean, she touched on a lot of the... Obviously it decreases our risk of a variety of diseases. Helps with cognition and mental health. And, fruits and veggies are an antidepressant, essentially. So, there's not a ton I can add from a clinical point of view.
We know that whole foods in the form of plants are helpful for a myriad of reasons. The thing that goes in my brain, also, because of the chef's side, is you can eat more. So, you can eat a lot of vegetables and a lot of fruit. And, a lot. You can eat more plants versus... A serving of beans is a much higher quantity of food than a serving of beef. So, if you are someone who likes quantity of food, like me, you can have a lot of veggies just pile them on there. So, that's a plant-based option. That is a benefit, I think.
Lisa Jones: Yeah. That's definitely a benefit. That's terrific that you're saying that because a lot of people think, oh, I'm put on a diet or I'm put on a restriction and they hear the word restrict. They think, I have to eat less. When really, you're telling them, no, you don't, you have to eat more.
Abbie Gellman: Yeah.
Lisa Jones: So, you probably just made so many people's day when they get to listen to this. So, thank you.
My favorite part, which is the next question, is what are some common misconceptions about plant-based eating because it's in the media so much, we hear all these different things. So, let's go to Abbie for a second for this question, first.
Abbie Gellman: Okay. So, for me, I have screaming in my face, is it is not vegan, right? So many people think that if you're plant-based, that means you are vegan. And for me, and what I tell people, and what I generally think, the actual definition is, that it's just a majority of plants. So maybe, half of your meals are plant-based. Maybe 50% of your diet is plants, or 95%, or somewhere in between. But, that if a majority is plants, then that, to me, is plant-based. So, my plate might have 25% animal protein in some form, but 75% of it is plants. So, that's the most common misconception that I see constantly.
Lisa Jones: Yeah. And, you probably see a lot in your current day to day what you do and-
Abbie Gellman: Yeah, well, people automatically go to well, especially because, plant-based meat is a big thing now. So, people are confused there too. They think plant-based means Beyond Burger or Impossible Burger or tofu or things like that. Where, we're talking more broadly about fruits, and vegetables, and beans and everything that's a plant, right? So.
Lisa Jones: That's an interesting point that you bring up because I think, as they continue to develop more products.
Abbie Gellman: Mm-hmm (affirmative).
Lisa Jones:That I think, we're going to start seeing more confusion, and we just go back to the basic. This is a plant-based diet, you're not a vegetarian.
Abbie Gellman: Right? Exactly.
Lisa Jones: Thank you. Annamarie, how about you? What, what are your thoughts?
Annamarie Rodriguez: Yeah, I totally echo what Abbie is saying. And, although I consider myself a vegan, I do get a little bit, I won't say the word annoyed, but I do try to steer people the right way when they're talking about plant-based nutrition. Because, it means so many different things to so many different people. But, some of the more common myths that come across my way is the perception that persons following a plant-based nutrition plan won't meet their protein needs. But, we've seen through different studies such as the Adventist Health study, British Oxford study, that persons are able, following a vegetarian diet, to meet their RDA for essential amino acids. They often exceed the minimum requirement for protein. And, another myth is the focus on biological value. That is an antiquated method of looking at protein. This rant, at all, has illustrated there's no significant difference in protein needs.
And, this is associated with the source of protein that's consumed. And, another myth is the protein complementing myth. We don't need milk with cereal, and we don't need rice with beans. The body doesn't care what is being put into it at any given time. It's a matter of specifics. Our body is able to maintain a storage pool from hours to days and it will use what it needs. The key is a very nice, well-balanced, diverse diet. And, a red flag to a dietician or a healthcare provider is an overly restrictive diet. So, that's one of the keys that I look to, when I'm talking with clients, is if the meal pattern is overly restrictive, then I want to dig in a little bit more. But, as long as someone is taking in a very nice, well-balanced nutritional intake, they're going to meet their needs.
Lisa Jones: Yeah, that is so true. It's such a great point. And, I really like how you highlighted the biological value. Cause, I remember, back in the day when I was working, in clinical more specifically, and I would chart, and a lot of dieticians would write like encourage high BV foods. That was something we'd write a lot.
So, it's interesting to hear that you're saying no, there's a different approach now. And, it just goes to show everything changes, everything evolves, and it's good that we're keeping up with, as dieticians, keeping up with everything in our field.
Annamarie Rodriguez:You're right. Lisa, that term is... It really needs to be kind of ditched. The newer current term is the protein digestibility corrected amino acid score. And, that's per referred by the World Health Organization. And, that term, biological value, it's really dated.
Lisa Jones: Yes. All right. Listeners take notes of that. Don't don't use HBV.
Annamarie Rodriguez: Yeah. Toss it.
Lisa Jones: All right. Abbie, what questions, I'm curious about this, have you received about plant-based nutrition?
Abbie Gellman: Everyone wants to know how to make plants, mostly vegetables, taste good. That's a big one. Everyone, not everyone. I shouldn't say that. A lot of people who don't enjoy vegetables, or grew up being told that they need to steam them, or aren't comfortable in the kitchen and don't really know how to cook them so that they taste good.
There's a lot of questions around that. So, I'm told I'm supposed to eat kale, but I don't like it. So, the answer is, for me, is you don't have to eat kale. But, if you want to learn different ways, let's talk about different ways to make it taste good. Or cauliflower, or brussel sprouts or broccoli. Because, those can be very bitter. But, just talking a lot about how to cook them properly so that they taste good. And, to use oil and to use other ingredients. And, you don't have to eat steamed broccoli all the time. That's a huge question. And then again, back to the plant-based meat and things. Just, do I have to eat that? Is that better than a burger? Or is that better than.. Why can't I eat a black bean burger? Why do I, should I be eating an alternative plant-based meat burger? So, a lot of questions about that lately too.
Lisa Jones: No, I can really relate to how confusing it must be. I try to put myself in the position of a patient, or client. And, if you're in the grocery store, there's so many products, it's overwhelming. You're like, should I be buying everything that says plant-based? If I was not a dietician, that's one of the questions I'd be asking you. Should I start buying everything that says plant-based?
Abbie Gellman: That made me think of something else too. I feel like a lot of people who are going dairy-free assume that it's an equal one-to-one swap. And, there's a lot of confusion there too. They don't necessarily understand that the protein level is different or that the vitamins are coming from supplements in the plant-based milk versus cows milk. And, you can't just swap it out one-for-one in cooking. There's things that kind of, when you make a change from animal to plant, there's sometimes other changes that are helpful to be aware of. I guess, kind of to have the education along with it.
Lisa Jones: Yeah. That's so important because, you can't just assume. And then, they're just following kind of, not to say a trend, but yeah, a trend in a sense, and thinking this is healthier. I should do this. When they're missing potential nutrients and other things that can happen from switching. That's a great point. Annamarie, how about you? How about some questions that you received about plant-based nutrition?
Annamarie Rodriguez:Well, since I work mainly with CKD, my questions are very different and most of my questions have to do with mineral intake. So, my questions from patients will vary from those that I receive from healthcare providers. But, the bulk of my questions have to do with phosphorus and potassium and the clinicians that I work with they're so afraid that these minerals are going to become elevated.
When patients begin to use a plant-based nutrition plan, whether they're CKD before dialysis or end-stage kidney disease and on dialysis, but the fact is that phosphorus it's not well absorbed from plant-based nutrition, because it isn't a form of vitae. And, we lack that enzyme, vitae, to break this down. So, it's not readily available or bioavailable, I should say, in the gut. It must be hydrolyzed to make this more available for absorption. There's additional data, also by Picard, and all that illustrates that this is likely true for potassium as well. Which, is very exciting, especially based on the new guidelines that were put out for CKD, in 2020. Regarding potassium though, the bottom line is fiber. And, with a plant-based nutrition, it's high in fiber. Fiber is the key, because it increases, I should say, stool quantity, the frequency, it facilitates the potassium excretion in itself.
But also too, if we really consider where patients are getting their potassium. It comes from beef. It comes from chicken, Mexican food. It comes from legumes. But, if we look at that and consider the fact that when we look at handouts that are generally provided to the patients, they're generally listing fruits and vegetables as the high potassium sources. But, the high potassium source are actually the meat, the beef, the chicken, the hamburgers. So it's easily to maintain those swaps. As long as we're teaching patients, simple fact of portion sizes. What actually is a serving and that's the bottom line, is instruction.
We need to teach patients how to cook. We need to teach patients what constitutes a serving, a swap, in general. And often too, clinicians tend to forget other factors that surround hyperkalemia, such as wounds, starvation, other medications, constipation, and there's other medications now that help with hyperkalemia such as those once daily potassium binders. So, those are very helpful, but the bottom line comes down to education and this is where dieticians play a key role in instructing their patients to keep potassium homeostasis. So, our job is really more than just a mission. It comes down to education. Both on the patient level and then the healthcare provider level.
Lisa Jones:Yeah, that's tremendous what you just said, all that information. And in addition-
Annamarie Rodriguez:A little bit too much.
Lisa Jones:No, no. I think it's great.
Annamarie Rodriguez:So much.
Lisa Jones:But, what you just highlighted, as well, is something that Abbie was saying. Which goes back to is... And, you said it as well, many times, Annamarie. Which is, educate. We have to continue to provide education. Educate, educate, educate. I can't say it enough.
Annamarie Rodriguez:Correct.
Lisa Jones:Provide more education. Cause, as these new products come out, there's going to be room for... So, dieticians will always have a job.
Annamarie Rodriguez:Yes, this is true.
Lisa Jones:There we go. All right. Another question I have is what is on the horizon for plant-based dietary interventions in the promotion of health? Annamarie, do you want to start with that one?
Annamarie Rodriguez:Sure. I read about a year ago in an article, I wish I could put my hands on it immediately. But, plant-based nutrition was cited to be the fastest growing job opportunities for dieticians. As the leading five opportunities. And, I kind of chuckled to myself, because that's basically my whole world and it was exciting to me, as well, because I promote plant-based nutrition for CKD, as well. So to me, it just illuminated the fact that we're on definitely the right path. But, people are focusing on functional medicine, improving immunity, stress reduction and COVID brought this a little bit to the peak as well. But, plant-based foods are functional medicine. And, I hate to use the quip so often because so many people say it, but Hippocrates said, "Let food be thy medicine and medicine be thy food", for a reason.
It's very distinct, but people are supporting their local community for nutrition. And, I'm a master gardener. I love gardening more than of being a dietician truth, be known. I see a great interest in people desiring to grow their own food. And, this is very exciting. People are concerned about climate change as well. Plant-based nutrition leaves less of a carbon footprint.
And, what I also note is that people are more willing to take the middle ground. I use an approach more or less as a flexitarian. People don't need to go completely to a vegan lifestyle or vegetarian lifestyle. Even simple swaps. Swapping a few plant-based meals for animal based or just increasing plant-based ingredients can make significant changes. And I think that, overall, people just want really good food. And, just choosing locally sourced foods with convenience is important. I think clinicians truly need to focus on individual food journeys. And, that's what I call a person who's desiring change. It's their own food journey. And, I try to look at it in that regard. It's individualized. We need to instruct patients to use food as their own purpose and look at those factors that incorporate society and health as well.
Lisa Jones: Now that's great. I love when you said food journeys because that is the most important thing. I really don't like the word diet. It has 'die' in it and we all heard that before.
Annamarie Rodriguez: I hate the word 'diet'.
Lisa Jones: But, your food journey and it's your own food journey. And, the other thing that stuck out when I was listening to what your answer is flexibility.
Annamarie Rodriguez:Yes.
Lisa Jones:And, just keeping it flexible. What really works for you. And, I want to hear what Abbie has to say about plant-based in interventions and the promotion of health. Cause, I know a lot of your recipes are very diverse and everything that you put out is catering to different wants and needs. So, if you wanted to speak to that for a moment.
Abbie Gellman:So, as far as plant-based dietary interventions, I think as far as consumers are concerned, it's broadening. People are becoming more into the idea. Younger people seem to already be open to the idea. Whereas, all the way up through boomers, are becoming a little more open to the idea, maybe, than they were before. So, I do a lot of workarounds, even things like, taking a beef bolognese and replacing half the beef with lentils.
And, baby steps, right? So, they don't have to get rid of all the beef. But, let's manage the portion size, cut back, and add some things, and work with those changes. So for me, a lot of the interventions involve creativity and cooking. So, if you're working with someone, you don't tell them, you can't eat this anymore. You try to figure out, well, first you...
This is also why I harp on culinary nutrition and dieticians needing to know how to cook because, if you're working with someone who eats foods that you're not familiar with, you need to be able to ask them how they make it, what's in it? And, to understand what the food is and the cooking technique, because they might... Why would you tell them to stop eating that food? It's probably fine. And, that's a whole cultural competency aspect, too.
So, I think we need to start involving all of that in there. And, if someone eats rice and beans every day, that's fine. That's great. It's rice and beans, but what else are they eating? How is that made? What is happening there? If they have diabetes or some other disease state, how can we work with the food that's currently happening and supplement with other options to enhance what they're already doing? For example. If, that makes sense.
Lisa Jones: No, that makes total sense. And, I'm thrilled that you mentioned the creative aspect and combining it with cooking and not taking away. If somebody needs to... You're not taking it all away. So they don't feel like they're missing anything. And that goes back to the restriction piece that we were talking about earlier. So, thank you.
Abbie Gellman: Yeah. I think, a lot of people... Our job is not to impart what we eat, on other people. Our job is to understand what they are eating and why they're eating it and help them with where they are. Not just tell them to eat a smoothie. Right?
Lisa Jones: Start where you are. Don't you don't need to be me. Eating my diet. That is so true. Because, often I'll hear, oh, you need a high fiber diet. Here's a diet. Follow this. I know you're following low fiber, now go to high fiber. It's a huge gap. And then, we wonder why people aren't listening to us.
Abbie Gellman: Yeah. Right. Exactly.
Lisa Jones: We're working with them, meeting them halfway. I love that.
Abbie Gellman: Yeah.
Lisa Jones: So how about we move into... Abbie, if you would share one story or example showcasing your work with plant-based nutrition and you kind of already mentioned it-
Read more:
Plant-Based Nutrition in a World of Opportunities: Nutrition411: The Podcast, Ep. 3 - Consultant360
