Plant Powered Protein with Brenda Davis, RD

Welcome everybody welcome welcome welcome just let people pour in here I am Dr Ted Barnett president and founder of Rochester lifestyle medicine Institute and I am so excited that so many people have signed up for tonight’s presentation with Brenda Davis we have people from all over the planet signed up very excited about that now we just went over 100 that’s good um I am going to share my screen here and uh now that it looks like everybody’s in the room once again I am Dr Ted Barnett president and founder of Rochester lifestyle medicine Institute and I would like to welcome you to the June uh lecture in our life dolls medicine lecture series with Brenda Davis and the title is plant powered protein and let us go to the next slide so we will get through with our introductions by 7 35 probably a little bit quicker than that uh and um Brenda’s presentation is going to be close to an hour so we’re going to be off the uh of that agenda a little bit I think already uh probably we’ll get to the Q a by 8 25 or 8 30 but we will move into the lobby at 8 30 for another 15 minutes during which time we will have a time for a q a so please type in the Q a if you have questions you would like to uh um have answered by Brenda and you can also use the chat section for putting in greetings and sharing thoughts and information in fact we’d love it if you type in the chat where in the world you’re from that’s always very interesting and fun we will have one of uh one of our medical students who will be helping with the Q a uh when it’s time it’s time for that so we run three programs which are all certified by the American College of Lifestyle medicine pivio which used to be called the complete Health Improvement program you can see we have some information sessions coming up in August these are all available on our website either on the calendar or in the footer of most of the web pages uh the Lyft project we have another start of that on July 18th at 6 30. that’s a 10-week program that meets for an hour a week and it’s designed to lift your mood with lifestyle medicine very exciting program lots of fun and then our own Flagship program the 15-day Whole Food plant-based jumpstart which we consider the prescription for chronic disease we have information sessions coming up on Thursday June 22nd which is next week and then Wednesday July 19th and Program start dates uh Sunday July 9th and Saturday August 12th we run uh the Jumpstart program every month and so far over 1800 people have gone through the program from over 44 States and about nine countries so again plant powered protein with our I guess with our lecturer Brenda Davis who is a world leading plant-based Pioneer and an internationally acclaimed speaker Brenda has been a featured speaker at Medical Nutrition and dietetic conferences in 25 countries on six continents as a prolific nutrition writer Brenda has authored or co-authored 13 books with nearly a million copies in print in 15 languages her latest book plant powered protein was hot off the press in April 2023 Brenda has also authored and co-authored numerous professional and lay articles and is a past chair of the vegetarian nutrition dietetic Practice Group of the American dietetic Association and Brenda was the lead dietitian in a diabetes intervention research project in the Marshall Islands on her last trip there in November of 2017 she developed a nutrition education curriculum for kindergarten through grade six and trained teachers in all public schools Brenda was the seventh recipient of the plantrician project luminary award in 2022 and was inducted into the vegetarian Hall of Fame in 2007 I’m very proud to be able to call Brenda a good friend and someone who I’ve spent lots of time with in the past including a very memorable afternoon going up and down a water slide so I’m gonna that was in Arizona so Brenda could you please reveal yourself let’s un uh turn on your video and unmute yourself there we go and it’s so good to have you thank you for joining us Brenda well thanks so much Ted it’s just exciting to be here and I want to thank everybody for joining us and I will get right into it because I have a lot of slides should I just get going to start start sharing please okay so everybody can see my slides looks great oh perfect awesome okay so my topic for this evening is plant powered protein and I’ll start with just a very quick overview first we’ll talk a little bit about historical perspectives we’ll just dabble in the science um just a touch and then we’ll spend a fair bit of time looking at protein quality can we get all the essential amino acids we need from Plants we’ll we’ll review some of the assessment tools used to determine protein quality and then we’ll move on to protein quantity can we get enough protein from plants and we’ll look at recommended and actual intakes and ensuring sufficient protein and we’ll talk a little bit about the safety of soy and then we’ll address any possible advantages to plant versus animal protein and we will conclude the presentation by looking at the benefits of plant protein Beyond human health so first um you know I I love this Benjamin Franklin once said that there are only two certainties in life death and taxes we’ve all heard that many times but for plant-based eater eaters I’m pretty sure there’s a third getting asked the question where do you get your protein we’ve all been asked it time and time again and I I do I do love this this uh Cartoon by uh Bizarro Comics the little rodent saying to the big muscular gorilla no meat at all are you sure you’re getting enough protein and the point here being that we have a very strong cultural bias towards me being the only real source of protein few people actually realize that plant foods provide ample protein for people while legumes are the most concentrated plant protein sources grains actually provide about half of the world’s protein so how did animal protein require or acquire such a health Halo well if you if you look back at public health history for many years hunger and malnutrition were the most serious Public Health Nutrition concerns and malnutrition was due to food shortages and limited diets centered around starchy Staples such as potatoes or rice government policies at the time were directed towards the elimination of hunger and deficiency diseases and nutrition education campaigns were dominated by what we call eat more messages and and protein was really a primary focus as animal products are very concentrated protein sources they were considered a critical part of the hunger and malnutrition problem and you can see some of the old advertising drink more milk for your health meet in the meal for health defense uh and and it really elevated their status and led to economic policies that sought to maximize meat and milk production we had farmer subsidies marketing support and price controls that were all set in place in addition protein quality assessment tools favored animal products over plant Foods as determinants of protein quality were based at that time largely on the needs of baby rats so animal products acquired a bit of a health Halo meat became synonymous with good nutrition and big mussels and dairy was associated with strong healthy bones and diseases of nutritional deficiency did diminish and the interests of animal agriculture became pretty deeply entrenched in the economy it it appeared as though the job of improving Health through nutrition was effectively accomplished however while diseases of nutritional deficiency diminished the eat more messages gave rise to an epidemic of over consumption the very policies intended to combat malnutrition introduced major threats to health and the threats came in the form of overweight obesity heart disease hypertension type 2 diabetes and many cancers and a lot of people don’t realize when you think of malnutrition often you think of hunger or under nutrition but there are actually three types of malnutrition and that’s just one the second is micronutrient deficiencies like vitamin A deficiency resulting in blindness or vitamin D deficiency resulting in rickets but the third is over consumption and over consumption now exceeds under nutrition as the number one form of malnutrition globally over 70 percent of American adults are either overweight or obese and Western diets that are rich in highly processed foods and animal products are the most strongly implicated diseases linked to over consumption are responsible for about 70 percent of deaths worldwide so the health Halo is starting to fade National and international dietary guidelines are shifting and are now advocating well-designed plant-based diets and these kinds of diets accomplish two things they ensure adequate nutrition at every stage of the life cycle and they also minimize the risk of our biggest killers so let’s move on to a little bit about protein science so what are proteins anyway well they’re very large complex molecules they’re actually one of three macronutrients which is nutrients we need in large amounts of course the other two being carbohydrates and fats and proteins are made of long strands of amino acids that are linked together by peptide bonds there are 20 amino acids used to make proteins in the body and nine of these are considered indispensable or essential meaning that we can’t make them in our bodies we have to get them from food and this is just an example of a protein in our body called insulin so why do we need protein well we need protein for our body structure it’s a component protein is a component of of many body tissues like muscles and vital organs but also bones and collagen and blood and skin and hair and nails it’s important for body function proteins have very specific tasks in the body they can act as Transporters Messengers enzymes and even several hormones are essentially protein a protein is essential for fluid and electrolyte balance for pH balance for growth for maintenance and to provide the body with energy so when it comes to plant protein there are really two key issues the first is quality can we get all of those indispensable or essential amino acids from plants and the second is quantity can we get enough protein from plants so let’s dig into protein quality protein quality for many years the subject of protein quality excuse me evolved around the ability of dietary protein sources to meet human needs for metabolism growth and the maintenance of body tissues this was determined by two factors the essential amino acid content of a food relative to human needs and the second was the digestibility of the essential amino acids from the food and and animal proteins were generally viewed as Superior or complete or high quality because they contain a lot of essential amino acids and they’re highly digestible plant proteins were viewed as inferior or incomplete or low quality as some plant proteins are low in one or more essential amino acids relative to human needs and they have a slightly lower digestibility generally than animal products but if we dare to look through a wider lens we see something a little different what we often ignore in this discourse is that food sources of high quality proteins are actually associated with higher rates of mortality and chronic disease while those that are considered lower quality are associated with more favorable Health outcomes in addition the so-called high quality animal protein foods have a detrimental impact on the environment leaving a much larger carbon footprint than plant protein foods so I would ask this question is it time that scientists actually redefine protein quality and my answer would be absolutely yes we’ve got to weave in the health and ecological impacts of various protein sources protein quality is a function of amino acid profile and digestibility protein of bioavailability in other words but it’s also a function of impact on morbidity and mortality and carbon footprint and its environmental cost if we look at the standard tools for assessing amino acid profile and digestibility per was used for years it’s still used as the main you know quality score in Canada uh it’s based on the ability of protein sources to support the growth of baby rats and it underestimates plant protein quality because baby rats grow very rapidly and they have fur so they need more sulfur containing amino acids which we find more of in animal products and then we have what we call the PC the pdcaas score the protein digestibility corrected amino acid score and it’s based on how much protein and constituent amino acids go in the mouth and how much end up in the feces and again it has laws largely because what and there there’s some that gets used by bacteria as well which isn’t accounted for in that score and then we’ve got the DS or the digestible indispensable amino acids or generally it’s based on equality and digestibility of a food for pigs and the foods it often legumes and grains are provided to pigs in the raw form and whereas humans consume them in a cooked form especially those Foods in particular and then we’ve got something called the true ileal digestibility and fortunately this particular quality score has tested certain foods on humans using Foods prepared as humans would consume them so for example cooked legumes and cooked grains and using this method absorption of different foods appears to vary by just a few percentage points including those of plant Foods so what is the RDA for essential or indispensable amino acids well what I want to point out here even though there’s a lot here is that as we as we get older our requirements for essential amino acids uh decline somewhat um because we don’t we’re not growing in the same way or hopefully not um preschool children uh require you can see the amount like lysine 58 milligrams per gram of protein methionine insisting 28 grams per mil per milligram per gram of protein in pregnancy it’s a little lower but it’s still much higher than it is for adults for children it’s lower still as they get older it’s lower still and then for adults it would be the lowest so you see for lysine at 58 milligrams per gram of protein it’s only 38 for adults and so can we get all of these sexual amino acids we need from Plants the answer is absolutely yes animals this comes as a big surprise to a lot of people don’t actually make essential amino acids it’s why they’re essential they they can’t make them they’re made by plants so it makes no sense to think we can’t get them from Plants it’s where they come from so all plants contain all nine essential amino acids we get essential amino acids from Plants either directly or indirectly directly by eating plants or indirectly by eating animals that ate plants or very indirectly by eating animals that ate other animals that ate plants they come from plants that’s the key point now a lot of people wonder if we need to do this you know sort of complementing of plant proteins because grains tend to be low in lysine and beans tend to be a little low in methionine do we have to eat them together to get the so-called complete protein and in fact we don’t we we thought this years ago it was in the early 1980s that we believed vegetarians needed to combine foods but we learned very quickly this was not uh necessary we now know that any excess is consumed in one meal are stored in protein pools that can be drawn upon for the next if all we ate was grains at one meal and legumes up the other we can actually get sufficient essential amino acids from Plants simply by eating a variety of plants over the course of the day and eating enough calories regularly including legumes helps to ensure needs are met throughout the life cycle and I I want to show you this because I want you to get a good idea of what we’re talking about when we say um you know a a plant source of protein may be low in one or more asexual amino acids so I’m going to show you six foods and and for each food if the amino acid has a little um uh yellow bar around it it means that it it is low that that that that that amino acid is low um per gram of protein for a preschool child if it has a red bar around it it means it’s low for both preschool children and adults and so let’s go to looking at wheat you can see that wheat has enough of all of the essential amino acids with the exception of Lysine there is 22 milligrams of glycine per gram of protein adults need 38 preschool children need 58. so if all you ate was wheat and you ate nothing else adults would need about twice as much protein from wheat um you know like let’s say you needed 50 grams of protein and all you ate was wheat you’d have to eat close to 100 grams of protein to meet your lysine requirements and for for preschool children it would be almost triple um now for pumpkin seeds all of the amino acids are there in adequate amounts for adults they’re a little bit low for preschool children at 41 milligrams per gram of protein and as you recall they need 58. soybeans contain every essential amino acid for all ages with the exception of preschool children but what I want what I want you to notice is that soybeans are low in methionine insisting at 27 milligrams per gram of protein what children need would be 28. so let’s uh say a preschool child needs 13 grams of protein and all they eat is soybeans to get that 13 grams they would need they would need six and a half tablespoons of soybeans but they’d still be a little bit low in methionine insisting they would actually have to eat seven tablespoons to get enough methionine cysteine so an extra half a tablespoon so just to put it in perspective really and then quinoa same story it’s it’s there are no amino acids lacking for adults the only amino acid lacking for a preschool child is lysine but it’s so close it’s 54 and a preschool child needs 58 so they would have to have another couple an extra couple of tablespoons if that was the only food they ate black beans very similar story a little bit low in methionine insisting but there’s nothing lacking for adults for preschool children at 26 milligrams per gram of protein it’s it’s about two mil two two milligrams short of their requirements so again they need a couple of extra tablespoons to meet their needs if that was the only food they were eating now almonds a little bit of a different story you can see the red bars around lysine and around methionine insisting so it’s a low in both of those amino acids for both adults and preschool children now to put this all into perspective if an adult daily requirement is 60 grams of protein that person would get all the necessary protein and amino acids from eating just one of these Foods two cups of soybeans four cups of black beans one and a half cups of pumpkin seeds three quarter pound burger patties 10 eggs or eight cups of milk so you can see you’re getting all the essential amino acids all of the necessary protein from any one of those foods but we do need to recognize that protein digestibility is reduced by fiber and fiber is present in all whole plant Foods it actually carries a small percent of protein from food through the gastrointestinal system and it’s excreted in our stool a trypsin Inhibitors can block the action of trypsin which is one of the main enzymes that that breaks down protein so we can we can absorb the amino acids uh tannins a type of polyphenolic compound found in in a number of foods but especially in tea phytates major storage form of phosphorus and plants but really concentrated in wheat bran lectins these are proteins that bind carbohydrates concentrated in raw legumes and other foods and then in the marriage reaction can cause linkages of protein that can reduce lysine availability by up to 30 percent now we can increase the digestibility by breaking down fibers if we grind Blend or or use food processing techniques that reduce particle size we free up the the protein for absorption so the protein absorption improves substantially removing or reducing fiber through refining by reducing or eliminating grips and Inhibitors and lectins simply by cooking so if we cook legumes if we cook grains we’re reducing or completely eliminating the trips and Inhibitors and lectins and then we can reduce phytates by soaking sprouting fermenting leavening foods and and so we if we look at the um uh if we look at the protein digestibility of these either foods that are a little lower in fiber have the fiber removed or have been Blended like peanut butter for example you’re looking at about 92 to 96 percent digestibility that’s very close to what it is for animal products now if we if we look at other plant foods like whole plant foods like oatmeal and lentils and legumes we’re looking at about 10 to 15 or so percent reduced digestibility from these high fiber foods so you might wonder do people eating plant-based need extra protein to compensate for the lower digestibility of protein implants and so we’ll we’ll address that question in our next section where we look at the quantity of protein and plants actually provide enough protein and the answer is absolutely positively yes even the largest mammals on the planet get enough protein from Plants to build very big muscles and people can too we’re puny by comparison but even you know competitive bodybuilders can seem to manage to build huge muscles uh without any meat so what is the RDA for program for protein well the RDA is determined in terms of grams per kilogram body weight and if you recall a kilogram is 2.2 pounds and so the requirement for infants begin at about one and a half grams per kilogram and it goes down to 1.2 during the second half of the first year of life and then for children it’s about one gram per kilogram body weight a little higher for for toddlers uh or you know one to three year olds about 1.05 and then it’s down to 0.95 but it’s essentially one for most of childhood for teens it’s about 0.85 for adults 0.8 and it does go up considerably during pregnancy and lactation 1.1 for pregnant women 1.3 during lactation and then the other way we can look at it is in terms of grams per day but the the RDA in grams per day only it is really specific to a reference body weight and and of course these reference body weights would have to be adjusted for individuals but one thing that people really need to know is that your protein requirement or or your estimated requirement is actually based on your healthy body weight so if your own overweight you need to you know figure out what your truly ideal body weight would be and that’s what you determine your your protein needs based on and and even pregnancy it’s it’s based on your pre-pregnancy healthy body weight so it it’s around 10 grams during infancy it’s it’s around 13 to 34 during childhood it’s about 13 for toddlers and about 34 for older children and then during our teen years and our adult years it ranges from about 46 to 56 grams a day for during pregnancy and lactation it ranges from 30 from 63 to 75 now one thing that is important to know is that the recommended dietary loans uh is is really the average daily level of intake sufficient to meet the nutrient requirements of nearly all healthy people 97 to 98 of the population the RDA for protein is set at about 25 higher than average biological requirements so it’s it’s a pretty pretty uh safe number generally but there are special considerations for Whole Food plant-based Vader pregnant and lactating women children athletes and seniors and so we’ll we’ll take a look at each of those quickly so for Whole Food plant-based eaters there is no separate RDA for people eating plant-based but but because fiber and plant cell walls reduces protein digestibility some experts suggest adding 10 to the RDA for adults and for teenagers even um to help compensate for for the losses of uh and for the reduced protein digestibility um this is somewhat controversial it isn’t always necessary and it’s certainly not necessary for those who regularly eat low-fiber foods like tofu and soy milk and plant-based meat Alternatives Not unseed Butters those kinds of foods or for plant-based eaters who do consume some animal products like Dairy and egg silver lacto OVO vegetarians for example now if we’re pregnant and lactating women the RDA is actually close to 50 percent higher than for non-pregnant non-lactating women and the RDA is as I mentioned based on pre-pregnancy healthy body weight it’s 1.1 grams per day during pregnancy but we might up that to 1.2 for people eating very high fiber Whole Food plant-based diets and and it’s um a 1.3 during lactation so we might increase that to 1.4 for Whole Food plant-based eaters another way of approximating protein requirement is just to add 25 grams per day for non-uh pregnant to the non-pregnant protein requirement that might be increased to 28 for for people eating a lot of high fiber whole plant foods and of course it’s 50 grams for those expecting twins that you would add to your non-pregnant requirement or possibly 55 for a whole food plant-based eaters now for children um who eat whole food plant-based diet an adjustment Beyond 10 percent is often recommended and some experts suggest 30 for toddlers 20 for four to eight year olds and fifteen percent for thirty nine to 13 year olds and and so and again it it ten percent is probably enough or even no increase at all for those children who are regularly using those lower fiber foods and for plant predominant children who regularly do consume some animal products so the protein RDA would look like this for if we add on those numbers it would be close to 1.4 for for one to three year old children 1.14 for older children around the one gram per kilogram for teens and about 0.9 or 0.88.9 for adults and it would go up to 1.2 and 1.4 for pregnant and lactating women and if we look at that in terms of grams per day for young children we’re looking at around the 20 grams a day for older children close to 40 and for adults and teens it would be closer to 50 to 60 grams per day and during pregnancy and lactation closer to 70 to 80 grams a day now for athletes there is no separate RDA but but 1.2 to 2 grams of protein per kilogram body weight are generally recommended by Sports and nutrition authorities depending on training Insurance athletes needing you know closer to the lower end of that Spectrum than and and strength athletes needing uh closer to the higher end of that Spectrum so if you know getting enough protein is actually not as difficult for athletes as a lot of people think it is an athlete let’s say an athlete needs one and a half grams of protein per kilogram body weight and that athlete weighs 70 kilos or 154 pounds they would need about a hundred and five grams of protein per day but for an athlete consuming 3 000 calories which would be pretty typical that would amount to 14 of calories for protein which is relatively easy to achieve on on any varied nutritious plant-based diet especially one that you know people are thinking more about protein when they’re athletes anyway so they’re going to be fairly conscious of including enough legumes in tofu things like that so what about branched chain amino acids Branch chain amino acids include leucine isoleucine and valine um and they these amino acids stimulate uh protein synthesis in skeletal muscle and in other tissues it in they inhibit muscle loss and improve recovery with leucine probably playing the most important role plant-based athletes can get enough leucine and other Branch chain amino acids from legume soy Foods wheat gluten which is seitan a veggie Meats seeds nuts grains although they are less concentrated than the branched chain amino acids in animal products so how much leucine do they need well adults need 42 milligrams of leucine per kilogram body weight per day so that would amount to just under 3 000 milligrams of leucine but some Sports Authorities suggest 700 to 3 000 milligrams every three to four hours or with each meal basically but I just did some calcium calculations you know from the USDA database and and looked at you know a typical athlete who might consume a cup of soy milk a cup of oats a cup of tofu a cup of beans a cup of quinoa two slices of bread two tablespoons of peanut butter and and a smoothie three cups of of a you know relatively high protein uh smoothie and you can see the amounts of protein from each on the right hand side um and and the amount of leucine they would get by consuming those foods which is you know certainly not that generous um is is uh almost nine thousand milligrams so really not not so difficult to meet those recommended intakes and plant-based protein can be just as good as animal-based protein for building and maintaining muscle mass we have a 2023 study it’s a small study 22 adults that reported comparable protein synthesis rates and skeletal muscle hypertrophy or growth in those consuming high protein omnivorous or non non-animal sources of protein there was a meta-analysis in 2018 of nine studies comparing soy to animal protein sources and they reported that the soy protein produced similar muscle gains and strength as animal protein sources such as whey and then a study of almost 3 000 adults in 2017 looked at at people consuming different dietary patterns and they found muscle mass of quadriceps strength were positively associated with total protein intake but plant and animal protein sources were equally effective in promoting muscle mass and strength and the picture the guy pictured to the left here is uh Nami El Delgado and he’s been vegetarian from birth he’s never eaten meat in his life and he’s been vegan since 2015. so I think that picture says a lot uh so can plant protein sources offer any advantages for athletes and I think this is really important plant-based protein sources can improve circulation they can reduce inflammation they can lower oxidative stress they can promote a healthy gut microbiome they can enhance glycogen stores and support leaner body weights which are all very good things for athletes and the proof is in the plant powered Champions and and I think one of the most impressive is Scott Europe he’s a world champion ultra marathon runner who has won multiple races and he actually set the American 24-hour record with 165.7 Miles which is 6.3 marathons in 24 hours it’s unbelievable he’s been a hundred percent plant-based since 1999. uh Julia Hubbard who’s a world champion bodybuilder and Sprint Champion as well plant-based since 2015 vegan since uh vegetarian since 1990. and then we’ve got Novak yogabet and I mean I I don’t even have to say anything about him everybody knows who he is he just claimed his 23rd Grand Slam title the most major singles trophies in the history of this Sport and he has been 100 plant-based since 2015 and then Sonia Looney a good friend of mine who’s a world champion Ultra endurance a mountain biker first woman ever to finish a 10-day Race Across Hannah Vernon Nepal in a 2015 World Champion uh and and now has two children but she has been 100 plant-based since 2014 and as a matter of fact I have to tell you when she went flat base she was really nervous that it would affect her performance and as she was in the top 20 in the world at that time within six months she won the World Championships so again that that tells you something Pat Patrick babbonian world champion strongman uh holds the world record for log lift 100 plant-based since 2011 Tia Blanco world champion Surfer uh 2015-16 world champion uh title 100 plant-based since 2013 vegetarian from birth uh then there’s Matt Danzig martial artist mixed Champion uh he was the winner of The Ultimate Fighter in season six hundred percent plant-based since 2004. so that I think says it all uh moving on to seniors we don’t have a separate RDA for seniors in North America although they do in Australia and in a few European countries as well but the consensus is building that higher intakes may be needed achieving greater intakes can be challenging as energy intakes it’s not like athletes energy intakes are typically reduced in in the senior population and aging bodies metabolize and absorb protein less efficiently muscle protein synthesis is reduced in seniors so adequate protein can help seniors reduce age-related muscle loss preserve mobility and function improve recovery from illness and possibly delay bone loss as well this is my um my 81 year old writing partner uh and and plant protein co-author vasanto Molina she’s been plant-based for 45 years and and although energy needs decline protein needs can increase by about 25 percent and experts commonly recommend one to 1.2 grams of protein per kilogram body weight for seniors and and again some very Whole Food plant-based high fiber eaters may want to add 10 to that and an intake of at least 700 milligrams of leucine per meal is also often suggested intakes of 60 to 80 grams of protein per day depending on body weight and health status may be well advised for a lot of seniors and it would mean about 20 to 25 grams of protein per meal uh average adult requirements are 46 grams for women 56 grams for men if we add 10 that’s 50 grams for women 62 per men so how much do people actually consume well based on seven different studies average intakes in meat eaters are 92 grams a day vegetarian 76 and vegan 72. so all well above those recommended numbers even when we add that 10 if if you know if that’s necessary it’s not always I know it’s not I I don’t think it’s necessary for myself because I do consume you know unsweetened soy milk and tofu and nut butters on a pretty regular basis and I think most people do that sort of thing so what about in infants and toddlers do they get enough protein well veggie is probably the biggest study we have on that topic they looked at 431 to 3 year old children and the average intakes were 2.7 grams per telegram per day in omnivores 2.3 in lactobil vegetarians and 2.4 and vegans and if you recall the RDA is 1.05 for children of that age they were all over double the recommended intake so how about in older children well again we have the veggie Youth Study 401 6 to 18 year olds and the average intakes were 1.3 grams per kilogram in omnivores 1.16 or 1.14 in in lot to open 1.16 and vegans and if you remember the rdas is 0.85 proteins and 0.95 for children so they were all well above that as well so where do we get protein in plant Foods well if you look at the amount in um you know a cup of soybeans 31 3 ounces of Veggie meat 20 to 25 a cup of legumes uh you know 18 16 to 18 uh basically a half a cup of tofu 15 to 20. so you’re looking at from these kinds of foods you know a range of 15 to 30 grams that’s exactly the same as what you would get from three ounces of meat poultry or fish then if you look at other plant foods like whole grains a cup of Cannon berries or spelled or wheat berries 10 to 12 grams a quarter cup of hemp seeds 13 a quarter cup of pumpkin a pumpkin seeds ten so you’re getting you know this this amount of protein from from a number of plant foods which is very similar to the amount that you would get from two eggs or a cup of milk or an ounce of cheese humans need about 10 to 15 percent of calories from protein so that’s another way of looking at the amounts of protein and if you look at the percentages of calories from from um uh in plant foods you can see veggie meat is about 30 to 65 percent of calories from protein soybeans tofu and tempeh about 35 to 44 percent of calories from protein other legumes about 20 to 30 percent of calories from protein seeds about 11 to 24 non-starchy vegetables range from about 10 to 40 percent grains from about 7 to 17 percent not say to 14 starchy vegetables uh and and fruits are really the only two categories that that you know fall sort of often below that 10 percent with starchy vegetables at about 7 to 12 in fruits at about 2 to 12. and and so if we look at you know ground beef versus spinach for example uh ground beef has 39 of calories from protein a Patty has about 22 grams of protein spinach has about 39 of calories from protein exactly the same as beef so sometimes people say well see they have the same amount but what a lot of people forget to to mention is that you would need 25 cups of raw spinach to get 22 grams of protein so although you know the calories from protein are High um the calories in in spinach are so low that you’d have to eat a truckload of the stuff to get enough protein it’s a different story for tofu so tofu has about 41 of calories from protein so just over a half a cup would give you 22 grams of protein so that’s why we need to be a little bit conscious about including these uh more concentrated sources in the diet so plant-based eaters generally get enough protein unless they don’t get enough calories and that we see sometimes for small children over needing very bulky diets and they just can’t eat enough food people with eating disorders people who are sick people who are poor have food insecurity um sometimes we see insufficient protein and diets that are very poorly balanced high fat high sugar junk food diets tea and toast diets fruitarian diets may not provide enough protein or they just fail to meet the increased needs like seniors with low energy intakes or poor appetite pregnant women with morning sickness for example so how can we ensure sufficient protein in plant exclusive diets well very simply by providing sufficient calorie calories by by including a wide variety of plant Foods by eating some protein-rich Choice with each meal like like beans or lentils or split peas tofu tempeh edamame or other soy Foods seeds nuts seitan veggie Meats if you like to include them um and include some lower fiber choices in the mix especially for children and seniors and also by selecting milks that are a little higher in protein you know almond milk and hemp milk and some of these milks can be very low in protein cashew milk and so on but the soy milk and pea milk tend to have a lot more protein six to ten grams per cup so if we select those it will boost protein nicely um also by aiming for three or more servings of legumes a day and it doesn’t have to all be in terms of bowls beans it can be you know some tofu or soy milk or or some peanut butter or other nut Butters um we can get inspired by cultures that rely on legumes as daily Staples like in you know Asian Cuisine African Central and South American Indian Middle Eastern if you look at African or American intakes they average 9.3 grams Which is less than a tablespoon of legumes per day or a tenth that of many other nations it’s unbelievable we can add protein at breakfast if we so choose by um choosing the higher protein milks for our smoothies and cereals by by sprinkling some hemp seeds or other seeds nuts Etc and breakfast bowls by using lentils and higher protein whole grains for breakfast bowls buying you know doing a tofu or pumpkin seed scramble this scramble here on the top left is actually a pumpkin seed scramble I made and by making lentil grapes with different fillings they are amazing it’s just lentils and water that’s all it is uh Blended and and and cooked like a pancake baked beans Nutter seed Butters hummus or smoked tofu on toast all good choices we can add it to lunch and dinner beans lentils split peas with soups or stews tofu or hummus and sandwiches and wraps stir fries and bootables with all of those things stuffed sweet potatoes peppers or squash Bean or lentilo with with gravy Burgers tortillas tacos pasta dishes with lentils um you know a baked tofu or tempeh all of those things we can eat an add it to desserts if we’re so inclined you know puddings made with Chia seeds and hemp seeds and soy milk or soft tofu black beans or chickpeas using cookies and bars nuts and seeds and tofu and cheesecakes Asian style red bean desserts we can do we can select more protein in our snacks hummus and veggies edamame or sugar snap peas these little chips that you see here are actually chickpea chips that I made using a dehydrator at home with all sorts of seeds and and and chickpeas and peanut butter nut seed spreads on celery or apples roasted chickpeas tofu fingers trail mix all of that stuff so what are the most healthful plant protein or plant protein sources whole plant foods for sure unprocessed or minimally processed legumes are our best choices cook legumes and you know edamame sprouted legumes like sprouted peas lentils or mung beans tofu tempeh unsweetened soy milk peanuts peanut butter unprocessed or minimally processed nuts or seeds or or Nutter seat Butters intact whole grains and fresh peas are all good choices the least helpful choices are highly processed foods with added fat salt sugar they can all increase disease risk for disease prevention and reversal we want to avoid deep fried foods like deep fried tofu or tempeh fried veggie Meats a highly sweetened dishes with sugary sauces and we definitely want to limit our intake of Veggie Meats many are high in fat and salt if we’re using them once in a while we want to be selective compare labels and just use them less often make our own at home using Whole Foods that is soy safe well doesn’t soy cause man boobs and infertility doesn’t it increase the risk of breast cancer well when it comes to these issues um you know these claims are made based on two cases of people that were consuming 12 to 20 servings of soy a day uh ex extensive clinical trials show no effect of soy or soy isoclavones on testosterone or or estrogen levels in men even when their intake exceeds typical Japanese intakes and we have more limited but consistent clinical evidence that there’s no adverse effects of soya or isoflavones on sperm or semen parameters and and with breast cancer many experts once believed that phytoestrogens and soy could increase breast cancer risk but evidence has confirmed that soy is likely protected Against Breast Cancer especially for those who consume soy during childhood and Adolescence there’s suggested a suggestive evidence that soy May reduce the risk of recurrence and mortality quality in those that have been diagnosed with breast cancer so I may also protect against prostate cancers cardiovascular disease hypertension kidney disease bone loss and symptoms of menopause and soy is not necessary in a plant-based diet but it can be a healthful addition we want to select mostly less processed organic soy foods like edamame tofu Tempe miso natto and soy milk reasonable intakes are thought to be two to four servings a day for adults and one to two for for children so do plant protein sources offer any health advantages compared to animal protein sources and the answer is a definite yes plant protein reduces morbidity and mortality compared to animal protein and and if we look at the studies there was a study from 2016 that that actually Quantified this impact very nicely and what they found is replacing just three percent of calories that’s 60 calories it’s less than one egg in a 2 000 calorie diet would result in 34 reduction in mortality if what we replace is processed red meat 19 if what we replace is AIDS 12 if what were replaces red meat eight percent for dairy and six percent for poultry and fish then another study out of Japan again replacing three percent of calories from meat with plant protein reduced total mortality if if what were we were replacing was red meat by 34 and if it was processed meat by 46 and for cancer mortality 42 per red meat 50 per processed meat unbelievable and then another study over 400 000 individuals followed for 16 years same deal replacing three percent of calories from animal protein 24 reduction when what we replace is eggs for male 21 for females 13 for males 15 percent from females with red meat eight percent with dairy for both and and and white meat was two percent for meals and five percent for females and what they found is replacing three percent of animal protein with plant protein reduced overall mortality three percent so or ten percent imagine if we replace thirty percent of animal protein or flat protein another study of over 6 000 individuals found high protein intakes greater than 20 percent of calories increased mortality 75 and increase the risk of dying from cancer diabetes four times the associations however were abolished or greatly attenuated when the protein came from Plants now this was a part of the study that kind of was surprising for me protein actually appeared protected for those 66 Plus in older adults compared with those eating high protein intakes more than 20 percent of calories those with low protein intakes less than 10 percent of calories had higher risk for overall and cancer mortality although diabetes mortality was still lower for those individuals eating very low protein and in older adults the authors concluded it appears that protein intakes of at least 10 percent of calories are necessary to reduce age-dependent weight loss sarcopenia and excessive loss of igf-1 and and Frailty do protein sources impact other chronic diseases absolutely there was a study on cardiovascular disease that found heart failure risk was 251 percent greater in the highest versus lowest quintile of animal protein intake and 56 percent lower in the highest versus lowest intake of of legumes another study on cancer reported a 31 increase in overall cancer risk and a 79 increase in breast cancer risk in the highest versus lowest quintile of red need intake and then for diabetes there was a study from Finland that reported type 2 diabetes dropped 18 when just one percent of calories from animal protein were replaced with plant protein that’s 20 calories in a 2000 calorie diet so why the advantage with plant protein well they offer the advantage because they’re higher in protective dietary components that are associated with reduced risk of of chronic disease and they’re low and potentially pathogenic components that are are associated with increased risk of chronic disease and when we think of the protective factors like fiber phytochemicals antioxidants plant sterols plant stanols pre and probiotics they’re plant protein sources are loaded with these components but they’re very low in you know they don’t have the excessive saturated fat trans fats new 5G ctmao pro-oxidants environmental contaminants products of high temperature cooking and endotoxins so if you look at you know legumes versus meat when you look at the protective components they’re all high or very high in legumes and they’re all absent virtually or virtually absent in need and when you look at the stuff that increases risk of disease there’s nothing in the legumes they’re either low or zero whereas in meat it’s generally moderate to high and if we look at red meat and mortality it doesn’t matter if it’s processed unprocessed total red meat it’s consistently associated with increased risk of mortality whereas legumes are consistently increased with reduced mortality this study showed a drop of six percent for every just over a quarter cup of legume intake and this study would which was shocking of people over 70 for every 20 grams or two-thirds of an ounce I think that’s about two less than two tablespoons of legumes there was a seven to eight percent reduction in mortality based on that study eating a cup of beans would reduce mortality 60 to 68 and of course the acid test is the blue zones the places where people live the longest healthiest lives and the common lifestyle practices in the blue zones uh you know you know about but they all consume legumes so protein-rich plant Foods put a lid on the drivers of chronic disease protein enrich plant foods promote a healthy gut microbiome they lower LDL cholesterol and blood pressure they stabilize blood glucose they increase satiety they reduce caloric density and support healthy body weights they reduce inflammation and oxidative stress and we have clear consistent evidence that people need to eat more plant-based foods and fewer animal based foods at National and international Health authorities agree with this the World Health organization’s 12 steps to healthy eating step number one is to eat a nutritious diet based on a variety of foods originating mainly from plants rather than animals and international leaders this is from the the FAO plant plants plates pyramids and Planet they they actually highlighted the international leaders that that were really advocating plant Foods Germany choose mostly plant-based Foods Brazil eat Foods mainly of plant origin Qatar emphasize plant-based diet UK eat more plant-based foods and then we see it with cancer organizations American Cancer Society you know eat a healthy diet with an emphasis on plant Foods World cancer research fund eat mostly foods of plant origin the American Institute of cancer research chews mostly plant Foods so it’s just like a broken record eat Lancet commission you know Universal healthy reference diet increases consumption of healthy foods vegetables fruits whole grains legumes and nuts and decreases consumption of unhealthy Foods red meat sugar refined grains even Canada’s food guide the 2019 rendition you can see it’s half the plate is fruits and vegetables a quarter whole grains and a quarter protein-rich foods but they say choose protein foods that come from plants every day plant protein foods can provide more fiber and less saturated fat than other types of protein foods and you don’t need to eat large amounts of protein foods to meet your nutritional needs and finally I just want to conclude the presentation with a very brief look at benefits Beyond ourselves plant protein sources are more ecologically sustainable if you look at the carbon footprint of various diets it goes from the the sort of upper of the keto diet to paleo to omnivore to pescetarian to vegetarian to vegan on average keto diets produce 4.2 times greater carbon footprint that Footprints than vegan diets and there are five main indicators of environmental impact greenhouse gas emissions land use water pollution water use and acidifying emissions and if you look at the you know these these charts you can see animal flesh products are in red Dairy and in yellow and and plant Foods in green and you can see the highest greenhouse gas emissions are with animal products beef herb produces 30 times more greenhouse gas emissions than tofu similar story for land use beef herd uses 105 times more land than tofu water pollution same song and dance beef herd causes 50 times more water pollution than tofu and water use so the one exception is nuts nuts have by far the lowest greenhouse gas emissions but they do use a little more water but beef herd uses 18 times more water than tofu acidifying emissions again beef herd uses 40 times more acidifying emissions than tofu and all the the top emitters are animal products and then in terms of f being ethically justifiable um you know we’re slaughtering 200 million land animals for food every day so over 70 billion per year and over 90 percent are raised in capos and in my opinion it just doesn’t make sense to cause such pain suffering and death and other living beings when it’s not only unnecessary but it harms us and it harms the planet so by getting our protein from Plants we all win and we have a choice when we consider the consequences of our food choices not just for ourselves but beyond ourselves getting protein from Plants becomes to me both an ecological and an ethical imperative and that’s the new book plant powered protein and I thank you very much and I will stop my share and I’m so sorry I I went uh over a little bit but uh there we go no need to apologize that was wonderful if everybody could please put some Applause in the chat you know they make the little Applause we’d love to see that since we can’t hear you here come uh thank you so much fantastic that was amazing thank you so much there will be a test nobody leaves until they uh fill out their little blue book with a test in it please uh and then just quickly share uh maybe I’m not let’s see here um here we go whoops I’m just gonna we’re gonna have a q a session now and I’m going to do a quick uh reminder to ever oh can you see that is Bob is it okay uh we got the right screen facilitated programs okay yes okay great thank you uh so yeah once again uh we run um uh three aclm American College of Lifestyle medicine aclm certified programs at Rochester lifestyle medicine Institute uh our monthly Jumpstart program which is a medically facilitated two-week esselstyn style nutritional intervention of course it’s very low fat Whole Food plant-based just for those two weeks after that we uh encourage people to experiment a little bit I’m with higher fat plant Foods I’m just putting that in there so uh Brenda Davis will not think that we Advocate that forever uh that’s just how we get people started uh and that includes seven facilitated Zoom sessions for a total of 11 hours the daily emails support in the Google classroom and then uh cooking demo and uh so seven meetings it’s really a lot of fun we have a great time doing that the lift project uh created by Darren Morton in Australia is 10-week program that helps people helps lift people’s moods it’s a wonderful program especially for people who aren’t really ready to make a big dietary change if they’re just too many other things going on in their life we recommend the lift project and then the grand the grandparent of all of these lifestyle medicine programs is Chip which is now called pivio and we also run that as a facilitative program so we’d love it if you’d sign up for those and you can also check out uh what we do at various places in YouTube we have a YouTube channel which this by the way this video will a video of this um uh representation of Brenda’s will be on our YouTube channel in a few days and you’ll be notified of that and you can follow us on Twitter Facebook and Instagram and I will now stop sharing and I’m going to introduce our medical student Alan Tsai if you would like to turn your video on Alan is a second year medical student at the University of Rochester in Rochester New York and is still trying to decide what kind of specialty he would like to go into some kind of primary care or maybe Sports Medicine hello Alan hello thank you for the introduction Dr Barnett absolutely uh where would you now you’re going to be managing our uh q a uh With a Little Help from me so where would you like to start um I guess we’ll start right at the top with that first question from Julie um she asked how does the RDA for amino acids compared to the RDA for protein and she’s wondering if they’re one in the same oh um no they’re they’re they’re not so so the the RDA for protein is the total grams of protein that we require per day or that you know 97 to 98 of the population would be covered for for a day whereas the essential amino acids are very specific so so let’s say you need 50 grams of protein and all you get is 50 grams of protein the RDA for essential amino acids tells you how many milligrams of each of those essential amino acids you would need per gram of protein to ensure you get sufficient so I hope that answers your question that’s great uh Brenda I’m just going to ask you a Brenda question myself how do they decide what the RDA is did they do some like deficiency studies or how did they RDA oh it’s a it you know they bring together so experts from you know from many different Realms and and then they review the evidence and it’s a very thorough review of the evidence and and certainly not everyone agrees uh and Stephen you know it and and actually a lot of people don’t realize this but it’s jointly done Canada and and the U.S together so they’ll be Canadian scientists and and American scientists and and so it’s quite a quite an impressive team for each nutrient and then a complete lit review and then you know discussions and and um yeah to come to you know these these determinations I think all right what do we got next all right um I’ll jump to a question from Joanne I apologize in advance if I’m butchering any of these names um but she asks what additional considerations or plant foods are needed for those who must maintain both a soy free and a gluten-free diet yeah so so that’s you know that’s it’s um it’s more it’s obviously more challenging The More Foods you have to eliminate because of course in a in a 100 plant-based diet we’re we’re already eliminating quite quite a lot of foods and so if you eliminate soy soy is one of the sort of highest quality uh plant protein foods and then if you have to eliminate gluten as well um but that doesn’t mean it’s not possible you’ve still got a ton of things to to rely on so lentils are a fantastic source of protein um all legumes are amazing sources of protein and and then of course seeds a lot of people don’t realize uh what exceptional uh sources of protein especially hemp seeds and pumpkin seeds and so they you know relying on those kinds of foods can help a lot and then even if you’re you know you know you could use p p milk for example and instead of soy milk but if you prefer to have something like almond milk one thing that you can do is you can I I I’ve done this for years is I just blend some hemp seeds in with my almond milk to boost the protein and nutritional value essential fatty acids and and and vitamins and minerals so that’s a that’s another option but don’t don’t worry if you if you choose not to or can’t eat soy and gluten uh there there are lots and lots of other places you can turn great uh well Allen is looking for the next question Brenda what’s your opinion on smoothies and there are different are there different kinds of smoothies yeah so so my opinion on smooth can be wonderful um foods for athletes especially who need a lot of calories and just it’s a large volume of food when you have to eat three or four or five thousand calories a day and so sometimes the smoothies when you blend up a lot of calories into a small area it it can make getting those calories and nutrients a lot easier and some athletes do use protein powders for you know to further boost protein I don’t think that’s necessary for most people but it can be helpful for some people uh and so I don’t think we should discount them completely because they they do have their place at times and I would just be very careful with the selection um but but what I do I I think protein powders generally don’t taste very good and so if I’m wanting to add protein to a smoothie I I don’t really have smoothies much because I like eating too much and and I can’t afford like that kind of number of calories so I will have a big salad instead but my husband loves to have a smoothie once in a while so I will do um what I add is hemp seeds soy milk and frozen peas um to boost the protein in his smoothie I don’t ever use protein powder so you can just use whole whole foods to do that now and for smoothies for people who are fighting disease to me a smoothie would then be a meal replacement and for some people who have a lot of food addictions when you say okay all you’re going to eat for two weeks is you know a little bit of a smoothie in the you know evening that’s your dinner meal or that’s you know one of your meals for the day it can make it easier for them not to stray from the guidelines so it can have an application uh for for that kind of thing but generally I would say for people who are trying to lose weight it’s better to eat your food because it’s more Sadie to chew and to swallow and to have that big volume of food as opposed to sucking back a smoothie and and again um you know there there are you know for pregnant women for people who are having a hard time because they’re nauseated it could be helpful and and for people with cancer and you know there’s there there are a number of of but but again I think we need to remember smoothies should be mainly um vegetables and and some seeds some people even add legumes which is absolutely fine if it tastes okay to you uh not too many fruits and definitely no juice added do not add juice uh you don’t need it uh and and I would say add a fortified non-dairy milk to boost nutrients further great thank you Alan what’s next great well we have a question from Melissa so she asks can you speak on um continuous glucose monitors with regards to non-diabetic populations and athletes using it more mainstream um how do we counsel these patients and let them know it’s okay to see a small transient increase in glucose after eating these fruits whole grains and unrefined carbs because some of her patients are now choosing low carb low fruit high fat high protein foods to keep their glucose levels more Flatline uh this is this is a really tough one I haven’t dealt with it a lot but I think that people you know for to me um what they need to to realize is that Flatline and glucose isn’t the goal um uh the goal is to reverse insulin resistance uh to to ensure inflammation is kept down oxidative stress is kept down to ensure that we have a good microbiome uh what we’re what we’re striving for is health and and when you eat in that way and you’re flatlining your your glucose you’re doing it at the expense of all of those things those drivers of disease lipotoxicity dysbiosis inflammation you know oxidative stress and so what you want is you want to choose foods that that really put a lid on those drivers that promote a how they got microbiome that reduce inflammation that do all of those good things and so the focus and you can you know explain to them that the the research is really clear on this in terms of morbidity and mortality the more fruits and vegetables the more whole grains the more legumes we consume the you know the better we do um the more meat we consume the more of these you know uh non-carbohydrate animal products we consume the worse we do so the goal is Health the goal is not flatlining blood glucose or just you know getting skinny the goal we can do that by you know um all sorts of horrible things um the goal is health and and so those are the things we need to think of okay thanks what’s next Island all right we have a recipe oh I’m good I’m okay I’ll let plant powered energy [Laughter] these questions Rolling Dead you bet all right we have a question asking is quinoa considered a grain acid a legume is it a good substitute for white rice and is there any bad effect if you eat too much quinoa and how much can you eat per serving for normal weight adult oh well that’s an interesting question so quinoa is actually what we know as a pseudograin so it’s technically not a grain but it’s used as a grain and it’s nutritional value most pseudo grains have um have better nutrition than true grains and and it’s one of those and so it it tends to be higher in minerals like calcium and and magnesium and so forth than other grains um and it contains more protein as well than some other grains it’s actually not quite as high as as kamut and and spelled per cup because it’s a little lighter and fluffier um but it’s a wonderful wonderful uh Choice it’s a an exceptional substitute for white rice um you know so much better than white rice now if you want the best of the best in quinoa choose a colored quinoa so it’s you know in in legumes and Grains when you can get a colored you know black rice is better than white rice red rice is better than white rice even brown rice is better than white rice but in quinoa you can get tri-colored quinoa you can get red quinoa Brown king or black quinoa and and they all have a little bit more of these uh these phytochemicals that provide color to food which is which is wonderful um you can eat too much of almost anything uh but but you probably aren’t going to eat too much quinoa and a cup is a very reasonable amount for a normal normal weight healthy adult if someone is trying to uh you know who’s very overweight who’s on a strict weight loss diet they may want to do a half a cup serving instead of a full cup but for a healthy normal weight adult a cup is a very reasonable serving excellent what’s next Alan great uh we have a question asking can you review some of the physical signs common with nutritional deficiencies and plant-based eaters who aren’t eating enough calories from protein or those transitioning from a standard American diet yeah so some of the things that I guess I’ll I’ll just stick to protein since that’s our topic for today but some you know and and many many plant-based um ex you know of our experts will say they’ve never seen a protein deficiency um and and we don’t seek wash your car we don’t see severe protein deficiencies really in North America or very rarely it would be in someone with severe anorexia nervosa or something like that um but it’s a or a serious disease um you know partial car or marasmus we don’t see that but but but I can’t say I’ve never seen um um symptoms of insufficient protein intake I’ve seen them many times and in fact uh what I what I generally see is it’s usually seniors who are are losing their hair they’re they’re having problems with their skin they’re aging more rapidly than they would their skin seems to be aging more rapidly they they um their their nails uh uh you know all of it they’re they’re seeing negative sort of health of the of those things hair falling out and so forth and then the other thing you see often is their their immune system they don’t the wounds don’t heal as well they’re they get sick more often they feel weak they they’re losing muscle mass they have sarcopenia uh they may even get stress fractures their mood May shift uh and and I I actually just dealt with a lady that that had a lot of those issues she was eating about 30 grams of protein a day we got her into a a healthier range and she could not believe uh how much better she felt and how things were starting to turn around for her and so we we do see this and and and it’s more common than what a lot of us would would like to think it it is but but in seniors they often do eat um a very small amounts and and are focused on familiar foods like the tea and toast kind of idea and and so for those sorts of people it can really make a difference to boost protein foreign how would you boost protein in somebody in that situation something like tofu or what would you yeah so so in that situation what I generally do is I find out exactly what they’re eating for breakfast lunch dinner if they eat any snacks what they’re drinking and I look at their total diet analyze it see exactly how much protein they’re they’re getting and then if they then I you know if they tell me well I eat a bowl of flaked cereal with almond milk for breakfast will we switch the almond milk to unsweetened soy milk we do a higher um you know a higher protein cereal so what I often do is I cook lentils in with my Oak Groats and and or and chemic berries and so forth so I might add some that way and then let’s sprinkle on you know a seed mix hemp seeds and pumpkin seeds and so on and so we bring the protein from five or six grams to 20 grams pretty easily doing that and then we go to to lunch and if they’re having a salad at lunch we look at you know adding some little cubes and some some nuts or seeds and some addressing made with tahini and hemp seeds Blended and you know just just infusing protein in that way and then we do the same at dinner making sure that that there’s some legumes at that dinner meal that it’s not just pasta and tomato sauce with a few veggies thrown in that they’ve got some sort of source of more concentrated protein so it’s even if we just switch the pasta to a legume pasta for example we go from 5 to 20 grams of protein just like that so it’s actually not that difficult and and and um yeah it can help a lot thank you Alan what’s next great our next question here yeah our next question is kind of related to the question asked previously about the quinoa but someone was wondering for those with proteinuria is it okay to eat a cup of quinoa per serving since it has high protein or should these patients limit their protein intake or as long as it’s plant protein it should be okay for these patients yeah well who have a kidney disease there we have a number of of plant-based experts uh kidney disease experts who who have really looked at these questions and one of the things we know is that when you eat plant protein it’s it’s way less hard on the kidneys than animal-based protein and you see improvements in all the markers of kidney function when you switch from animal protein to plant protein and a cup of quinoa is about eight grams of protein it’s not a hugely concentrated protein source so I I wouldn’t worry about that at all the more concentrated protein sources in a in the plant kingdom would be things like tofu and of course the concentrated protein foods like veggie Meats if if people are eating veggie Meats they’re much more concentrated and so things like like quinoa not a problem at all grains aren’t you know or pseudo grains for that matter aren’t you know problematic in that regard actually I’m going to answer there’s a question in here what’s the average protein grams per day in the Jump Start program um I’m gonna ask Brenda to help me out here but I’m going to do a rough calculation and just say that it’s somewhere between 10 and 15 calories from protein we don’t really know it’s Whole Food plant-based and we don’t want you consuming uh processed food or sugars or Oils so I’m guessing it’s between 10 and 10 to 15 so if it’s 15 calories from protein and you’re taking in 2 000 calories it’s going to be 75 grams of protein because it’s uh right yeah and that and and yeah and and exactly and so it’ll depend a little bit on on how you slant your diet so if you’re having a few more leggings they’re 20 to 40 percent of calories from protein as opposed to more of the grains which are a little bit lower in protein but that that’s a you know I mean if you’re eating if you’re doing jump start you may be eating a little bit fewer calories than 2 000 I don’t know depending on your body weight and how much you’re trying to lose but but yes if you’re eating see that’s the thing that’s really interesting what dilutes protein in a whole food plant-based diet is well in a plant-based diet I should say is oil and sugar um they have no protein and so if you’re eating more processed foods that contain a lot of oil and sugar you’re diluting the protein in your diet if you’re getting 2 000 calories from truly whole plant Foods the vegetables and fruits and and nuts or where you’re not having nuts and seeds in the beginning of jump start but in the grains and the legumes your protein is probably going to be in the neighborhood of 15 or very close to it could even be higher I mean if it could even be higher legumes are all in the 20s professionalism on the 30s right vegetables yeah they range from about 10 to 40 but a lot of them are in the 30s yeah yeah and then grains are going to be for what 14 or 15 calories yeah a lot of them are in that range rice is a little lower it’s closer to the seven but but we don’t tend not to focus on Rice as much we tend to focus on on you know on oats and and barley and and Camo berries and quinoa and so forth and they’re all significantly higher in that 12 to 17 range yeah great thanks that’s a great question thank you whoever asked them yeah really good question go ahead Alan great um our next question asks whether it’s soy milk lose its nutritional value slash protein density does powdered soy milk oh that’s an interesting question I I’m not really very familiar with powdered soy milk but I would say that in the powdering process I would expect some nutrients to be lost such as the you know some of the B vitamins but not the minerals and so and not the protein so I would think that it’s still got a you know a reasonable nutritional value but I’ve actually never compared it it’d be interesting to go to the U.S database and just look at the nutrients compared to um yeah the other type of soy milk I haven’t done that so that’s that’s a good one thank you so I’m going to make an executive decision here it’s 8 56. we’re going to call it at nine o’clock exactly eastern time I’m so grateful to Brenda Davis for doing this but keep going Alan we got maybe one or two more all right let’s see what I can squeeze in here in these last couple minutes um we have a question asking is there a generalized test to assess the type of protein deficiency someone may have especially someone who’s self-taught on eating a more plant-based diet yeah I wish I could say yes there’s an easy you know you do a serum albumin or a total protein but they vary with you know those kinds of tests will be affected by inflammation in the body and other things um so there’s there’s not really it’s it’s probably better to have an assessment looking at your overall health and your protein intake is probably the best way to go okay one more Alan okay we have one last question asking what can I do to get my basic amounts of protein in if I have to avoid all middle and high level purine foods whoa um yeah this this is a that’s an interesting question um what’s what’s what’s really interesting is a lot of the the sort of purine information on legumes suggesting legumes are you know to be avoided are looking at dry leggings and when you you actually um look at cooked legumes um the it they’re they’re very moderate uh you know very moderate sources not nearly as high as meat not nearly as high as as uh Seafood that’s for sure and so I think even with purine restriction I can remember working with a man who had gout seven eight times a year it was just chronic gout when he was on a sort of standard American diet we switched them to a whole food plant-based diet never an incidence of goat again and he consumed plenty of legumes so I think legumes definitely can fit in uh nuts and seeds and and whole grains they can all fit in I mean you can you know look at you know purine content a little bit and moderate intakes a little bit but but generally um you know this these are diseases of Kings they’re diseases of people that are eating um usually generally very high animal food diets great answer well um Brandis do you have any final words of wisdom for our audience well I’m just so excited that there are so many people interested in eating plant-based I was just so excited to hear about the numbers of people that are doing the that have gone through your program and um I just I really want to encourage people this is this is I think what we really have to do as human beings we need to move in this direction not just for ourselves but but you know forever for the for our grandchildren um and so uh thank you all for what you’re doing for getting educated and for living this way so I’m I’m so grateful uh you know I’ve been doing this for what 35 years and 35 years ago I would have never imagined we would be where we are today so I’m very grateful well thank you so much Brenda uh thank you Alan thank you for your help uh Bob uh Frankie in the background thank you for engineering and thank you to all the staff of Rochester lifestyle medicine Institute and thank you all for attending tonight good night good night bye bye