ORDER OF OPERATIONS: FIBER OR FERMENTATION?
Megan: And I love thinking about your actual foundation and whether it cracks, because that makes me think about order of operations. So much of the information out there says, well, if you’re having gut problems, just add more fiber, add more fiber, add more fiber. I know you’ve spent far more time clinically working with the gut and the microbiome than I have, but I feel like that’s such a big misconception. It’s sort of like lighting a fire. If your body can’t break that stuff down, adding more fiber is going to cause inflammation, your immune system reacts, and you feel like garbage. And if you’re in perimenopause, your immune system is already not working very well, you’re already having histamine reactions, all of those things. So when you’re thinking about that foundational piece, let me ask you: are you a fiber or a fermentation person? How do you feel about order of operations? Do we think about testing? Are we adding things? Where do you start?
Kara: Good question. My blanket answer is that it really depends on the person. I always get a little bit of pushback from other nutrition professionals when I say I’m not necessarily a diet-first dietitian, because diet is just not always accessible. Emotionally it can be difficult, or our lifestyle isn’t conducive to making those changes. There are a lot of factors that come into dietary changes. It’s always part of the conversation, and there are always ways we can meet people where they are, but I don’t always start with the diet.
When someone isn’t feeling well and they’ve been suffering for a while, it’s hard to add more stress to the plate. And I don’t care who you are, even as a dietitian, when I think about diet changes, it brings stress to me. It gives me anxiety. I have eosinophilic esophagitis, and I’ve taken myself through lots of elimination diets. I’m probably my worst patient, in all honesty. It brings stress because it’s removing or changing something that we all do, something very comforting, something we get very patterned around. So I think sometimes with some patients, I might start with, what can I do or provide that’s going to quell or calm some of the symptoms, so that we can do the deeper work?
That might be a good place to start. And sometimes that is the diet. Sometimes it’s, okay, let’s remove certain foods that we know can create a lot of reaction, for a short period of time, and here’s what you replace them with. That way it becomes a little less of a mental ping-pong of, well, I can’t eat this, so I’m just not going to eat, because we don’t want that to happen. Maybe that’s not where we start. Maybe it’s with specific supportive tools that get people pooping better. When I have that constipated woman, it’s like, I don’t care what you do, let me just get you pooping, because that’s going to make you feel better.
So it really depends on the person. I also think sometimes testing is warranted, although with microbiome testing, unless you really understand it, it can be confusing and can guide us in a clinical direction we don’t necessarily need to go. There’s nuance to that. In the perimenopause state, there’s also a lot of other testing we can do to see how off things are. For me, that’s why I became such a gut-first dietitian. It gives me a central place where I can add tools that I know can provide some immediate relief, but also start working on the background, root influences of what can actually be driving symptoms. So I take a dual approach. But no matter who I work with, the diet always comes up.
MAKING FERMENTED FOODS WORK FOR YOU
Kara: In all honesty, I think fiber versus fermentation depends on the person. If you’re not someone who likes fermented food… I’m that girl who can drink a jar of kimchi juice. I love it.
Megan: Same. We’re the weirdos.
Kara: But I don’t love all of it. Have you ever tried natto? I had natto when I was in Japan.
Megan: Natto is a lot. I can do a little, itty-bitty bit.
Kara: Yeah, with a lot of soy sauce.
Megan: An acquired taste, if you will.
Kara: It’s an acquired taste, and I don’t love all of it. To me, a diet is only as successful as what you can do long term. If you’re not someone who likes fermented food… I go in my refrigerator and take forkfuls of it. And in that study that you mentioned, they were consuming quite a large amount of fermented food, so I think that can be hard. But how can we consume these things in ways that work for you? Working with a nutrition professional is really helpful because we can get so creative about how we consume. I’m a huge fan of red miso paste. You want to try something really good? Don’t think it’s weird. It’s an umami bomb in your mouth. I have this every weekend because it takes a little more preparation. We buy a really good sourdough, or a really good gluten-free bread, or maybe you make it. I haven’t gotten into bread making. I don’t have the time right now, although I’d love to.
Megan: It takes so much energy to make bread.
Kara: I just don’t have the time. I can make sauerkraut, because it’s one step and then you put it away.
Megan: Right, and then you put it away for weeks and let it ferment.
Kara: Yeah, or pickles are easy. But really good sourdough, a little bit of cream cheese (maybe if you’re dairy free, skip the cream cheese, I eat dairy), red miso paste on top of that. So good. And then a couple of fried or poached eggs, and some microgreens on top, so you get that sulforaphane, by the way. I could eat this every day. Am I just going to eat spoonfuls of miso paste? Am I only going to make miso soup? No. I’ve thought of other creative ways to consume it that are so savory, and we live for it. My daughter loves it too. It’s just so good. So anyway, you can try it. Let me know.
Megan: I will definitely put that on my list of weekend activities. That sounds amazing.
KARA’S PATH: FROM HOSPITAL DIETITIAN TO GUT MICROBIOME SPECIALIST
Megan: With all of this creative nutritioning and dietitianing, if you will, I wonder about your own personal story. What got you from an allopathic, GI-based practice into this functional space? Most people have a story. You don’t just wake up one morning and go, well, this job that I’ve had forever was great, but peacing out. There’s got to be a story there.
Kara: I was always into this from early on, before I even knew what I wanted. I went down a bit of an alternative path. I was always into natural medicine, and I became vegetarian very early in my life, at around seven years old.
Megan: Wow. That’s commitment at seven.
Kara: I blame my father for that. He doesn’t like to hear it, but he cooked a piece of meat too tough and I just gave it up. Then as I got older and I was an athlete, I really had to focus on nutrition. I was always into healthy eating, obviously as a vegetarian, but I didn’t know that much. When I got to college, I didn’t know what I wanted to do. Who knows what they want to do at 18? I was in the business school, then I was pre-med, and then I got into horticulture.
Megan: You did a lot of things.
Kara: I was jumping all around. I think I always wanted to go down the medical route, since I come from a medical family, but that didn’t resonate with me. It wasn’t until my first solo trip at 18, backpacking across British Columbia, where I met some really wonderful people and started to learn about holistic medicine. I was living with an herbalist at the time, and I started to see there might be a career in this natural medicine space. Through a little bit of back and forth, I discovered nutrition. I actually had no idea what a dietitian was. But for me, food was integrative medicine. Everyone eats. We know there are so many beneficial compounds, so much good that comes from our diet, and that resonated with me. I was getting into all this fermentation stuff, and that’s when I started to study nutrition.
I really loved the science behind it, but I loved the medicine side. Functional medicine wasn’t really a thing then. I was looking into naturopathic medicine, and I went the dietetics route because I wanted to focus on food. Of course, dietitians go through very traditional training. We work in the hospital, and I found that I loved the medical side. Working with patients on TPN or tube feeding, and labs, fed this nerdy brain of mine. I didn’t love educating on a cardiac diet and what we were feeding people, but I loved the acuity and piecing things together. I really appreciated that background in acute medicine. It made me a better counselor, a better dietitian working with more long-term conditions, because I could look at the whole picture and not just specific systems.
As I got further into dietitian training, I was always into supplements. In my internship, I was doing work on the side with an oncologist, educating his patients on supplements and alternative nutrition. It was always in the background of my interest. I thought I wanted to go for my PhD in oncology, so I was all over the place a little bit, but I went through very traditional hospital work, then started outpatient. When I started outpatient counseling, that’s where I could bring in some of this other stuff, from herbs to supplements. I learned by doing, since we didn’t have the breadth of information available.
It wasn’t until I got to the GI clinic that this integrative, functional space solidified for me. They hired me to do celiac and gluten-free education, but we were working with patients with ulcerative colitis, Crohn’s, gastroparesis, and IBS, and SIBO was starting to come to the forefront of the gastroenterology conversation. There was so much we could do, from diet changes to microbiome products to other supportive agents, and the research was starting to follow suit. A long-winded story, but I always had that interest in alternative medicine. In college I was doing everything on Linus Pauling, all the CAM stuff. I went to school in Massachusetts, and the medical school out in Worcester had a huge complementary and alternative medicine program. I had a mentor there who let me start working on research projects with them, and they were doing a lot of cool research on diet and IBD. It solidified that I could go down this dietetics route and still do something in this space. And of course, in the last ten years functional medicine has really blown up, so the availability of education, products, and research is much, much more vast than it was.
Megan: And then also the opportunity to work at something as exciting as a company like resbiotic, which wouldn’t have existed ten or twenty years ago. The research wasn’t there, but also the desire and the market for something developed at the level of a drug, when you think about how much pharmaceutical background your founder has and bringing that over to the probiotic side. I feel like all of your meanderings got you here. If you hadn’t been fermenting things in your kitchen, you might not have been like, you know what? Probiotics, postbiotics, this is where I’m going to go.
Kara: I know. I wish I’d known back then. I probably would have gone on for my PhD in microbiology. But I always say your experiences and your path take you where you’re meant to be. As much as I look back and say I should have done this or that, who knew? It was always there. It was always a seed in me that clearly needed to be sprouted.
Megan: And you have. So much sprouting.
Kara: And I sprouted a lot of seeds, yeah. So good for you.
KARA’S THREE TAKEAWAYS
Megan: Well, Kara, thank you so much for joining us today. I feel like you gave us a whole master class on pre-, pro-, and postbiotics, how they play a role in our health, and a lot of the nuance that I think is missing from what’s happening in the marketing space, because it does make a difference. I would love for you to share with our listeners three things they could think about this week as far as their gut health is concerned.
Kara: I love that question. The first thing is that one of the biggest myths around gut and microbiome health is that you have to have GI issues. You don’t have to have bloating, gas, diarrhea, or constipation to have an unhealthy gut. I want everyone to take a step back and think about how your sleep is, how your mood is, how your energy is. Do you have food cravings? Are you exercising and eating well but not seeing metabolic changes? These are all things that can link back to the microbiome.
I am someone who feels that most people would benefit from some type of microbiome support. It’s not necessarily the same product, but whether it’s different prebiotics, because we want to nourish that garden and nurse that growth, or specific probiotics depending on what you’re struggling with or trying to target, I think most people could benefit, kind of like a multivitamin. It doesn’t mean it’s the same one for each person. No matter where we are in life, our microbiome is impacted by so many external factors. Just like I take D3/K2 and fish oil, all the things I know my diet isn’t providing, I take various probiotics, postbiotics, and prebiotics to add to diversity, even though I eat a pretty high-fiber diet and quite a bit of fermented foods.
A second thing I would love people to take away is that when it comes to dietary changes, the best diet is the diet that we can sustain. There’s a lot of diet philosophy, a lot of “we shouldn’t eat this,” and a lot of fear around food, and that’s a whole other conversation about what we actually know and understand. Ultimately, I don’t work with patients who are like, hey, I feel amazing, I just want to optimize. That would be very fun.
Megan: Just want to optimize.
Kara: But we’re working with people who are really struggling. Still, I think all foods have a place. There are always better substitutions we can make, but those changes need to be something you can sustain. So I take away that 80:20. Now, obviously, if we’re struggling with lots of GI issues, or in a really heightened histamine state, there may be some more short-term bridges we have to do just to get people to feel a little better. But I want us to look at diet from a truly holistic lens of, all right, this might not be the best version, but I’d rather substitute something else. How can we create the best diet for ourselves? Diet is truly personalized.
I don’t make everything from scratch. Maybe there is a better version of this cracker that I can buy, and I really like it. And maybe not. Maybe this is the only cracker my child will eat, and that’s the one we’re going to buy right now, because it’s fine. For every season there’s a reason. Cynthia Thurlow said that, and I love it. It doesn’t mean it’s going to be the same thing forever, but I think we put a lot of pressure on diet, and a lot of pressure on ourselves. There’s a lot of fear, and there are great professionals like yourself and myself who specialize in nutrition and would be happy to break down some of those myths.
My third takeaway: the social media and marketing world we live in influences me all the time, not necessarily with supplements, but with skincare.
Megan: Yes. Makeup. Of course I need my eyes to look like that. Lip color.
Kara: I get it. I do get influenced. But as educated consumers, which most of us are, I always say do the double click, because you can pay a celebrity to talk about it. Is this a company that’s doing third-party testing, getting extra certifications to ensure that makeup is clean? Or are they doing actual clinical studies? Anyone who does research is going to blast it, because research costs so much money. So I really challenge consumers, don’t get influenced. It might be that I get influenced, but how can I do the double click? How can I go to the company website? How can I send a message in? How can I start to dig a little deeper so I’m not just wasting my money? We don’t do that second or third step of looking into a company more deeply.
Megan: That’s a really good point. It took me a long time to realize that even though something sounds like a great product, and even though my friend recommended it, we need to do the double check. And to your point, everybody who spends money on research is putting it everywhere. It’s not going to be buried at the end of their website. It’s going to be on the front page, like, look at us, we did a clinical trial. They spent a lot of money on that. They want you to see the results, they want the press to see it, they want it to be everywhere.
Kara: Yep. And just because something is more expensive, or has more of something, it’s the same thing with menus and food advertising. All of this is to get us to purchase. But we are more educated, and we have a lot more tools at our fingertips. I’ve always worked for companies that prioritized research and really emphasize research, whereas others don’t, and you could probably find that next best product that does. So don’t get influenced. Like I said, I’ve had to stop myself with the skincare and the makeup.
CLOSE
Megan: Okay, guys. We are thinking about our gut health beyond gut symptoms and recognizing that it is connected to everything. We are thinking about our diet being expansive and inclusive of us. And we are not getting influenced. Those are our three focuses for the week. Kara, where can everyone find you?
Kara: I’m on Instagram. You can find me at Kara Siedman, S-I-E-D-M-A-N. And at resbiotic.com, follow us, like us. We’re doing some fun stuff. You’ll see my face on there quite a bit, trying to educate, because this is such a complicated space. So don’t hesitate to reach out to me.
Megan: It is a complicated space, but you explain it really well. Thank you so much for joining us on Mornings with Megan. Thank you for listening. I hope you enjoyed everything that Kara shared. It was such a fascinating conversation. Everything that we talked about will have follow-ups in the show notes, and I’ll see you next Wednesday.
