 This is Stink Tech Hawaii, Community Matters here. What are we going to do now? This is Michelle Tom. Michelle, alone at last. Oh my god. She's a registered dietitian. And I met her in the Ornish program, in Straub. And she was really fantastic, fantastic Michelle. Thank you. Welcome to the show. I want to talk about the stuff you talk about. OK, OK. Thank you for having me today. Yeah, yeah. Great for you. Thank you for coming down. I wanted to have this show a long time ago. Finally, we're together. Yes, we got it. We got the date, OK. So what does it mean to be a registered dietitian? What does that involve? OK, I mean, there's a lot of different avenues you can take when you are a registered dietitian. So there's an inpatient setting where you can see patients that are hospitalized for things like diabetes, heart disease. You even see patients in the burn units and in the intensive care unit. So we work with patients inpatient, with tube feeds, nutrition through their veins if they need it, but also education in the hospitalized setting on their specific conditions, whether it be chronic kidney disease or heart disease. So that's the inpatient setting. And then you also have the outpatient setting where I think you can have a pretty big impact on helping patients learn more about nutrition and incorporating that into more of a lifestyle change. OK, I get two things from that. One is that a dietitian is a nutritionist. Yes. Because that meme shows. So they are actually a little bit different in terms of education levels. So we go through that four-year undergraduate program, but we also have a year. The UH, they have this at UH? They do have it at UH. Yeah. I went to Ohio State to get mine. It's just east of UH. Just east, a little bit. But then after that, we do a year-long different rotations as a dietetic internship to get experience. And then after that, sit for the R&D exam to be certified. Oh, and you've done that. I have done that. Yeah. You're very knowledgeable. I'm serious when I say that. She bolted me over every time we talked. Thank you. So anyway, the thing is, I want to go back to the Ohio State for a minute. OK. Because you go to class one morning, you're in this kind of program. Biochemistry, right? It's biochemistry? It is biochemistry, yeah. It's a lot about medical nutrition therapy, how to help people with specific conditions. So a lot of that. Yeah. And that's the second point I get out of what you said just now is that it's kind of a matrix that you have to change your strategy depending on what the problem is. Exactly. And that's a lot of possibilities. That's a matrix as big as all outdoors, isn't it? Yeah. So with that education component, we really learn the nitty-gritty on how to tailor nutrition programs for a patient with specific conditions. But you also have a majority of patients that have multiple comorbidities. So that's something that we have to take into account as well as dietitians. Are you a nurse, too? I'm not a nurse yet, but I want to be a nurse practitioner eventually. What's the relationship between a dietitian, nutritionist, what have you, and a nurse? Well, nurse practitioners specifically, they really emphasize the importance of preventative care, lifestyle changes. And for me, I want to be a family nurse practitioner in the primary care setting. So I have a broader impact of how I can help patients. Is that like a family doctor? It's so special, too? Yeah, kind of. So you become, and I want to talk about this, you become a kind of primary. As a nurse in that area, and you will track on what a doctor might do and become sort of primary nurse as opposed to a primary doctor. It's called an advanced practice nurse. So you go back to school and get a higher level of education. There's a lot of schools across the nation. There is a nurse practitioner school here, but there's a lot of good ones as well on the mainland, too. So you go back to school, how long do you have to study this? Good question. So it kind of varies for, depending on the school, it's looking for me going to be about four years. So the first year to two years is going to be where I learned how to be a nurse. And then I have to sit for the NCLEX exam. That's an acronym, isn't it? Yeah, OK. So that exam is just to be certified as a nurse. Yes, it's the acronym. Oh my god. It's a long one. I even have to go back and look that one up. But after that, once I'm certified, then it's the core work to become a doctorate, to get your doctorate in nurse practitioner. That's what you're shooting for. You're shooting for that. You are shooting for that. Yes, that's what I'm shooting for. Doctorate. Yes. You're completely up to that. I'm telling you now. I know, I know. Anybody else out there tells you no, no, no, no. It's going to be a rough road, I know. This is your game, I'm telling you. It's going to be a rough and long road, but I know it's going to be worth it in the end because I'll be able to help people on a broader range. Where do you stay here? I have applied to UH, but I also plan to apply to some schools on the West Coast as well. Ohio State? I think I'm going to stay away from the cold weather. That's severe cold weather. It's a practical consideration. Yes, it is, yeah. But I think West Coast would be a good choice for me as well. And when you get the PhD, God, I hope you're coming to see us, talk to us again. Of course, yeah. When you get the PhD, what kind of money can you make? Give me your broad range. I mean, it's six figures, so. Right out the box, yeah? It's about, national average is six figures. No, that's fabulous, so yeah. But you're not doing it for the money, I know that. No. What is your worldview, I mean, about helping people? That's actually one of the reasons why I want to be a nurse practitioner is, so last year, I went on a medical mission to denying Vietnam. And I worked at different hospitals to learn more and teach other people about America's practice in medical nutrition therapy. So whether it be for people with ulcers or different conditions, we kind of would go back and forth to see the similarities and differences in our nutrition care. And so that's why I want to be a nurse practitioner is because I can have a bigger impact on patients and help people abroad. So when I'm not working in the US, I can take vacation from here and then go abroad to help people. Wow, how nice of you. Yeah, that's the goal, so. You're an altruist in the finest way. In the finest way. Well, we were talking about the kinds of places you can go. I mean, the world is your oyster, and there are a lot of organizations, and it doesn't stop with medicine on some frontier. We have a low-high medical mission right here, because it's Nepal and the Philippines and other places, too. So you have a great assortment of possibilities there to make the trip. What strikes me, though, is that they don't necessarily focus on nutrition as a specialty they take into the woods. Right, right. You're going to cut some new territory with that. I hope so. Yeah, I mean, I think having a nutrition background paired with a nurse practitioner degree is a really good combination, so. Yeah, because you can do other things as well. Yes. But what I get from what you were saying a minute ago is that you can actually affect health. Maybe this is an overstatement. Actually affect health by diet. Oh, yes. You can cure people of diseases, maladies, conditions by diet. Is that the way it works? In certain cases, there has been research done for reversal of certain diseases. Wow. If you think about it, a lot of chronic diseases are caused because of the lifestyles that we live. So our society today is based on convenience. We're so quick-paced that we want to grab anything that's the most convenient. That's why there are so many fast food chains. But with those fast food chains, high-fat diets, high-sugar diets, that's when you start to see a lot of problems. So it's really important that you recognize, and I'm going to talk some more about this in the next part of our show. It's really important you recognize there's a connection between what you eat, and I was saying, it's not what you eat is what you are. It's what you eat is the level of your health. You can actually affect your health and therefore your life expectancy and everything by following a few simple rules, which we are going to examine right after this break. We're going to take a break now, OK? Let's do it. We'll come back for the break. When we get to the nitty-gritty, then you're going to help the people who are listening to the show live longer, be healthier right here at Think Tech. Wow! Think Tech Talks. All right. That's Michelle Tom. Fabulous. We'll be right back. This is Think Tech Hawaii, raising public awareness. Aloha. I'm Kay Lee Ikeena. And I volunteer at Think Tech Hawaii as a host of the program, Hawaii Together. Why? Because Think Tech Hawaii is doing a very important job in making sure that there is a conversation ongoing between people of all backgrounds and all views. That's what Citadel Discourse is all about. And Think Tech is an important part of finding solutions for a better Hawaii. For the first time, Think Tech Hawaii is participating in an online web-based fundraising campaign to raise $40,000. It's called Give Thanks to Think Tech. And it will run only during the month of November. And you can help. Please donate what you can so that Think Tech Hawaii can continue to raise public awareness and promote civic engagement through free programming like mine. Please send your tax-deductible contribution by going to this website on the screen, www.thanksforthinktech.causevox.com. On behalf of the community enriched by Think Tech Hawaii's 30-plus weekly shows, thank you, mahalo, for your generosity. In case you were wondering, that is Michelle Tom, dietitian and altruist. She is organizing her life to help people, which is so sweet and kind and nice of you. Not everybody does that, you know. I can take us some names to name in Washington, for example. So let's talk about the substance of this. And your PhD role as an advanced practical nurse, you're going to be covering much more. But the core for me, anyway, and maybe for you too, is the dietitian. Because that's always present. It's always a factor, no matter what. Whether you're well or sick, it's always a factor. So I want to talk about some of the basic rules. We'll start with my notion of the food store, the food market as a minefield. You walk down there and the potato chips are out there picking at you. Oh, I know. I know it, Jay. You can taste the salt and the fat. You can taste it so good and so bad for you. Yeah, not ideal. You can walk around the store, and it's like little voices are calling you, like sirens, the odyssey at the mast. Sirens directing you to a bad place. So you've got to resist that. So what do you have to resist most as you walk through this minefield store? Okay. I would say one of the hugest things is fat, right? So average American consumes around 40% calories from fat. And so you actually only, you need a low-fat diet. That's ideal. Everyone. It's ideal for health. So people that don't necessarily have heart conditions or things like that, I think they have more wiggle room, but as far as overall health, fat, a large amount of fat is not actually that necessary. Research has shown your body actually only needs about 5% total calories from fat in order to prevent fatty acid deficiency. So when I worked for the Ornish program, we specifically recommended a diet that was 10% total calories from fat. So the reason why heart disease is the leading cause of death is because we eat so much fat. Saturated fat and cholesterol directly linked with heart disease, and a huge source of that is going to be animal-based products, right? When we're looking- Wait, this is an important point. Okay, yes. Animal-based products have an inordinate amount of fat in them as a general rule. And we've talked about cholesterol, too. Right, so total fat, cholesterol, and saturated fat. Therefore, if I stop eating animal-based products, we'll have to define what that is, then I'm gonna be better off. Yeah. I mean, if somebody came to you and said, Michelle, and I've heard of you around the world about your expertise in this area, what should I do? You would never tell them, you need to eat more fat. I- You would never tell them that. No, I don't think I would tell them that. No. You would never tell them that. You need to eat more red meat. No, no. I definitely- Protein and red meat. There is protein, but there's also protein in tofu or beans and things like that. Without the fat. Right, without that significant amount of fat and cholesterol and saturated fat, so. Okay, so how can I assure myself and my future of avoiding fat? I mean, okay, I'm not gonna eat potato chips because there's a lot of fat in there. That's good. Anything fried is fat, right? Yeah, I would say away from fiber. And meats have fat. That's fish have fat? Fish has fat, yeah. Chicken? Chicken has fat, shrimp has fat, yeah. This is the eye theory here. It is the eye theory, but people do tell me, well, clams don't have eyes, and I say they still have fat, so. So not everything. I actually don't say eyes because they always get me with that one. You gotta be careful of those clams anyway. I know, I know. Wow. Clams. Beyond fat in our contaminated environment. Yes. Okay, so then how else, where else do I find the fat? I find the fat in cheese. Cheese, yep. That's a new product. Animal product, animal product, yeah, yeah, yeah. Right. Butter? Butter, butter, yeah. What else? Cream cheese. Cream cheese. Any kind of dairy? Milk, yeah, dairy too. Okay, and I mean, some of this is permissible, but you really have to put a lid on it, right? Yeah. Well, there's none of it permissible. I mean. Can you live as a human being on this planet without any fat at all? That's actually really hard to do because even like a vegetarian diet, it's still gonna give you the amount of fat that you need. So people think that vegetarians don't get enough fat, but that's a huge misconception. You're getting it naturally occurring from the whole grains, the beans, the soy products, all of those things. So you rarely, rarely see a fatty, a fat deficiency. Okay, what about cholesterol? You mentioned that what is cholesterol and where do I find it? Just in case I wanna have a pure cholesterol diet, where do I find it? Oh, perfect, okay. So cholesterol is what builds up in your arteries, right? So that is only gonna be found in animal products. So that's one of the biggest reasons why we recommend that you avoid animal products as much as possible is because of that cholesterol component. So if I have no animal products, and that includes the meat, plus the cheese and all that stuff, then I won't have any cholesterol coming with my body, is that right? You won't have it coming into your body, but your body naturally makes all the cholesterol that it needs. So anything that you eat that has cholesterol in it is gonna be in excess of what you actually need. In excess of what your body is creating for you. So it goes beyond your normal systems and gives you too much. And one gram of cholesterol from any outside source is more than what you need in your body. That's really kind of a shake-up, isn't it? Cholesterol is not good for you, is it? I mean, there's the terms good cholesterol and bad cholesterol, right? But your body makes all the cholesterol good that you need. So if I came to you and I said, Michelle, Tom, I've heard far and wide about your skill, this area, would you ever recommend to that person to get on a cholesterol diet? No, never. More cholesterol. I would never say that today. Never. Okay, all right, what about salt? We've heard so much about salt and I wanna tell you, I'm gonna admit disclosure, I love salt, I'm sorry. I know a lot of people do. It gives it that kind of umami flavor to it, to the food that you eat. I almost feel it's healthy, I almost feel that. Oh, I don't know why you would feel that way, though. You see it actually. So, okay, salt is a good topic. So American Heart Association guidelines, 2,300 milligrams of salt per day. How much is that? So in a teaspoon of regular salt, table salt, you've already met that specific amount, right? If you're going to the grocery store and looking at food labels, an item can be termed low sodium if it's 140 milligrams of sodium per serving. So special kind of salt is what it is? No, no, no. It's not salt, it's sodium. I mean, salt, salt, yeah, yeah, yeah. It's low sodium salt, or does that mean just low salt? Low, okay, so if it says low sodium on a package, that means it's low salt. Okay. Yeah, yeah. So that means, I mean, I know the answer to this myself, but that means that there are products out there which have salt in them and you can't control them. So you can always look on that food label to see how much salt is actually in it, but that's why it's always good to cook your food as much as you can, because then you know exactly what's going into it, right? And you can control the amount of salt or herb spices. Or did I not, yeah. Right, yeah. Should I have zero salt, zero? Would you tell me, hey, find out, cut it out completely? It doesn't help you, it only hurts you, so don't do it. I mean, we encourage patients not to add salt to their food, because as you know, a teaspoon if that already contains your daily recommended amount, sprinkling it on on every meal that you have can easily add up, right? So we don't recommend that you add salt to your food. You're getting it from the packaged food items that you buy already. Yeah, so you don't need to sprinkle it on anything. Not really, no. But if you start with ingredients that have no salt in them and then you put a little on, that's okay. If you don't have that, like. See, the thing about Michelle is that she's kind of flexible too. It's not hard, hard white line rules. There's a humanity involved in this. I mean, I try to keep it real, Jay, I do. I would say it depends on your situation, right? So if you do have heart disease or you have congestive heart failure, something like that, I would say try to be as strict as you can and not add salt to your foods and choose low sodium options. But there is wiggle room for people that don't have many chronic diseases, right? So it just kind of depends on your health. On your health in general, yeah. But your health would be better if you didn't. I mean, even if you're healthy, it'd be better in the long term. I suppose you could take a kid like four years old, right? And teach him these things as a habit kind of thing. And he'd have a better life because then he'd be used to it from early on. Yeah, I mean, teach them just general healthy eating, having some of their favorite indulgences occasionally, but overall trying to raise them as healthy as possible so they have those tools. So I know, for example, that contemporary civilization is not taught in the schools of Hawaii. Probably not taught in the mainland either. And I know that don't do a lot with history. And music is not so interesting anymore and don't have time for it, right? And so forth. And you sort of get a skinny down kind of curriculum as against the things we might have studied a few years ago, which we felt were making us renaissance people and all. Do they teach this kind of stuff in the schools? Like nutrition and, so since I haven't gone through the actual programs yet, I can only go off of what I've heard from people that are already in it. I know a lot of med schools don't incorporate a significant amount of nutrition into their program. They do not. For, I know for the prerequisites that I'm taking, for a nurse practitioner school, I am required to take one nursing, or one nutrition course. So that's good. But as far as a lengthy amount of nutrition classes, I don't think that that's incorporated into a lot of programs out there. Yeah. Too bad. It is too bad. Because we want to be healthy and avoid issues around health insurance and what stuff. Right, yeah. We should learn this stuff early on and build it into our whole system, yeah. Exactly. So I want to talk about meat for a minute. That was when we were together in the Onish program, I was so impressed. I mean, that one lecture, you sort of changed my whole view of the whole universe of food. Okay. I know what you're talking about, Jay. Yeah, you remember that. I do, I do. Okay, so basically animal products have this amino acid in it called carnitine. Okay, so what? Can you spell it? C-A-R-N-I-T-I-N-E. Thank you, thank you. You're welcome. Sorry I am. Okay, so what happens is when you eat this, right, you're digesting the carnitine and your gut bacteria actually turn and metabolize that carnitine into this end product called T-M-A-O. And I know you're gonna ask me what that is. No, no, no, I'm not. Well, I can tell you, I can tell you. So this one is, it's thymethylamine N-oxide. Okay. And so we'll- I hope you're writing this down because it's gonna be in the final exam. Yes, I know. It's important that you know this and the final exam is very important. It's personal. Okay, sorry, Michelle. So what research has shown is that people with higher levels of T-M-A-O in their system actually have a two and a half times increased risk for having some kind of heart related event. Interesting, so you got real numbers that are real studies here which are undeniable. Right, right. So very clear. But you know, do we know all the side effects of this T-M? T-M-A-O. Yeah. Is it just heart disease? Is it more than circulatory? What about the biochemistry in general? If this is not native to us, is this creating problems in the circulatory system maybe it's somewhere else in our, you know, in our cellular structure that has another secondary effect? So I know what I've read is that this specific compound T-M-A-O increases the likelihood that the cholesterol is gonna stick to your arteries. So given that, that's why you have an increased risk for having a cardiac event. Yeah. Yeah. Okay, that's pretty scary actually. It is scary. And ever since you told me that, I mean, not that I was doing a lot, I was not doing a lot of meat. I had been one of your most, you know, zealous. Good. You know, I do slip little tuna fish once in a while but that's all. I should add, you fully understand what's going on. In the Ornish program, and Michelle was, you know, an essential part of that, they do vegan. Okay. Not vegan, not vegan though. Remember, because you have the non-fat dairy and then the egg whites. Okay. So, borderline. Borderline. Borderline vegan, yeah. So can you talk about vegan for a minute? What is it exactly? What are the exceptions? What are the surprises about being a vegan or not? Okay. And why in general, you think that's a good idea. So the difference between vegetarian and vegan is, vegan is exclusively plant-based products. So there is no, there's no eggs, there's no milk, there's none of that. Everything is plant-based. Whereas a vegetarian diet, they'll sometimes incorporate eggs and dairy products as well. So that's where that difference is. So with even milks and cheeses, even eggs. So eggs in the egg yolk, there's over 200 milligrams of cholesterol just in one yolk. Okay, so that's why... It's so bad it's almost a yolk. Yes, okay, yeah. You can use that. I will, I will, I will use that. But that's one of the reasons why sometimes people will avoid egg yolks and they'll still have the egg whites for the protein. But because of that high cholesterol component in the egg yolks, that's why people will avoid it. Yeah. That's okay. So there you go with all vegetables, a lot of salads, a lot of vegetables, a lot of fruits. What about fruits? Fruits have what do you call them? Fructose, they're loaded with fructose. We hadn't talked about sugar yet, not in any detail. So what about fructose as compared to sucrose as compared to all the coffee houses that have a big table full of sugar there, right? Okay, that is a good question. So fruits are, they naturally have naturally occurring sugars inside fruits, right? Fruits are really good because they have antioxidants, a lot of different vitamins, right? So that's why we recommend people do eat fruits. But we don't want people to go overboard in eating fruits because it still has sugar, no matter whether it's naturally occurring or added in. So that's why we limit that, right? So in coffee, oh, go ahead. I want to ask you ultimately about the effect of the worst kind of sugar, sucrose. Sucrose, yeah. Pure sugar, cane sugar, for example, what does that do to you? Does that create a TM, TMA, TO kind of thing? It doesn't create a TMAO thing, but just simple sugars in general, what it'll do is, especially for diabetics, it'll raise their blood sugar really quickly and then you'll see drops. So that's why, for instance, eating a whole fruit instead of fruit juices is because you're getting all of that additional fiber in it so you get a more balanced blood sugar level. It's not going up and down, up and down. I suppose you know when you're in a bucket list kind of approach that Dr. Cumsy is, you're done. You have three days to live. Oh no. Instead of, okay, bring me all the potato chips you can find, pile them high. I want potato chips, I want salt. I want cholesterol. I want animal products. I want filet mignon everywhere. And I want sucrose, piles of it. If you had three days to go, it wouldn't make a difference. You know, if the three days is set three days and that makes you happy and that's what you want, then I would say you get it, you get it. I have one last question. With all of this careful eating, you still have to moderate your portions, don't you? Oh yeah. Because you can follow every rule perfectly and still blow up from perfectly healthy foods. I mean, if you're eating more of a whole foods, especially like a vegetarian diet, it's actually really hard to blow up, right? There is issues if you eat too much, way too much fruits or drink way too much juices and things like that. But if you're eating more whole foods instead of packaged foods, it's very hard to blow up like that, right? Okay, that's comforting, comforting. That's Michelle, Tom. She's such an expert, you know? And it's wonderful to talk to her, sort of get real again because we often, you know, our food habits are based on habit and we don't think, we don't use our critical thinking skills in order to select those foods in the landmine food stores. And I mean, it's really important to make the connection and that's what Ornish was about between the one and the other and then try to build that into your daily life. And so you are really altruistic, helping people like that. Thanks, Jay. Yeah, do you follow these rules yourself? I try to do as much as possible. I believe that. Michelle, Tom, dietitian extraordinaire and altruistic at the same time. Thank you so much for coming down. Thank you, Jay. Oh, ha, ha, ha, ha, ha, ha.