Balancing Ideal Weight & Hypertension Control

Brenda Davis, RD

Oh, I’m great. I’m just so happy to be with you today, Dr. Marbas.

Laurie Marbas, MD, MBA

Oh, please call me Laurie. It’s an absolute delight to finally get to meet you, but it’s just to educate our audience about all of your experience specifically surrounding the quality of diet, which we can start with. Maybe you can share with us what the quality of a diet is—in particular, a plant-based diet versus a medium-omnivore diet. What are the differences, specifically around hypertension?

Brenda Davis, RD

It’s interesting when you look at the evidence on plant-based diets and various chronic diseases, including hypertension, cardiovascular disease, diabetes, and so on. The evidence is quite overwhelming that people who are eating healthy plant-based diets where whole foods predominate do remarkably well. On the other hand, people who are eating plant-based diets where highly processed plant foods predominate aren’t at any advantage over people eating an omnivorous diet. We need to just be conscious of that because when we say Italian or vegan, it can be a vegan diet, predominantly a vegan diet, or it can be a predominantly highly processed vegan diet. Those are very different where chronic disease and hypertension risk are concerned.

Laurie Marbas, MD, MBA

Because you describe what that is. What do you mean by healthy? Because that’s the important key here.

Brenda Davis, RD

Whole foods are generally whole foods. We’re talking about whole fruits and vegetables. We’re talking about whole grains. We’re talking about minimally processed, either unprocessed or minimally processed. So I would say grains are good examples because an intact grain like quinoa, berries, groats, or something like that has nothing harmful added and nothing healthful taken away. It takes the body some time to digest and absorb the nutrients in that food. It has a very, very low glycemic impact and a low impact on blood sugar. But even if you take that same whole grain and you roll it, grind it, flake it, or puff it, it’s a very different thing; even though it’s still whole grain, it’s more highly processed. In doing the processing well, we often add fat, sugar, and salt, and we make that food a lot less conducive to disease risk reduction. So even when it’s whole grain, of course, it’s even worse if it’s refined grain. The degree of processing of food makes such a difference because processing often means adding cheap fat, sugar, salt, additives, preservatives, and so forth. That’s the big difference.

Laurie Marbas, MD, MBA

Before we started our conversation, you mentioned an advantage study looking at the quality of diets between vegans, vegetarians, and omnivores that were healthy. Could you speak to that? I thought that was interesting.

Brenda Davis, RD

There are probably three main groups of individuals that we’ve been following for years and looking at. These groups of individuals are similar health-conscious individuals who eat different dietary patterns but exercise about the same amount, sleep about the same amount, and drink about the same amount. They smoke about the same amount. All of these potentially confounding variables are controlled for, and one of them is the Adventist Health Study 2 and others at Oxford. The third is the Taiwanese studies—the Taiwanese vegetarian studies in the Taiwanese health study. In all of these studies, we tend to see the lowest risk of disease among vegans and the highest among omnivores. That’s true for hypertension as well. In the Adventist Health Study 2, lacto-ovo vegetarians had a 55% lower risk of hypertension compared to similar health-conscious non-vegetarians, and vegans had a 75% lower risk. Just phenomenal. The results for Oxford were very similar as well.

Laurie Marbas, MD, MBA

That’s incredible. What do you think about these diets for the liver? They’re doing everything else—other lifestyles, things that we would be encouraging people to do, exercise, or whatever. What do you think it is about the vegans, so to speak, that makes them stand apart?

Brenda Davis, RD

So there are many reasons why they do better. Number one is that they have a lower BMI, and a lower BMI just means they have less body fat. In fact, in Adventist Health Study 2, the victims were the only dietary group that was within that healthy BMI range between 18.5 and 24.9. Other groups that are above-average eaters and overall vegetarians were above 24.9. Now in Oxford, all of the dietary groups were within the healthy BMI, but the vegans had the lowest BMI somewhere around 21, 22 compared to those, and even though they were within the healthy range, they were at the higher end of the healthy range in the other dietary categories.

Body weight is a big one, and sodium intake is also a big one. Of course, in Whole Foods, people eating healthy, less processed plant-based diets tend to have a fairly low sodium intake because 70–75% of the sodium in the diet comes from processed foods. When you are limiting or eliminating those, the dietary sodium is generally well within the CDRR, Chronic Disease Risk Reduction range. So that’s another thing: a lot of people are eating plant-based, are health-conscious, and use fewer highly processed foods. They would have less sodium intake. The other interesting thing is that potassium and magnesium are both pretty generally higher in plant-based diets, especially potassium. Those can both provide an advantage, and magnesium is at the center of the chlorophyll molecule in it. It’s concentrated in leafy greens and legumes, nuts and seeds, whole grains, and other high-fiber foods. Plant-based eaters tend to have reasonable intakes. Dietary magnesium also helps to lower blood pressure by promoting health. a healthy endothelial function, and there’s a dilation, so that’s important as well.

Then calcium. I would say generally that calcium helps prevent or treat hypertension. That’s one of the challenges for plant-based eaters: they tend to have a little bit lower calcium intake. However, they don’t need to, but we think they can fairly easily get calcium to where it needs to be. Then the other thing that provides a significant advantage is a higher intake of fiber. We certainly know that fiber is independent and reduces blood pressure as well. High fiber, of course, is found only in plant foods. It’s not present in animal products. People who are eating only plant foods, and people who are 100% plant-based, have the highest intakes of dietary fiber, and that is likely quite protective as well. The other thing is that we consume more naturally occurring nitrates from nitrate-rich vegetables. and they tend to help reduce inflammation and enhance nitric oxide production as well. That can also help lower blood pressure. The other thing that is worth mentioning is two other things.

One is vital nutrients, the polyphenols it compounds by estrogen, or getting all the organ sulfur compounds in the vegetable plant sterols. All of those are protective in terms of antioxidant, anti-inflammatory, vasodilation, and all of those things. Of course, phytonutrients are concentrated in colorful plant foods, trees, herbs, spices, and so forth. The last thing that is worth mentioning is that there are certain things that a plant-based diet would naturally consume less. for example, less saturated fat, fewer advanced glycation end products, and fewer of the precursors of TMAO, which is an assertion that compounds those, which has also been linked to hypertension. There are a lot of potentially problematic compounds, even if you think of some of the other compounds like heterocyclic amines and New Five GC, which is a very pro-inflammatory molecule. all of these things, when you eat plant-based, you’re minimizing grain takeoff.

Laurie Marbas, MD, MBA

That’s perfect. This is a wonderful segment to jump into. If you had someone who was presented to you and said, I’m willing to do this plant-based diet, how would you design an optimal whole-food plant-based diet for someone who maybe wants to prevent hypertension or who has hypertension?

Brenda Davis, RD

Number one is to make whole-plant foods the foundation of the diet. What you want is at least five servings of vegetables a day. I would say, ideally, at least three servings of leafy greens. When I say a serving, we’re talking about a cup of leafy greens or a half-cup of cooked or raw vegetables. You want the dark greens, if at all possible. Then I would say at least four servings of fruits. These are good sources of phytochemicals and potassium as well. Some of the optimal choices in this group are berries and citrus fruits. Tren I would say in terms of whole grains, you’re looking at probably about three grains or something that you vary your intake according to your energy requirements.

For people who are limiting calories to reduce body weight, to reach a healthy body weight, you may be eating only one or two servings a day. For people who are athletes, you may be burning three or four thousand calories a day. You might be eating 14 or 16 servings. It will vary depending on your energy needs. But the key here is to stick to intact grains as much as possible when you’re trying to reverse disease because intact grains have nothing harmful added. There’s no added sodium. There’s no reason that there’s no added fat, sugar, or any of that. Whereas if you take that whole grain and grind it, and then you make flour, crackers, cookies, or whatever the case may be, generally you’re adding, so you’re adding sugar, you’re adding fat, and so forth. When you increase the surface area of the grains, you’re also increasing their rate of absorption into the gastrointestinal system and their impact on blood glucose. You want to stick mostly to intact grains, and that doesn’t mean cut grains like steel, cut oats, bulgur, or whatever are fine as well. Grains are a reasonable choice, like rolled oats, but they get too much. But you want to stick mostly to those grains. then, as you go down looking at the flour products, you want to reduce your intake of those if you’re trying to reduce your disease risk.

Looking at plant-based protein choices, I would say you want to aim for about three servings a day, or more for some individuals. But one serving is half a cup of beans, lentils, split peas, tofu cafe, or a cup of raw sprouted lentils, a quarter cup of peanuts, and two tablespoons of peanut butter. So in this group, if you’re trying to have the greatest impact on blood pressure, you want to stick mainly to whole foods. beans, lentils, and split peas. Certainly, tofu is a very reasonable option as well. Tempeh is a great option, but the vegetarian meat substitutes are not that you should never consume these foods, but they are going to be higher in sodium. They are going to be higher in fat. Those are more optional foods than something that you would be eating daily. Of course, when you’re preparing the legumes and so on, you want to be conscious of the use of sodium, and then, I would say, a vital part of a healthy plant-based diet is also nuts and seeds.

These are our sources of central fatty acids, and they can be wonderful sources of some of the minerals, especially those that are a little more challenging to get enough of. so including nuts and seeds can be helpful. The other thing about nuts and seeds is that they contain, in my view, the healthiest sources of fats, and fats are necessary for the absorption of all of the fat-soluble nutrients in the diet. Whether it’s vitamin A, vitamin B, or vitamin E carotenoids, or things like vitamin D and vitamin E and these nutrients, but also all of the phytochemicals and antioxidants that are fat-soluble as well, they’re just a very important part of the diet. The other thing is that you want to generously anoint these foods with herbs and spices because these are concentrated sources of valuable antioxidants and phytochemicals.

The other thing I would say in terms of fine-tuning the diet is that you do want to make sure you’re meeting your nutrient requirements. You’re getting enough fiber, which isn’t an issue when you’re eating whole plant foods, but you do want to make sure nutrient needs are met. You’re going to get plenty of potassium, magnesium, and most of your B vitamins other than B12 and vitamin E. With all of these nutrients, we tend to be at an advantage in terms of many micronutrients compared to omnivores. But there are some nutrients that we will fall short on often if we’re not planning the diet well. Some of those nutrients include calcium, vitamin D, iron, zinc, iodine, and calcium. I mentioned B12, of course. So calcium is one of the nutrients we need to be aware of. One of the reasons people are so aware of calcium is because we’ve been trained from a very young age that dairy products are the source of calcium.

We don’t teach people about other sources. One of the things we can do is include some fortified nondairy milk or yogurt in the diet to help boost calcium intake. But grains that are low in oxalate, like broccoli, bok choy, kale, mustard greens, cabbage, and turnip greens, are excellent sources of calcium because the calcium in these greens is very absorbable, in contrast to spinach, beet greens, and Swiss chard, which are high in oxalate. We tend not to absorb much of the calcium that is present there. then tofu can be a great source of calcium, and then things like chia seeds, almonds, almond butter, and even some ligands like soybeans and white beans. Black beans are all good sources, too. The other thing that, of course, we need to mention is that sodium intake needs to be limited.

There’s no question; the evidence is pretty overwhelming that sodium is directly associated with increased blood pressure. So how much sodium? I would say it should be limited to not more than 1500 milligrams a day for people who are at risk for hypertension. But if you’re eating a Whole Foods plant-based diet and you’re not using a lot of processed foods, it’s pretty easy to fall into the range of 1500 milligrams of sodium. So the biggest way to reduce sodium is to minimize processed foods. They’re the biggest sources. That means canned and packaged foods. One of the things to do if you’re using canned foods is to look for low- or no-sodium options. Then, of course, you want to minimize your salt in cooking as well. Of course, many of our favorite seasonings, like tamari, soy sauce, and Braggs, are fairly high in sodium.

You want to just limit your use of those. And then the other thing is to be aware of restaurant food and eat at home more often. If you do eat out at a restaurant, just be conscious of not adding extra sodium. The sodium levels used in restaurant foods tend to be very high. then you want to limit added sugars as well. Not drinking sweetened beverages and using very little sugar at home, we want. I would say the limit should be 5% of calories, which is about two teaspoons or six teaspoons a day. 2000-calorie diet. There’ll be a lot of people who say, Oh, I’ve never used six teaspoons of sugar, but if you have fruit-flavored nondairy yogurt, you probably get double that in one serving. There are a lot of foods that you wouldn’t necessarily think have sugar that do. then you want to minimize added fat, especially solid fats. people that aren’t completely plant-based butter, margarine, or shortening, tropical oils like coconut oil, palm oil, and palm kernel oil. If you do use oil in your cooking, you want to keep the amount moderate, and you want to select mainly monounsaturated oils like extra virgin olive oil or avocado oil.

Then we also want to make sure we get a source of omega-3 fatty acids. So, alpha-linolenic acid, flax seeds, chia seeds, hemp seeds, and walnuts are all excellent sources. for people with hypertension, and the conversion of the alpha-linolenic acid into the more biologically active EPA and DHA is not very efficient. So for someone who already has hypertension, I would recommend including a direct source in the form of microalgae. I would probably look at at least three to 500 milligrams a day. You want a mix of BPA and DHEA, and those are the key things. For some people, you may also want to include a high-quality multivitamin, mineral supplements, or, at the very least, vitamin D and B12. Vitamin D is so important, and very few people get enough. So, looking at most experts, they will recommend 1000 to 2000. I use vitamin D, and then I make sure you have a source of iodine, B12, and B12. We’re looking at a thousand micrograms at least twice a week, which I would say is reasonable for most people. 

Laurie Marbas, MD, MBA

There were so many things you said I was in line with. But this is a great point, and I’d like to dive into the micronutrient stuff a little bit more and just speak to my experience with some of the things you said, which I agree with 100%. But I just want to share with everybody real quick. I want to thank you for joining us today, and I hope you found this part of our conversation insightful and engaging. If you’re a summit purchaser, stay here, because we’re about to dive even deeper into this captivating discussion. If you’re not, click on the button below or to the side to get access to the rest of the conversation. If you’re watching this, thank you for being a valuable member of our community. We are going to continue with Brenda. I want to talk a little bit about the potassium and sodium components of that. because higher potassium will help negate the sodium intake. Can you talk a little bit about things like how much magnesium, how much potassium, and how much calcium we should put in the water or the amounts? Because honestly, I get these questions all the time. They’re going through people’s heads as they’re listening.

Brenda Davis, RD

Let me see. I’m going to just pull up to make sure that I have it, and the RDA for potassium recently changed, so it used to be like 4500 milligrams, and now I’m just going to make sure I’ve got that, so it’s 2600 for women and 3400 for men.

Laurie Marbas, MD, MBA

They decrease. that’s interesting.

Brenda Davis, RD

They decreased it. It was darn near impossible for omnivores to meet that. It used to be 4500,  it was.  Now, it’s a little more manageable for people. A lot of vegans will be asking for that three, 4000, or even more range. But certainly, it’s not that easy for omnivores to get their muscle.

Laurie Marbas, MD, MBA

What about magnesium in calcium? Would you recommend it?

Brenda Davis, RD

Interestingly, calcium intakes are higher in North America than they are in many parts of the world. But I still would suggest meeting the RDA of a thousand milligrams for women to age 50 and for men to age 70, and then it’s 1200 for women 50 plus and men 70. Question: I would still recommend getting there. If you can’t get there with a Whole Foods plant-based diet, I would look at just adding in a little bit more of the fortified foods, like fortified nondairy milks, and using that in your smoothie instead of water. If that is rather than using calcium supplements, it’s better if you can do it with calcium-fortified foods.

Laurie Marbas, MD, MBA

100%. Then what about magnesium?

Brenda Davis, RD

Magnesium, again, is one of those nutrients that may be one of the nutrients that people are lacking more than just about any other nutrients. It does come up for people eating plant-based foods. But it’s more of an issue for people who aren’t eating plant-based foods because magnesium is concentrated in leafy greens, legumes, seeds, nuts, whole grains, and all of these high-fiber foods. So it’s one of the nutrients that plant-based eaters tend to do better with.

Laurie Marbas, MD, MBA

You spoke of Iodine. A lot of the iodine comes in, and iodized salt comes in. When I’ve had patients go on an S.O.S.-free diet or a salt-, oil-, and sugar-free diet, which is fine. What’s interesting is that if they neglect the iodine or where they live, they can make some difference. It depends on the person what they’re eating—if they like to eat or see vegetables or different things. But I have had a few cases of someone going plant-based. They come back with an elevated TSH, so their thyroid is off a bit, and we have to collect 24-hour urine iodine, and it’s low, so we put them on an iodine supplement, or we are very mindful of what’s trying to get some of these foods in. It resolves itself. Can you speak a little bit, either to the iodine or even the zinc? Because if someone is pushing nuts and seeds because they’re worried about the caloric density, can we speak a little bit about maybe some of those other micronutrients as well?

Brenda Davis, RD

I completely agree with you, Laurie. The iodine thing is that people who are 100% plant-based or vegan are at higher risk for iodine deficiency. That’s because some of the key sources of iodine in the diet are animal foods like fish, eggs, and so forth, and dairy milk. After all, we use iodine to clean the cows’ teats. So there’s some iodine in milk. So when you eliminate all of those foods, there are fewer sources. then when people go based and you mentioned people that go SOS, they often, if they, may eliminate salt or they may use these healthy salts that they, Celtic sea salt, Himalayan sea salt, or whatever of these more natural salts that don’t have very much iodine.

We also see this in the raw food community, where people can develop iodine deficiency because they tend to use more of the natural salt. Now, some of the most concentrated iodine sources on the planet are seaweeds. So, a 16th of a teaspoon of kelp powder provides 150 micrograms that an adult needs, and a half teaspoon of those or some of these other ones. But for the Nori sheets, you’d probably need one and a half or two sheets to get the 150 micrograms of an adult lead. You’re not going to O.D. on its own with NORI sheets quite as easily as you might with kelp. You have to be careful with kelp because, for a child, for example, the RBA may be between 90 and 120 micrograms.

They’re the upper limit for a fairly small child, with 200 and 300 for a little older child. So that is so easy to exceed if you’re using powder. But those are reasonable sources that could be included. If you like to eat Nori and then rolls and so on, then those are reasonable sources. Otherwise, you need to rely on iodine supplements, and this is so important during pregnancy and lactation because iodine deficiency is the number one cause of cognitive impairment globally in children and a preventable cognitive impairment. So we need that even a slight, mild deficiency in pregnancy can rob your child of 10 to 15 IQ points. This is something that we do need to be conscious of. And so, iodine yourself is a big deal. And then the other thing you mentioned was zinc.

Laurie Marbas, MD, MBA

Yes.

Brenda Davis, RD

Zinc. One of the things about zinc is that we can have adequate intake if we consume legumes, nuts, and seeds, which are also very good sources. But if we eat, especially on a diet that’s high in phytates. We can reduce absorption by about 50%. So even if our intake is the same as that of omnivores, our absorption may be significantly lower. Some mechanisms will help to compensate, improve the absorption, and all of that. But zinc is so important to growth and development in children that we need to be cautious there and make sure because children often like to eat a starch-based diet like pasta, they like bread, and they may not be as keen on beans, nut butter, and so forth. We do need to be conscious of making sure that those foods are plentiful in our diet. If we provide a multivitamin to a child, I would say finding one that improves zinc would probably be a reasonable idea. And then in adults, that’s iron, zinc, and protein. These foods are important sources of beans, lentils, chickpeas, tofu, and other foods, as well as nuts and seeds.

Laurie Marbas, MD, MBA

You mentioned phytates, so someone doesn’t quite understand what you mean by decreasing absorption. Could you just mention what that means and how?

Brenda Davis, RD

Phytates are the staunch form of phosphorus in plants, and they can have some protective qualities. They may be anti-cancer, they are anti-inflammatory, but they can reduce the absorption of iron and zinc, especially in and so there are a lot of things that we’re seeing this being problematic in countries, where they tend to eat predominantly flatbreads, which are a staple in the flatbreads, tend to be quite high in phytates or in diets where people are sprinkling wheat bran on their food. wheat bran is a very source of phytates.  We used to do this years ago. You’d sprinkle it on your cereal, you’d put it in your vegetables, and all sorts of things, and we shouldn’t be doing that. We get enough fiber. We don’t need to be sprinkling bran on our food, which is like a phytates bomb. And so there are lots of ways to reduce phytates. We can soak our beans and grains, sprout them, and leaven them. We think of breads rather than flatbreads; we can even cook them. Cooking will help to get rid of some of the phytates. There are just food processing techniques; even blending can help make the nutrients more bioavailable. All of these things can be helpful.

Laurie Marbas, MD, MBA

That’s awesome. What are your favorite sources of zinc in your diet?

Brenda Davis, RD

For me, it’s because I use a fair number of cashews. After all, cashews are quite high in zinc and pumpkin seeds as well. But I get that cashews are one of the most versatile of the nuts, and you can just make a pear cashew cream that replaces whipping cream. You can make a white sauce with a cashew base for a creamy sauce. Just as you can make cheesecake with cashews, they’re quite versatile, they’re quite high in zinc, and pumpkin seeds are amazing in terms of iron and zinc. I would say they are a go-to snack. Sprinkle them on your breakfast bowl, on your salads, and so forth.

Laurie Marbas, MD, MBA

Pumpkin seeds and cashews are the two staples in my pantry, just specifically for those reasons, too. But another thing I just want to touch on time, maybe a little bit outside of the hypertension thing, but you touch upon is iron, and I found it is such an important thing to be looking at because when I have women in particular, including men, but mostly women whose ferritin is low, so many times they’ll check just iron or iron saturation. It might be normal if their ferritin is below 50. I’ll point visitors. Maybe they complained about hair loss, restless leg syndrome, or just this. They can’t quite figure out the fatigue thing they were. We took ferritin, and we started working on the iron. Sometimes supplementation, because women, men, and men season up, is such an important thing to be paying attention to. It can dramatically change people’s quality of life, and they can’t quite figure out what’s going on. Could you say that you like higher and richer foods? Like, how can we have issues or options? Because I just think it’s important.

Brenda Davis, RD

The legumes are so critical, and some of these seeds are even more concentrated in some of these trace nutrients than nuts. They’re more concentrated in some of the central fatty acids as well. But in terms of iron absorption, we see reductions of 50 to 90% with high intake and high intake of some of the polyphenol compounds like tannins in tea. If you drink a cup of tea with your dinner, you could reduce iron absorption by 50 to 90%. so keeping tea separate from the meal is a very reasonable choice. and then, in terms of enhancing absorption, eating something with vitamin C with the meal. and we do this naturally when we’re eating plant-based foods; fruits and vegetables, of course, are the sources of vitamin C.

So including that if you’re having a bowl of oatmeal to have an orange with it or some strawberries on top or something like that. and then there are a few other interesting things. For example, allium vegetables like garlic and onions have carotenoids that can help with the absorption of iron as well. Organic acids in fruits and vegetables can help with iron absorption as well. So those are all helpful. then cooking in cast iron, some of that iron in the cast iron gets into the food, and you increase the iron concentration in the meal by doing that. Those are all things to be aware of. The other thing to be aware of, especially for people who are just beginning the transition towards a more plant-based diet, is that what people often do when they’re switching from a completely omnivorous to a more plant-based diet is swap out meat for dairy. So they’ll have pizza and macaroni and cheese, lasagna with cheese, or grilled cheese sandwiches—these kinds of things. Dairy products inhibit the absorption of iron. They’re very low in iron. When you replace meat with dairy, you’re replacing a high-iron food that is highly absorbable with a low-iron food that inhibits the absorption of iron. It’s a double whammy. So we need to be careful not to replace meat with dairy but rather replace meat with legumes. That’s the key to preventing iron deficiency.

Laurie Marbas, MD, MBA

If you’ve ever had a small child, your doctor is checking. Why are they taking these little ones for iron? Many times they’re consuming cow’s milk, which, as I’ve mentioned, can cause not only that but also some micro bleeding within the intestine. It’s an interesting conversation to have a slight decrease in your milk consumption because this is causing this issue. Like, exactly why would I be recommending it at all to begin with?

Brenda Davis, RD

In the first year of life, that’s why milk isn’t recommended at all because of its potential to form a hard curve and cause microbleeds. So that’s for young children; it’s important. A lot of people want to do everything all-natural, but iron deficiency in infancy and the toddler years can cause cognitive impairment and be a significant cause of delays for children. so we need to make sure that we’ve got reliable sources. One of the easiest ways to do that is to include an iron-fortified cereal because the RDA for an infant from seven to 12 months is 11 milligrams; it’s eight milligrams for an adult man. Good luck getting 11 milligrams in a seven to 12-month-old child with Whole Foods. It’s just not possible. Even for you, baby B, it’s 79 tablespoons. You’d have to feed a child to meet the RDA for 11 milligrams. And for lentils, it’s about 20 tablespoons. It’s better for lentils than it is for beef. But realistically, if you are trying to meet that RDA, it is a much easier thing to do if you’ve got some iron-fortified. If you’re opposed to that and you do a regular zero, you may need to use some iron drops at that stage.

Laurie Marbas, MD, MBA

I feel like there’s so much more we could talk about, but I will end it here. Thank you so much, Brenda. This was fabulous and one of the highlights of all the conversations I’ve had so far for the summit, and I appreciate your time today.

Brenda Davis, RD

It’s my privilege, and I’m so happy to meet you, Laurie. I look forward to our next interview. 

Laurie Marbas, MD, MBA

Thank you for listening.