#306: Dr. Regina Ragasa - This Obesity Doctor's 3 Weight Loss Rules That Actually Work
What happens when a doctor realizes that pills weren’t healing her patients—but plants were? You have the makings of a wonderful interview with triple board-certified physician Dr. Regina Ragasa
As a specialist in obesity and lifestyle medicine, Regina opens up about her transformation from a conventional doctor (aka - “drug dealer”) to a fierce advocate for whole food, plant-based nutrition.
You'll hear how a single conversation with a colleague sparked her interest in reversing chronic illness through diet—ultimately leading to a life-changing shift in how she practices medicine.
Dr. Ragasa breaks down her three core rules for sustainable weight loss and optimal health:
Remove all animal products
Eliminate ultra-processed foods
Cook without oil
Each rule is backed by science and real-life success stories—including the inspiring case of her “patient zero” who reversed diabetes without medication.
Rip and Dr. Regasa dive deep into the challenges and misconceptions surrounding obesity, GLP-1 medications, and food culture and, with honesty and hope, she urges us all to embrace food as medicine and rethink the way we define health and healing.
🌱 Key Topics Covered:
Regina’s transition from traditional medicine to plant-based healing
The story of “patient zero” and diabetes reversal
Why animal products and oils hinder sustainable weight loss
The truth about processed “health” foods
How to start your own plant-based journey, no matter where you're coming from
Triple board certified, Dr. Regina Ragasa
About Dr. Regina Ragasa
Dr. Regina Ragasa is triple board certified in Family, Lifestyle, and Obesity Medicine. She graduated from Nova Southeastern University in Fort Lauderdale, FL and completed her Family Medicine residency through the Wright Center GME, affiliated with Lutheran Medical Center in Brooklyn, NY. She came back to her stomping grounds in the San Fernando Valley to start her career with Kaiser Permanente. Frustrated with the worsening of her patients’ chronic conditions, she was inspired by a colleague, Dr. Lawenda to learn more about the benefits of Lifestyle Medicine and became certified in 2020.
Since then, she established three successful plant-based patient education series in English and Spanish and personally taught a course herself in both languages. Now serving as Chief of Obesity Medicine and Regional Co-Chair for the Lifestyle Medicine arm of Obesity Medicine, she is dedicated to empowering patients and colleagues with lifestyle-based health solutions.
Episode Resources
Dr. Ragasa’s Three Rules of Weight Loss Video
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Full Episode Transcription via AI Transcription Service
I'm Rip Esselstyn, and you're listening to the PLANTSTRONG Podcast.
What happens when a physician realizes healing is plant-based?
[0:05] What happens when a physician realizes that pills weren't healing their patients, but plants were? Well, you have the makings of a wonderful interview with triple board certified physician, Dr. Regina Ragasa, who is going to share her incredible journey from writing prescriptions to prescribing plants. That's coming up right after these words from PLANTSTRONG.
[0:36] I have some exciting news from the PLANTSTRONG events side of the business. We are proud to announce that PLANTSTRONG is now a platinum partner of the American College of Lifestyle Medicine. And this is a powerful step forward for us in our mission to reach as many people as possible, including healthcare providers, with the proven benefits of a whole food, plant-based lifestyle. And as part of this commitment, our upcoming November PLANTSTRONG Retreat is going to offer continuing education credits for licensed providers, giving them the chance to recharge both personally and professionally while learning how to apply nutrition as the most effective tool in the fight against chronic disease. And for those who can't join us in person, we have created the next best thing. I'm introducing our medically tailored pantry meal plan bundle. This is a full week of delicious done-for-you meals that, when paired with fresh produce from a simple grocery list, costs you less than $8 per meal. It's designed for people who've been told by their doctor, eat more plants, but they have no idea where to begin. We've already seen amazing results from people using this plan. And in many ways, it's like attending a PLANTSTRONG retreat from the comfort of your own kitchen.
[2:05] Just follow the plan and then experience how amazing it feels to fuel your day with real, satisfying meals made entirely from whole plant ingredients. To learn more, visit plantstrong.com and then click on the new meal plan bundle or send us an email at hello at plantstrong.com and we'll be happy to send you all the details right to your inbox.
[2:33] I want to welcome you back to the PLANTSTRONG Podcast, where we celebrate the power of plants and the everyday heroes who are transforming lives through food, through compassion, and through the science. Today's episode is one of those conversations that hits you right in the gut, but in the best possible way. I am thrilled to be joined by Dr. Regina Ragasa, a triple board certified physician who made a radical pivot in her career after realizing that pills weren't healing her patients, plants were. She's gone from feeling like a drug dealer in the clinic to becoming one of the most passionate voices for lifestyle and obesity medicine that's rooted in whole food, plant-based goodness.
[3:29] Regina doesn't just talk the talk, she walks it alongside her patients, empowering them to take charge of their health with her three foundational rules for weight loss. These simple tips are game changers and the success stories that she shares, including the reversal of diabetes without any meds, is super important for you to hear. We're going to go deep today into cultural food norms, the truth about GLP-1 drugs, and what it really takes to reclaim your health in a world that is rigged against you. So get ready to be inspired because what Dr. Regina is doing, it is the future of medicine.
Dr. Regina Ragasa's Journey
[4:20] Dr. Regina Ragasa, welcome to the PLANTSTRONG Podcast. Great to have you. Thank you for having me. I am so honored and psyched to be here today. I am so psyched to talk to you. But before we begin, tell me, Regina Regasa, it's got a great ring to it. Is Regasa your maiden name or is that the name that you took with your husband. It is. It's my maiden name. I won't lie. My husband was a little upset that I didn't take his name, but I'm going to have to blame a little bit of laziness on this. I was like, listen, we got married after I got my medical degree. So for me to even change my driver's license, I was like, I don't even want to do that. There's no way I'm going to change my medical license too. So I was like, all right, fine. If our kids can have our name, that's fine.
[5:16] We're a Hanenberg family I'm just, Yeah. Yeah. Nobody wants to spend a day at the driver's license offices trying to make that happen. I got other things to do. I'm looking for having a different name. No, it's a great alliteration. Regina Ragasa. Tell me, Regina Ragasa, what did you have for breakfast this morning? The Plant Strong audience loves to know what people eat and I want to know what you had for breakfast. Yeah. Uh, our staple at home is tofu scramble morning. We have tofu scramble and I've really been on a juicing kick. So, uh, I threw a bunch of greens into our juicer with an apple and a pear, um, some carrots, beets. Um, and I, I had that for breakfast. That's, that's, it's pretty typical breakfast for me. And you in your family is comprised of how many people? Well, got the hubby and I got two little girls, three and six years old. And what are the three and six year olds think of the whole food plant-based lifestyle? That's all they know.
[6:28] Yeah. I've been raising them plant-based since they've been born. So that's all I know. We call tofu scramble. We call them feggs at home. Wait, wait, wait. I didn't hear that. You call it what? we call them feggs. They're feggs. F-E-G-G-S. That's adorable. Yeah. So the kids, if we're asking them what they want for breakfast, sometimes they'll say, oh, we want feggs. And we're like, okay. And we know what that means. Not everyone else, maybe my husband's family or my family, my own other family, my parents, they may not love the feggs themselves, but in our house, it's fine. Prior to going plant-based, I was an egg fiend. I would have like eggs every morning and I just loved eggs and everything, which explained my cholesterol levels at the time. But yeah. And so I, sometimes I just want something savory in the morning and the eggs just do it for me.
A Day in the Life of a Plant-Based Doctor
[7:22] Wonderful. Well, so you are, let's, let's dive into like what you do kind of on a daily basis. You're the chief of obesity medicine for Kaiser Permanente Panorama City. Is that kind of outside LA, in LA? So, you know, it's the Valley, basically. When you think of the Valley in LA, it is, you know, from Clueless when she gets lost in the Valley where we're there, the San Fernando Valley. We represent that area. So that's Pan City. Okay. Okay.
[7:58] Wonderful. And so did you, when did you know that you wanted to be a doctor? Oh man.
[8:05] You know, I don't, I don't know that I had a specific moment in my life. I knew that as a kid, it was just kind of this really interesting allure to me. And I was like, oh, wow, you get to help people. That's cool. And I was like, I have a knack for science. This is cool. This is a good combination. And I think as I got older, I was like, oh, wow, how, how wonderful would it be to help people around me and help them have better lives. So I think in high school is when it really got solidified for me. And I was like, okay, I'm going to really get my ducks in a row when it comes to college and all that stuff. So yeah, down the path I went. Originally, I wanted to be a pediatrician, which as you interview other doctors, I'm sure you've heard them say, well, I wanted to be this and this and that. Eventually, I wanted to be an OBGYN. Well, that didn't quite pan out for me and ended up in family medicine. And I have to say, I'm so, so grateful that that had happened because I don't think I'd be on the path that I am today had I not landed in family medicine. So.
The Shift to Lifestyle Medicine
[9:08] And you obviously are a huge fan of the whole food plant-based lifestyle. You became, you know, certified in lifestyle medicine in 2020. Tell me what led to that decision. Oh, yes. To be completely honest, two years into practicing medicine, I felt like I was a drug dealer.
[9:34] And I was just like, why did I become a doctor? I thought I became a doctor to help people get healthier.
[9:41] And, you know, being in primary care, you see a lot of diabetes. You see a lot of cholesterol issues, high blood pressure. And as a physician, what we're taught in medical school, you're taught how to prescribe these medicines to help control these chronic conditions. So our patients would come in they'd be stable for a little while and then six months later maybe they got a little bit worse so i'm adding more medications so that's why i felt like a drug deal i was like none of my patients are actually getting better and i seriously questioned my career path i was like oh my god if i don't if i don't continue being a doctor what am i going to do and so anyway um one of my colleagues dr stephen lawenda who's a fantastic family physician out in Antelope Valley, he gave a lecture to all of our physicians in Panorama City. And he gave this fantastic lecture on how he was reversing diabetes in his patients and helping this woman who was, you know, an oxygen in a wheelchair, unable to enjoy her life. And after adopting a whole food plant-based diet, she was singing karaoke and dancing and sends him a video. And I was like, what is this voodoo that's going on here? And he got me really curious about it. And I was like, is this true? And if it's true, why don't we learn about a medical school? But I got curious. I was like, there's got to be some truth to this. And honestly, I'm tired of prescribing medications. And maybe this is the answer.
[11:07] So I did a deep dive into lifestyle medicine and started reading more. I think the first book that I read, honestly, was um, how not to die. And I was like, Oh my gosh. And you know, most of the books, um, they have all these references, so I can go back into the papers and reference them myself and read them. And I was like, wow, this is really incredible. Um, and again, I still had doubts as I was learning more about lifestyle medicine. And before I became even certified, I had this one patient. Um, I hope you don't mind that we're going to go into this story zero. Um, If you're not familiar with A1Cs for the audience, so A1C is what we use as doctors to determine what your blood sugar is like over a three-month span. It's an average. And what we consider normal is 5.6 and below. Anything over 6.5 and above is considered diabetes. And this patient of mine, she had had diabetes for several years now. Her A1C was 8.5, and she was on a whole slew of medications. She was on metformin for tablets a day, gliposide for tablets a day, and then insulin 60 units a day.
[12:20] And, you know, she comes in. I'm like, listen, your A1C is not really well controlled. I think we need to increase your medications because this is what we're taught in medical school. We need to increase medications. And if you ask any doctor, they would say the same thing. They're like, increase your insulin. And so I offer that to her. And she says, no way. You're not going to do that to me. And I'm thinking to myself, oh, my God, this is going to be malpractice. I'm going to give her more medicine. And she's like, there's got to be something else. And so this was the first time I was almost challenged to dive into someone's lifestyle. And I said, OK, fine. Well, what do you eat? And she's like, well, I start my morning with breakfast and I have myself a nice bowl of oatmeal, maybe some fruit. And I'm like, OK, that doesn't sound bad. And then for lunch, I'll have a salad with a little piece of chicken. Same thing for dinner, but maybe fish. And then if she gets hungry and I'm like looking for the breads and the cookies, you know, I'm looking for all that stuff. And I'm like if you get hungry in between what you eat and she's like oh I have like maybe a yogurt or a piece of cheese and you know to any doctor hearing that diet they're like wow you just really got bad genes you know you're doing everything you can so I dive a little bit deeper and I'm like okay I bet she's not exercising and then she's like I do 45 minutes of cardio every day and I was like oh my god she's doing everything but in the back of my head I've learned about the plant-based diet.
[13:40] And I've received some reassurance from my colleague, Dr. Lawenda, about counseling on this. And I was like, oh God, I don't know. I don't know. I don't know. And this woman's very resistant to starting medications. And I said, listen, I just learned this thing. It's called a plant-based diet. I don't know if it works, but if you want to try something, you can do it for a month. And if in a month your sugars don't get better, we are going to have to add insulin. She's like, deal. I obviously take my diabetes very seriously, which is why I don't have those cookies and treats and all those other things. No problem. I said, okay, so continue to eat what you're going to eat. You're going to have your oatmeal, have your salads, but instead of having, you know, the chicken or fish, your protein source is going to be beans. And when you get hungry, you're going to have a piece of fruit, maybe a handful of nuts. She's like, no problem. I'm like, okay, we'll see what happens. So anyway, I call up, I have an appointment with her a month later and I get her A1C done and it drops from 7.5, excuse me, from 8.5 down to 7.5. And if they don't want to. And I asked her about her medications and she says within one week of going plant-based, I stopped all of my insulin because I was having so many lows. So she went from 60 units to zero in one week. And by the time I was talking to her on the phone, she had stopped all of her oral medications for diabetes.
[14:54] And technically 7.5 is still not controlled for diabetes. So what I do with my patients is I check them monthly until they get controlled. And so I checked her a month later and she got down to 6.9 with zero medications. And I was like, wow, this stuff really works. This is, I can't hold this back anymore. I need to tell the world about this.
Patient Zero: The Power of Food
[15:15] So she was my patient zero and I love her story because she's truly inspirational. Aside from getting her A1C down and getting her diabetes under control, she lost 30 pounds. You know, she was just really enjoying life. And I was like, wow, it really shows how powerful food can be. And how, obviously, like, I don't know why we don't think about how close our health is intimately, you know, intertwined with food. It's like, how do we not think about that? No, it really is. It is a huge miss. And I just can't believe it's a miss just to begin with, right? It's crazy. Tell me this. So you said her A1C was 8.5. What's the highest A1C you've ever seen in a patient? I think in my career I've seen, I've heard of others, but personally I've seen, I think 12, 12.8 maybe.
[16:12] Yeah. Yeah. I have a story for that one too. She was new to me and never had, hadn't had a checkup in a long time. So she had that A1C of 12.0 or 12.8, I can't remember. And same thing comes in, I'm like interviewing her, find out that she has like a quesadilla for breakfast and like maybe a salad for dinner um but she does admit to loving sweets and same thing i offer medications and she's like no and i was like oh my god malpractice.
[16:38] And i'm like listen other doctors seeing you they're going to start you on insulin i just wanted to give you pills and she's like no and i was like okay fine teach her the same thing a month later she literally a month later i think she drops to like six or something like that i can't remember the numbers off the top of my head it's just incredible it's really incredible um And those are just two stories, but everyone who takes that leap of faith and, you know, decides, you know what, I've tried everything, but I haven't tried this. They all pretty much benefit from this. Yeah.
The Three Rules for Weight Loss
[17:06] Well, it sounds like you're really doing a deep dive into obesity and weight loss. And in fact, I watched your presentation on the three rules for weight loss and maintenance. Yes. And so today... Because it seems like weight loss is just such the huge topic with, you know, Ozempic and the GLP-1s and all that stuff. I'd love, if you're cool with it, I'd love to actually talk about your three rules for weight loss maintenance and then have you share some of your success stories. And then I'll ask you a bunch of questions throughout. Yeah, sure. So let me kick it off. So your number one rule for weight loss success is no animal products. So explain to me why. Yeah.
[18:02] So in terms of weight loss and the presentation that you saw, I've added a new slide since. And I wanted to understand why my patients were losing a lot of weight once they switched their proteins over to more of the beans and the lentils. And it was a very simple and clear answer. And basically, if you're looking at a normal serving size of meat, a normal serving size of meat is three ounces. And a lot of people eat way beyond three ounces in one sitting, right? That's about half the size of your palm. Yeah, yeah.
[18:34] And, you know, I built a little protein hierarchy. So basically, at the very bottom is pork. In three ounces of pork, it's about 200 calories and about 54% of that is fat. And I was like, oh, that's pretty high fat. So it makes sense to eliminate pork. And then people are trying to eat leaner meats right so leaner meats would include maybe lean beef but even if you look at lean beef I went on to nutrition x to find this information and in three ounces of lean beef it's still 49% fat so still 50% fat and I think if you were to buy any product on the market that was 50% fat you would not call it lean by any chance like right so those are definitely my bottom two and i can see that why people when they start limiting red meats um and you know work and things like that in general they tend to lose weight because they tend to have less fat as you move up the hierarchy chart um you have uh chicken and fish so chicken is about 150 calories for three ounces and it's about 19 fat so significantly lower in fat compared to the red meats.
[19:41] Fish, also 19% fat, maybe 109 calories. So getting lower in calories, technically, you can probably have the same amount of, or twice the amount of fish for the same amount of beef in terms of calories. So again, as you move up this hierarchy, people tend to lose weight. The one protein that everyone's always missing when they come to this type of counseling is beans. And beans is only 3% fat versus the 19% of the chicken and fish. So when I look at this entire protein hierarchy, I'm like, listen, chicken is better than that red meat, but it's mediocre. It's mediocre. And that's why you're getting mediocre results. And do you know, and do you know, I'm going to jump in and ask you a question. Do you know?
[20:21] Because I like where you're going with all this, especially with three ounces of pork, red meat, chicken, the beans, three ounces of beans is roughly how many calories? Do you know? Is it like. It's about 100. Yeah. 98 or something like that. Right. Okay. So it's. Okay. Perfect. Yep. Yeah. So I have that slide. Eventually, I think I'll make another video on that.
[20:46] But yeah. So and not only that, you know, I think beans have two superpowers. It's low fat. So what so I always tell my patients, listen, I want you to focus on high quality proteins and high quality proteins is not what you think. It's not the chicken. It's not the fish. It's focusing on proteins that are low fat, high fiber. And, you know, the animal products, unfortunately, don't have fiber that plants do. And the beautiful thing about consuming beans is there's the soluble fiber and insoluble fiber. And just to get a little geeky, the insoluble fiber is kind of like a loofah that you use on your intestines, just kind of cleans you out real nice. And then the insoluble fiber produces what we call short chain fatty acids, which produces a lot of really anti-inflammatory effect. So you're having a much healthier gut. And overall, if you're having all this anti-inflammation in your body, so less inflammation in your body, you're going to start feeling it. And I have patients that, you know, even their husbands, when they start losing the weight, They're like, wow, your face just looks less puffy. Like, not to sound bad, but it's like a good thing, you know? So if we were to break it down in science parts and just help people understand why I push that and why my patients have so much success in transitioning their proteins, I think that's the easiest way to understand it is that it's very, very low in fat and high fiber. Well, I really like the way you...
[22:10] The way you term, you use the term, you're looking for a high quality protein and animal products don't fall into that category because they're not low fat and they're not high in fiber. So they get a big, a big, basically X across both those. So love the, the no animal products. Yeah. And then who wants to be riddled too, with all the other gifts that they bring? Oh yeah. And I can go into so much more. Why not the animal products, but if we were to break it down into like the most simple, basic things. That's it. You know, great. I love it. Um, you know, another thing that I heard you say in your presentation is that just three ounces of red meat has 11 grams of saturated fat. That's like crazy. And we as human beings, we don't need saturated fat. We don't want saturated fat. Exactly. Yeah. There's a reason why it doesn't really exist in the plant kingdom. It does in a few different products, but overall it's incredibly low. We don't need it. Yeah. It is. It is quite remarkable. I mean, outside of, you know, nuts and seeds and coconuts, it's really kind of not there. Yeah.
[23:25] Which makes it really great. You know, I'll let you go into the other rules and we can.
Defining Processed Foods
[23:31] So, yeah. So your, your second rule is no processed foods in your opinion what are processed foods and what should we be staying away from for maximum weight loss yeah so that's a great question um, I've updated that slide a little bit more to really specify, because I've had questions about this, that what I really meant was I want you to stay from ultra-processed foods, right? Because if we're talking about not-processed foods, you're literally taking it from the ground and putting it in your mouth. As soon as you put a knife to it, it's technically processed, but that's a little ridiculous, right?
[24:08] So what I say is you want to stick with whole foods as much as possible. And my rule for patients and for them to figure out whether or not it's processed is can you find it find it out in nature like that right so if you're going to find a bean that's probably looking like a meme you can recognize it you know avocado looks like right we all know that technically oreos are plant-based but there's no such thing as an oreo tree but if there is if you guys love one you know so it was obviously plant products that were highly manipulated by human beings turned into something else. Not to say that like Oreos are off limits forever. It's just not exactly a health food. And if we're trying to get healthier, we should be eating more healthful foods. So yeah, rule number one, try to avoid animal products, avoid anything that had eyeballs or came from something with eyeballs. And then rule number two is try to eat food that looked like it grew from the ground. So avoid anything that came from anything that had eyeballs, meaning dairy products. I would assume you mean by that. Yeah this is when i start losing friends when i start.
[25:17] Yeah yeah well you have to ask ask yourself then were they really your friend i don't know, i could um i i had that attachment to eggs for a really long time so i know I crush people when I tell them no eggs. But yeah. In your opinion, what is the most, ultra processed foods that maybe you you see or hear about your patients consuming that you love this question oh it's so good protein shakes.
[25:59] They're sold aren't they i'm sorry there's a rage yeah yeah it's it i mean obviously we live in a protein obsessed country. So that's all we're talking about. But it's, you know, every time, it's the one thing that like, I just kind of irks me a little bit when patients are like, listen, I'm trying to eat healthier. So for breakfast, I have a protein shake. And I'm like, not real food. There's no protein shake tree. It's like, incredibly processed. And it's sold as a health food. You know, you're literally just taking just the protein from milk, and then you're sticking it into this other stuff with like maybe fake sugars and mixing it with water and selling it as something that's supposed to be this amazing food that's supposed to help you with weight loss. What it really does is maybe some patients do lose weight with it. I'm not here to knock it, but it teaches patients to be reliant on those foods. What if one day nobody could make these protein shakes anymore you'd be lost right so it's it's really again just trying to dive deep into more foods that look real you know and it's funny you bring that up though because sorry.
[27:19] My kids apparently were going to my parents house and we have some guests over right now and you know there's cookies around there the grandparents like that stuff it's fine but my kids are now asking they're like is that food real and they're like what do you mean by that. Of course it's real. And they're like, mommy doesn't say it's real.
[27:39] Yeah. Well, so what do they think about what you're doing, Regina? You know, they're learning. I think my six-year-old is curious. Of course, her taste buds still loves the candy. And so they'll still ask for treats and we're trying to wean them off of that. But they do appreciate eating healthy foods. And when they have that orange or they have that apple, they like to confirm that they're having a healthy treat. What about what about your your parents and your husband's parents yeah um you know they've come a really long way i'm really proud of them um i'm half filipino and half thai my father's from the philippines my mother's from thailand and uh growing up in america as you know we're pretty meat heavy and um for me to introduce the concept of plant-based eating was not totally foreign to my mother in Thailand, they eat a lot of fresh fruits and vegetables. Um, but as an American Filipino, it can be very intimidating because, um, I think I'd like to draw it back to the cultures. Um, in the Philippines, if you grew up really poor, you know, meat was not really on your plate that often. So when you come to the country, you come to America and you've made it, it's almost like a sign of success that you're providing for your family that you're able to provide them meat on their plate every single day.
[29:04] And so I would slowly introduce little pamphlets here and there to my mom and dad and benefits.
[29:12] And now I'd say that they're mostly plant-based. I'm really, really grateful that they respect our decision to be plant-based. So whenever I eat at my mom's place, she always makes a tofu dish for us. Yeah, it's wonderful. And she is a fantastic cook she's fooled people at a party so um at a filipino party so at a filipino party there's tons of meat usually and my mother made this uh a peanut stew that is typically made with like intestines and like other meats um but she did it with all plant products and i was like oh my god and she fooled everybody everybody's like wait that's vegan what are you talking about, hopefully plant products without the intestines yes exactly yeah so it's really interesting i mean and and it's not incredibly processed either she used seitan um there are ways that seitan can be cooked to make kind of give a chewy consistency that people might want in that kind of i know it sounds weird to say that you eat intestines but it's common in the culture Um, yeah, she did fantastic on that love say tan. I think they refer to it as the Buddhist meat, uh, say tan, but it is, it's really good. Um, I just want to get back to the protein shake that you mentioned. And the thing about these protein shakes is most of them are just made out of, you know, concentrates and isolates.
[30:35] And we know that that has a tendency to also drive up our IGF-1 insulin-like growth factor, which is a, you know, tumor and cancer promoter. So yeah, for a number of reasons, I think, you know, these protein shakes are a miss, another miss. Yeah, yeah. Yeah. I think it was Campbell, right? That did that study with the casein high protein is low protein. Yeah.
[31:05] That's always in the back of my head. And so when people say that, I just kind of sit there and smile a little bit because I'm trying to convince people to just take a step in the right direction. So I don't always tell them all of that stuff up front and I'm not trying to withhold information. I just don't want to bombard them with so much that they're like, oh my God, I'm doing everything wrong. And for some people that works for them. I don't really believe in scare tactics and things like that. So I try to come at it other ways that is more relatable to the patient. Oftentimes, I'll try to dive deep into where their family comes from and I'll try to draw, I'll try to have them think about what their great, great grandmother ate and they'll think back and they'll oftentimes tell me, you know, cause we, in, in LA, we have a huge Latin population, um, Latinx population. So, you know, some of them are from Mexico and they'll say, yeah, you're right. My grandma, like she didn't have money. So she was eating rice, beans, and like nopales, like lots of veggies. And I'm like, yeah. And when was she killing that chicken? And it's like, well, you know, when her brother came to town, so we were celebrating the presence of her brother.
[32:17] Maybe they're killing a pig for like a quinceanera. And I think when you're able to kind of frame it that way, they're like, you're right, this wasn't part of our culture. And if you think about how long your grandmother lived, she lived into like 95 with no medications, you know, and here we are at the age of 50 on five plus more medications.
Cultural Perspectives on Plant-Based Eating
[32:34] So my goal, and when I frame it that way for my patients, I feel like they can see it a little bit more. And it doesn't seem like such a foreign concept to them because it's actually embracing their Well, I love a couple of things about what you just said. First, I think it's really smart for you to meet, meet your patients where they are.
[32:52] That like full stop. And then I love the fact that you as a physician, you're walking the walk, right? You're talking the talk, you're representing. And so how much more credibility does that then give this lifestyle when you suggest it to them? They're like, oh, well, if my doctor's doing it and she says, it's, you know, going to cure what ails me, then I should give it a try as opposed to the doctor that says.
[33:18] Yeah, there's this plant-based thing, but nobody does it you can't do it instead just take this take these pills yeah yeah yeah i mean it was really if you go into the wise you know i'm sure you go into the wise a lot with your um people um and i always love diving into the wise because it's evolved for me over time uh initially i wanted to be that i didn't want to be a hypocritical doctor so i didn't want to tell people to eat beans and have steak for dinner um that was not a strong enough why for me i thought it was for health reasons um but i think as you go more and more into the plant-based world you find about the environmental impact i have two little girls i would love them to enjoy mother earth um and again the deeper and deeper you go into it um eventually it also became uh for ethical reasons um and we'll write that so um you know i think we all strive to be our best um and like you said i always try to meet patients where they're at so if i can get them mostly plant-based I think we can have the best of both worlds without taking away too much of the things that they do love. Yeah. Um.
[34:24] I want to zero in on a word you just said there. You said, get my patients mostly plant-based. What is your philosophy when it comes to 80%, 90%, 100%? Talk to me. It's a good question. So when I first learned about plant-based eating, I was teaching patients, you got to be 100%. You got to be 100%. And when I started teaching that way, it just seemed impossible for my patients to even handle. And they're all like, you're kidding me. I'm, you know what? I can't be a hundred percent. I'm not going to do it. Like if there's no reason.
[35:01] So one of my patients who had a fantastic weight loss journey, um, who was actually highlighted in that, um, video that you watched, um, was that wonder woman or super lady? It was wonder woman. Yes. Yeah. So wonder woman, um, I w she was, I was her primary care doctor. At the time, so family medicine doc, seeing her for other issues.
[35:23] And I can't remember if I actually talked to her about her weight or not. She was 4'11", 259 pounds.
[35:29] And of course, I was teaching her plant-based for other reasons, for her cholesterol and whatever else. But I knew that that was going to also help out with her weight. She didn't really like my advice and went on her merry way. Nothing really changed, dropped a couple pounds. Eventually, she's like, you know, I'm tired of my weight. So she starts calorie counting, 1,500 calories. And then she drops 30 pounds in a year. Beautiful. And then a year after that, I see she drops 94 pounds and I'm like, Oh my God, what did she do? So I call her up and I'm like, Hey, I saw you dropped weight. Are you, are you okay? What did you do? And she's like, you know, I finally took your advice. I went plant-based, But and she almost apologetically said, you know what, I don't do it 100% of the time. I do it 90% of the time that once or twice a week, I get to go out with my friends and my family, have a little bit of chicken, fish, enjoy these events with them. And the rest of the time, I'm sticking with my beans. And that's when it dawned on me. I was like, you don't have to be 100%. I can choose to be 100% for other reasons.
The Importance of Flexibility in Diet
[36:25] But if people are doing it for weight loss reasons, other health reasons, where I really see the most success with my patients is the 80 90 right around there anything less than that not that great you know um some people can get away with 70 plant-based and still be really have good results um but i like i like to think about it as if you were taking an exam yeah you know if you're in school and you scored 50 on your math test you're not passing.
[36:56] So you're not going to see the results and i have patients who are really frustrated they're like i've really changed i'm plant-based two days a week and i'm like yeah not exactly passing and you know if you want to be successful i want a's and b's and that's where i get my 80 90 percent, so you know if they choose for again for other reasons ethical environmental reasons that they want to be 100 more power to them um but in terms of health this is kind of where i see that and i a lot of people too are like oh you're strict this and that i'm like it's actually a mediterranean diet is what I teach. I just have to put it under the disguise of plant-based because when I say Mediterranean, I've had people come into my clinic, say I eat a Mediterranean diet. And when I interview them, they tell me they have shish kabobs every day. And I'm like, that is not a Mediterranean diet.
[37:43] Well, I have a couple of comments based upon everything you just said there. One, I have found that most people, when they say they're doing it 80 or 90%, they're actually doing it more like 60, 70%. They just think that they're doing it a lot better than they actually are. And some people that think they're doing it a hundred percent, unless you're actually looking at what they're eating and they're keeping a food log or food journal, they need all kinds of course corrections and help identifying, you know, that Amy's frozen burrito didn't grow on a tree and it is about 60% fat. So, and it's loaded with oils and all that other stuff. And then the other thing I'll say is I, I think people need to, you need to know yourself and your personality. And if you do well all in then fabulous, but I've just seen too many people since I started doing this and, and helping people in 2010, that if they have That one piece of pepperoni cheese pizza, they backslide like nobody's business. That one donut, that fried chicken. So you got to know yourself too.
[38:59] I love that you brought that up because I tell my patients the exact same advice. Yeah. When my husband and I were transitioning to plant-based, I think what really did it for me was the game changers. I had seen Forks Over Knives. I introduced that to my husband. And after that movie, he was like, okay, let's do it. And I was like, okay, great. And I was the one who wanted to be 90%. And he was like, no, we can't do 90%. And I said, well, why?
[39:24] I'm like, this is a transition phase. I want to be 90%. And and he said exactly what you said it's a slippery slope for him and he knows himself well enough to recognize that so he needed a really clear line in the sand to say not doing this because as soon as you have as soon as he had that chicken he would probably continue to make more exceptions so you brought up a really good point that i do bring up with my patients and i'm like listen you know yourself best and you have to be honest with yourself weird all on the spectrum yeah all right let's talk you let's talk about your third rule for weight loss yeah and so the first one is no animal products so nothing that has eyeballs or comes from something that had eyeballs love that no processed foods so it's gotta have come from a tree or a bush or the ground something like that i like that
Cooking Without Oil
[40:17] and then your third one oh i am so on board with this one. You say, you say no cooking with oil. I'd love to know what that means. And does that also include like adding olive oil to your dressing? Cause you're not cooking with it, but you're putting it on your salad. So. Yeah, that's a good point. Okay. So by the, by the time most patients get to me, cause like you said, I'm a weight loss specialist, so I'm getting kind of the most severe cases, right? So they're the ones who need the most help. And these are not people who can kind of get away with a little bit.
[40:51] So with the no cooking of oil, the reason why that is one of my rules is because it's incredibly calorie dense. And, you know, if you look at Jeff Novick's calorie density chart, you have your whole food plant based stuff all the way at the bottom with very, very low calories and highest calories. You know, it's oil and fats in general, about 4000 calories per pound.
[41:14] So when i and people come back at me they're like but what about olive oil isn't that okay and i'm like no it's still 4 000 calories per pound does anybody here go to the grocery store buy themselves a bottle of olive oil and just can't wait to get home and pour themselves a glass no it doesn't add any flavor to our food and so usually when i say that they kind of chuckle a little bit they're like, okay, but you're still crazy, Dr. Ragasa.
[41:40] And so I had this one patient, I introduced my three rules to her. She was like, I'm not ready to give up my meat yet. And that's fine. And then she's like, okay, no ultra processed foods. I already kind of don't eat junk food. So it's fine. And she's like, she got curious about the third one. She's like, what if I cut out oil? Like she had said, he got rid of all the oil in her house, got rid of butter. Obviously she got rid of processed foods because processed foods can have a lot of added oils as well. And in six weeks, she lost 20 pounds from just putting out extra fats in her diet, including salad dressing. Same reason, just empty calories that you're pouring on top. So I think that if you're looking for ultimate weight loss, um, achievements. I think this is the best way to go is to eliminate oils as much as possible. You, you, you said she lost how much weight over what period of time? Oh, um, she lost about 20 pounds in six weeks.
[42:45] Yeah. Yeah. Isn't that interesting? I mean, you know, everything that I've kind of read is that your average American consumes somewhere in the neighborhood of without knowing it three to four table i'm sorry three to four um tablespoons yes of of oil a day whether it's in you know their packaged goods or they're putting it on their salad dressing or their stir fry or dipping their bread in it or or some people even do shots of it which is incredible yeah but but think about it i mean you know at 120 calories a tablespoon spoon, if you're doing four, that's over 500 calories. That's almost 25% of the RDA a day. And, And how many calories are in a pound? Is it 3,500 that I think? Yeah. I mean, if you're getting like really nitty gritty, I just throw an overall 4,000 at there. Yeah. But so losing 20 pounds in six weeks just by cutting out the oil, that's phenomenal. That's great. She actually started freaking out a little bit. She's like, is this safe? And I'm like, do you feel okay? And she's like, I do. And I'm like, then you're fine.
[43:56] Um i actually wanted to add one more visual to that if you don't mind so you're saying the average american which i did not know uh consumes about three to four tablespoons per day of fats or oils in general okay that's added oils either it's either in in their packaged foods their salad dressings their pasta sauces it's because you know it's so ubiquitous in all of your packaged boxed and canned goods. So I'm going to add another visual to that. Four tablespoons is about a quarter cup, right? And let's just make it an eight-day week to make math easy. Yeah. That is basically two cups of oil in a week.
[44:37] Yes, it is. Just that visualization, that's like a bottle of olive oil. That's good. And it is. And a cup is right around 2,000 calories. So that's 4,000 calories in that eight day week. Yeah. Just to make math easy. We like easy math. That's smart. All right. So anything else you want to add to your no cooking with oil rule?
[45:03] No, I just love her story the most. I, you know, it's funny because with the no cooking with oil, it took me three years to get over that fear. I knew all the science behind it and i just couldn't get behind it and finally i was like you know what and i work with a dietician um shannon martine i'm gonna give a shout out to her and she's like dr agassa just get rid of the oil and i was like oh god so one day i'm making some spaghetti or i can't remember what i'm making and um i was like okay you know what i'm gonna chop up this onion and we're gonna try to steam fry this and if the onion is absolutely disgusting i will it's one dollar it's fine you know and i cooked it and i just never went back because it didn't make a difference it didn't make a difference in the way that my food tasted in fact cleanup has never been easier because there's no grief anymore um so i really don't regret um being i i can't say i'm 100% oil free i still cook with oil once a week and that's to make pancakes for my kids and i can right now yelling at me just get a good nonstick pan but you know it's it's a huge improvement from where I started oh yeah oh yeah.
The Joy of Helping Patients Heal
[46:13] Tell me how fabulous it must feel as a physician that's trying to help people, truly help people. And as you said earlier, you didn't like being a drug dealer to have now found what must feel like the key that has unlocked the treasure chest to the answer to everything. And and you and then now feel like okay if you truly want to lose weight i have the solution i have the answer and here it is as opposed to kind of not knowing right yeah it feels so good um it's seeing all these success stories from my patients that give me motivation to keep going.
[47:08] And honestly, if it wasn't for Dr. Lorinda's talk to introduce me to all the wonderful books I've read from the lifestyle world and educating myself, I don't know that I could survive being a physician. I just, it didn't sit right with me that none of my patients were getting better because without nutrition and all the other lifestyle measures that actually heal you, you're dependent on these medications that just slow disease progression potentially. Well, so let's talk, how, how long have you been dealing specifically with obesity? Yeah.
Understanding Obesity Treatment Options
[47:51] Um, so I started dabbling about a couple of years ago, um, but I became the chief of obesity medicine about a year ago. So officially a year. Yeah. And, and you're a Kaiser Permanente. Don't that doesn't Kaiser have a little bit of a different incentive incentive, incentivation or whatever the word is a way of incentivizing your physicians, because if your patients get well, don't you get rewarded for that? Am I wrong with that?
[48:24] Yeah. So we do have what we call metrics and we, we want to see, you know, people with diabetes, get their A1C, get better. Right. And to know that you can do that with lifestyle changes, with less medications is definitely so incredibly rewarding. I mean, you don't need, you know, a plaque to tell you that you just feel it every single day when you see your patients and they're like, thank you for freeing me that I don't have to take all this insulin anymore. Um, you know, thank you for shedding this extra 30 pounds. I feel so much lighter. Yeah. Yeah. Okay. Now do you do any kind of weight loss surgeries or is that, is that not in your wheelhouse? Now as much as i like um suturing i did not become a surgeon so i work with surgeons and um i'm going to slowly convince them that they need to counsel on whole food plant-based as well we're going to leave the bariatric surgery to garth davis i know i know i love him he's so great yeah garth is great So let me ask you this. Let's say I'm a 40-year-old male. I'm 480 pounds. I come to you. I'm very interested in bariatric surgery.
[49:42] Are you going to say, are you going to counsel me to, um, A, have the surgery B get on GLP one drugs or C do a whole food plant-based lifestyle? Um, you know, I really like patient centered care and I like to make decisions with my patients. So no matter what whole food plant-based is there, That is the bottom and the base of all the treatments. So in terms of whether or not I'm going to offer surgery or GLP-1s, I like to educate my patients on what are the risks and benefits of both. And this, again, comes down to knowing yourself best.
[50:26] I had a lovely gentleman who was very, very successful with GLP-1s, lost a lot of weight. And I saw him again. I was like, why are you here? Because he was so thin. And he came off the medications, and he's gained weight. And so and he knows he knows that he should be whole food plant based. And unfortunately, at this time in his life, he's not ready to fully accept that yet. And so he's 50%. Right. And that's why he started getting that weight back and being realistic with himself. But the GLP ones, what they do is they help you feel not hungry. So you're not consuming as many calories. So in the end, he decided that surgery was the best option for him because we'll always need something to help restrict how much food he is consuming. So, um, you know, I don't like to push my patients in either direction. If someone comes in and they're just gung ho surgery, I'm like, okay, you know yourself best. That's what you want to do. But let me tell you how you are going to be successful and never step foot in this office again, five years from now that, that breaks my heart. I see patients who come into my into my office, who've had the surgery. And they'll tell me, you know, I don't understand why I'm gaining weight, I am eating healthy, I don't eat any junk food, I'm calorie counting, etc, etc. And when I eat with my friends, they all call me a bird, I don't need anything.
[51:49] And so you know, I think using those examples, like, like I said, it breaks my heart, because I think it's just about food restriction, but it's not about how much you eat, but it's what you're eating right which you know very well and and then if they take that leap of faith with me and they're like okay fine i'll eat the beans that's when i really start seeing that drop and then they have this kind of like hope again in their lives that there there wasn't anything wrong with them it was what they were consuming and i think i think that's what my biggest um kind of ish i guess you want to call it just yeah i get like really upset about with the weight loss world is that.
[52:29] Everyone blames the patient. And it's so confusing. Even as physicians, we're not all giving the same advice, right? We learned everything that everybody else learns on social media. And as you know, we don't get much nutritional counseling or we don't get taught that well in medical school in terms of nutrition. So whatever our patients know is probably what we know.
[52:54] And as you mentioned and brought up, you're like, what's your most least favorite processed food that patients always think they should be consuming as protein shakes, right? So there's just so much mixed messaging out there. We don't know what's healthy. Well, we do, but the world doesn't know.
Navigating the Challenges of Modern Eating
[53:11] And not only that is that these ultra processed foods are highly addictive, right? So we're trying to pull people off of these things that people feel comforted by.
[53:24] And they're like, well, if you could just stop eating that. And it's like, well, it's not that easy because all that stuff is around us too. You go to the supermarket, 80% of it is highly processed. And we live in a society where we encourage unhealthy eating behavior, right? We get advertisements to go eat at McDonald's or Burger King, or we get people on Instagram eating these really lavish meals. And what we should really be doing is kind of eating what our grandmas ate like great great grandmas. I'm not even gonna say grandmas because we've come, you know, unfortunately our food has been processed for some time now. Um, yeah, I don't know. I just really feel for our patients and I just want them to see what I see, um, and just start taking those baby steps in that direction and knowing that it's not their fault. They're just in a really poor environment. Um, and we've created this environment for them, unfortunately, and we've Falling for the traps. Yeah. All the, all the, the pleasure traps. If anybody doesn't know what we're talking about, check out Doug Lyle's book with Alan Goldhammer, the pleasure trap. Incredible. Um.
[54:33] Yeah, it is. It is incredible how in this culture you you said it so aptly, but how in this culture today you can be eating the most unhealthy food imaginable and nobody will say a thing. Right. The doughnuts, the Fritos, the cheese pepperoni pizzas. But you start eating a, you know, something that looks remotely healthy, a bean burger, a salad, you know, something a pizza without cheese. All of a sudden, like you're the odd man out and people are, you know, circling around asking all kinds of questions.
[55:09] Absolutely. Absolutely. And I, and so we do this thing, um, where I do group consults. So, uh, basically I have, I teach everyone about all their weight loss options. And then of course the core of it is learning how to eat a whole food plant-based diet with my three rules. And, um, at the very end of it is kind of like what you said, you know, you, you get teased and your people are going to ask you, why are you eating that rabbit food? And then I always tell my patients, I'm like, you got to remember your why, why are you on this journey? Why are you in this room with me right now? And that person who's making fun of your food, they have not been in your shoes. They don't understand your struggle.
Remembering Your Why
[55:48] You're not trying to impress them. You're trying to do this for yourself. So remember your why, because I, in the end, the why is the reason why i am able to consume a whole food plant-based diet without a strong why there's no reason for me to continue eating like this how many how many people since you've.
[56:09] Been i guess prescribing or had the ability to prescribe glp1s like would you say what percentage of those patients actually can stomach the drugs and don't you know have some sort of a gastrointestinal distress? Because I've heard that it's pretty high, like 60%, if I'm not mistaken, actually have some sort of a negative reaction to these drugs. Yeah. I would imagine it's pretty similar to what you have heard and read. I will say most of my patients are willing to stomach those side effects. So they don't always necessarily report it to me. You'll hear more about the severe ones who are like, oh my gosh, I really can't hold anything down or it's i'm running to the bathroom that often or i can't go to the bathroom i actually hear that more often is a lot of constipation yeah so yeah it's pretty high up there but unfortunately um they're willing to to deal with those side effects in order to achieve and and are you i mean i don't know how the average person can afford it was it's like $1,500 a month and most insurances are not reimbursing that. Correct. Yeah, it's very expensive.
[57:25] What I like to tell my patients too is, you know, these medicines aren't forever. GLP-1s are a natural hormone that your body makes, which I'm sure the pharmaceutical companies don't want you to know. But the reason why we don't make enough of it is because we're just eating the wrong diet, right? So like basically a high fiber diet, low fat is where you end up producing more of that GLP-1 and you have that baseline level that everyone's asking to be on a maintenance dose. That maintenance dose is your diet. Oh my God. That's so beautiful. And tell me what, repeat that again, what you said, what is it? It's the, it's the high fiber. Did you say, what was the second thing you said that was part of that? High fiber, low fat. High fiber, low fat. Right. Yeah. Well, isn't that something? That's kind of the, what you said about the high quality protein.
The Future of Plant-Based Medicine
[58:13] Yeah, basically. Yeah. Yeah. Just try to frame the whole food plant-based diet in a different way so that people understand. Yeah. Tell me, who does most of the cooking in your family, you or your husband?
[58:29] You do. Do you like to cook? I do. I just wish I had more time. I've got so much stuff going on. So our meals are quite simple. It's funny that you bring that up, though, because the girls... I made a yellow curry. And then I made like a plain soup so that the girls could have this. And we had it two nights in a row. And the second night, my daughter goes, I want something else.
[58:55] I'm too busy. I don't have enough time. I made two different meals you can choose. That's really big. You know, one of the things that we love doing is we love upcycling our leftovers into another dish that takes its lickety split. Let me give you an example. So my wife loves making, she calls them sloppy jills. Instead of sloppy joes, sloppy jills. And she makes them out of red lentils with onions and the tomato paste and all that. And so we'll have... Sloppy, sloppy jills, uh, with, uh, you know, the Dave's killer hamburger buns. And then the next, actually right after she, that right that night, while everybody's washing dishes, she will put them, put the leftovers in a big, uh, stirring pot along with oats, uh, ground up walnuts and some other spices, puts them into these loaf pans and then makes a, uh, a lentil walnut loaf, right? Like kind of like a, you know, a meatloaf, but it is, it is, you take the foundational ingredients, but there's so much, they taste so much different as a, as a kind of a oat walnut loaf and they're fantastic. So, so good. Look to do that with other foods too. Yeah. Yeah. That's great. I'll probably have to get some sloppy Jill, uh, Jill's from you guys.
[1:00:22] Happy to um man regina i am so glad that uh that we got to meet we got to get you on the podcast i love what you're doing um for you know all of the overweight and obese people um thank you it's huge stuff it's my pleasure i just want to see the world healthier and then maybe i can get a different job yeah yeah yeah make me retire not because you hate me but make me retire because you're all healthy and you don't need me. All right. Hey, will you hit me up with a virtual plant strong fist bump? Boom. Thank you. Thank you. I appreciate it. Such a pleasure being here. Thank you. Thank you.
[1:01:04] Huge thanks to Dr. Regina Ragasa for sharing her wisdom, her heart, and her mission to change medicine from the inside out. If you found value in this conversation, please share it with someone who needs a little inspiration on their health journey. Give us a like. And as always, thank you so much for being part of this growing movement. Stay strong, stay curious, and always, always keep it Plant Strong. The PLANTSTRONG podcast team includes Carrie Barrett, Laurie Kortowich, and Ami Mackey. If you like what you hear, do us a favor and share the show with your friends and loved ones. You can always leave a five-star rating and review on Apple Podcasts or Spotify. And while you're there, make sure to hit that follow button so that you never miss an episode. As always, this and every episode is dedicated to my parents, Dr. Caldwell B. Esselstyn Jr. And Anne Crile Esselstyn. Thanks so much for listening.
