Diet & Weight Magazine

Diet Doctor Podcast #38 — Dr. Hassina Kajee

By Dietdoctor @DietDoctor1

And through a number of different experiences which you will hear she realized that she could impact people much better with a low-carb lifestyle to help them to prevent even showing up in the acute care ward. So she transitioned her practice and also she got involved with social action with public health especially in the poor communities of South Africa, working with the Eat Better South Africa campaign with the Noakes foundation and the Nutrition Network and she is currently the medical director of the Nutrition Network.

And through her outreach she has helped thousands of people understand the importance of nutrition, the importance of health and has helped people adopt a low-carb lifestyle in a culturally sensitive way and in an economic sensitive way. And those lessons I think we all need to take away that there's not just one way to eat, there's not just one way to eat even low-carb and we have to be sensitive about the individuality of people, about their cultural norms, about their ethnicity and their history and kind of help devise a way for people to be healthy in ways that work for them.

She also has some strong beliefs well beyond nutrition about healthy lifestyles and the mind-body connection, all of which I think are such important lessons for us all to hear. So I hope you have some good takeaways and really enjoy this interview with Dr. Hassina Kajee.

Dr. Hassina Kajee, thank you so much for joining me on the Diet Doctor podcast.

And I became more intrigued with the human body and the functions of the body in the pathophysiology and so eventually I actually did almost two years of emergency medicine and then I became tired of the trauma, a lot of trauma in South Africa. And I was more interested in the 'why' behind chronic disease.

Eventually I specialized and got my dream job at the time. I actually stopped working for a little while when my daughter was born, I was pregnant during my final exams. So the family is really important to me and my husband and I wanted the kids to have either parent home and as much as I had a career aspirations being a mom suddenly made me feel like, "How am I supposed to work now?"

So I mean my husband and I kind of swapped roles there for a little bit when I was off at this dream job, once I had specialized as a specialist physician and he stayed at home; he's also an emergency physician. He stayed at home for a little while, he worked after hours.

But in climbing the ladder and eventually reaching this goal dream job, my heart broke wide-open because all around me in my 10 bed high care unit I was meeting patient after patient a lot of them under the age of 30 coming in with cardiovascular disease, coming in with a first heart attack and not only was that the problem; their wives were overweight, their children were walking into the unit carrying crisps and cool drinks.

And there was so much work to do, my nursing stuff were overweight and I would talk to patient after patient in the ward. Sometimes I would have the entire unit paying attention to the lecture I was giving to one patient.

And it was desperate... it still is. And eventually I had the nurses on the program just having listened in and making tiny changes that started a low-carb clinic for the patients I was seeing in the high care unit, but it became too much to sustain and I felt like I was standing at the edge of the cliff catching one or two patients, and I didn't want to do that. I wanted to get them way before- I'd never wanted to meet them in the emergency unit.

And, you know, it's about educating people firstly about what can go wrong and it's not too difficult because most of them are terrified that they're going to develop diabetes because they've cared for a family member who's been diabetic and only lived there for a few years after their amputation or a few months.

So that's my passion. Is educating people in a simple way that speaks to them from the heart to the heart and as much as I had success I would say in terms of people taking the message, understanding the message, and trying to translate that into a practical way of life, it was just too few people. It was thus far specialized I felt to be reaching enough people.

So, you know, we have many different hurdles, yes, but it was shocking to me that it was the norm that cool drinks- and even the porters in the hospital earning a much lower salary would use that little income to go to the shop and to buy a cool drink. And would say, "I drink water from the tap", because we've got actually great water coming out of the tap, so, you know-

You should be dealing with nutrition. It's the dietetics department. And the dietetics department refused to get involved. So I approached the chief dietitian and said, "I'd like to talk to about this." And she didn't return my emails and I found out through the grapevine that she felt that she was not educated enough in low-carb treatments to have a conversation with me. So I tried even higher and, you know, we faced a lot of issue, a lot of hostility within the department. Colleagues coming into the department and tearing up diet sheets or food lists that we'd given to patients.

And we had patients coming in actually having been on a low carbohydrate diet for a couple of years speaking to a cardiologist and the cardiologist was saying, "This is terrible. You're going to die." And they would say, "Thank you very much doctor, "but I know that this diet has helped me get off my blood pressure pills, I've lost weight... I respect your opinion, but I'm not getting off the diet." So we still have patients who are- I think it's a revolution in the patient world as well.

That's an amazing transition and I'm sure it was very difficult. But you can't talk about low-carb in South Africa without bringing up professor Noakes. I mean, I am sure his presence is everywhere. So how much do the other doctors know about him or his message or his challenges and how pervasive is that and does that make your job any easier or harder having him kind of led the way?

And having that association with him in tertiary level hospital for me was actually more difficult to practice medicine because a lot of people were against what he was saying and what he was teaching. But on the other hand it's quite divided because people who- So this is my view that if you're doctor and you've never had a weight issue, it's very easy to say, "This is rubbish. Just eat less and move more."

When you are a doctor and you gain weight and you know the physical aspects and the physiological aspects and the clinical association of that weight gain, then you have a personal responsibility to- if you have a personal responsibility to improve your health or, you know, you want to improve your health, then you start looking at different options. And it's only then that people will realize exactly how difficult it is to eat less and move more.

And then for somebody of that caliber to say, "I felt sick, I got better, I've done the research, this is what works", if you really care about obesity and if you really want to make a difference and you can see that somebody has a solution- And he's not some Tom, Dick or Harry; he is an esteemed A-1 rated scientist.

Why is it not possible for you to be able to sit at the table with him and discuss, "Well, I'd like to hear your thoughts on this"? In fact when Eric Westman came to South Africa I arranged a meeting at the University of Cape Town for the clinicians to attend. While it was reasonably well attended, it was not at all well received. There was much hostility in the room from various departments and it was so clear that no matter how much science is out there some people will refuse to listen.

And then I was like... I mean the way I practice is I never- I always practice what I preach so I have to do- whatever it is I'll take it up personally, whether it would be fasting or extended fasting or budget eating. And how can I prescribe to my patients when I don't know what it feels like?

And I felt that my husband was a couple of- maybe 20... 15 to 20 kg overweight, no matter how much we ran and no matter how well we ate and I noticed an immediate transformation. We used to call him Hoover because he would just finish everybody's meals.

So when you experience that, I'll tell you stories from working in emergency department, there is no time to go to the loo, there's no time to have lunch and when I started eating low-carb but I had been for a while before I started that job, and I would keep going without eating and I would never had breakfast and my interns would look hungry, they would be hungry. I remember an intern coming up to me and saying, "You need to tell me what you're doing "because I'm going to kill someone, I need to eat now.

And you just look so serene." You know, it's like that across the board and I used to have this issue with the body, this fascination with the body that the body is remarkable. But how can we have to stop so many times a day to eat and if we don't eat, we feel crazy?

It was a personal transformative journey for myself and that is the thing I think that's lacking, that people have no- in my experience... the professionals that I had these discussions with and debates with, it felt that they just read an abstract and they quoted the abstract and that was- you know, they don't have time to read the low-carb literature because they are too busy reading their own departments literature.

So whether it's a hepatologist or cardiologist or an immunologist or whatever it is, they just don't have the time to read, but, you know, why not talk through the information? Or be guided or be willing to be guided?

And that was how Eat Better South Africa was founded. It was a particular community in Oceanview, in the southernmost tip of Africa and these people were just so passionate about improving their health. And so behind Eat Better South Africa is a huge team of people including many volunteers.

And so we had a game plan. What we needed was we needed somebody in the community who people would trust, who would also had some experience with a low carbohydrate diet and Euodia Samson ticked that box. And then we formalized a program of education, so we met the community - it was about 14 people at the first time, did blood pressures and had bloods done, checked sugars and took readings - abdominal circumference and those kinds of things and then they would be in the community center.

We would either give an educational talk about what insulin resistance is, just explaining how insulin resistance is the root cause of disease in a very simple format.

And so they came up with something as close as possible to the traditional pap and so we taught them how to turn that into porridge, how to turn that into bread, how to turn that into a stiffer form of the porridge and then how to pair whatever they were eating with that.

So for example if it was meant to be curry or spaghetti, I mean having spaghetti and mince or something like that, it would end up being the mince with cabbage that was sautéed in animal fat. I mean it's a cheaper fat, so we encouraged them, we taught them how to render fat. You can get fat from the butcher for free and then you can cook it down and funny enough that community when that was taught to them, they went, "Hang on, that's what my grandmother did."

But to see this and for people- so normally when you have high blood pressure as you know, when you are on four or five different pills and you go to the clinic and the doctor says, "You're obviously not taking the tablets." And one of the ladies actually said, "I'd go to the clinic and the doctor would say... 'you naughty patient, you're not taking the tablets. Okay now let me come see you first."

And within three or four weeks her blood pressure was completely normal obviously on those five agents and she would have to be reduced- the meds would have to be reduced. But it was all these wonderful stories and seeing how practically we could do it on a low budget diet.

So you cannot expect real change if you do a six week intervention and you don't follow up. And obviously with Eat Better South Africa being a nonprofit organization we rely heavily on funding. So without funding there's only so much we can do, because people need to pay bills and we need to pay people to do the interventions.

And which articles do you read? Which books do you read? Who would you follow? Sometime there's some conflicting advice. And so to create a network and a community of professionals who would support each other- and there's no right or wrong answer and even if you have something that's going lopsided, share it with the community and it probably is a point that we need to learn or we haven't heard about before either.

But the great thing was to use this as an opportunity for funding. So the majority of the profits of the Nutrition Network goes into funding and we're so excited because, I think is now the third month that we've actually been able to turn the Nutrition Network into actual real-life donations towards Eat Better South Africa. So I think I lost track of your question there, sorry.

Now how has it been received though because if the doctors in the hospital think it's rubbish and are tearing up the papers, if they see the impact you're having on these communities, I mean it has to open their eyes some way to see these populations of predominantly poor people who probably don't have a high level of healthcare, who probably are ravaged with chronic disease, to see that slowly starting to change?

Are people starting to wake up to this a little bit?

So in some communities we've been able to partner with GPs and to get them to our course and to pay them to see our patients, but we haven't been able to do that in all the communities and this community is strained to public health.

And so we have something budding at the moment with the local regional Hospital that have been sold. We've met them and presented the Virta Health data and from the super all the way down to the head of the medical unit have said, "Actually we're not in a position to bargain anymore. We don't have space in our wards; this is crippling us, we need to do this now." And so we do have some hope coming up.

There are specialist physicians who have done the course in the local hospitals and are trying to make the change within their hospitals. You know, obviously the wheels turn slowly, but I have to go back to what I believe which is that it does take one person to make a difference, even if it takes forever. There's a long-term plan, so you have to look at a 20 year plan rather than wanting to see those results right away.

So tell us what else you think are some of the important factors that people need to focus on to help them beyond nutrition?

So my job is to help that patient facilitate- I'm just a facilitator helping that person journey back to the intelligence within. And so what I do is I have a questionnaire that I go through and I focus on and I use all the will of health... the wellness will... And I used to feel- it's ongoing learning in life for me as it is I think for all of us, but in my practice I used to feel this pressure to get the patient on the journey and have the patient on that journey and successful.

And I realized with patients falling off the wagon and I took it personally like I put so much effort into teaching this patient... why could they-? They are so empowered, they are so intelligent... why is it that they're not following this advice? And I realized that that was my ego speaking, because I needed the patient to succeed because I needed to feel good because I'd done something and that my ego had no place in healing.

And it's every interaction is important and especially that it's not that- every patient that comes through the door is actually bringing me something and I'm learning from that patient. You know, with my medical history I've got so many stories, as I'm sure you do that you generally you see something like as weird and wonderful as a dislocated jaw just once in a while.

Or a cerebellar stroke, you would see, you know, every couple of weeks or Wernicke's aphasia or those weird and wonderful things... and why is it that you see that three times in a row? Suddenly you see it and then the next day you see a patient with something; the same thing with a different clinical kind of presentation. And I only learned now that that was nature's way of teaching me that it wasn't that- it didn't just happen, that it happened to teach me that different clinical syndromes can present in slightly different ways.

And I've had loads of these kinds of clinical experiences and so I firmly believe that the patient is there to teach as well. So I now would "prescribe" and say that with inverted commas, because I don't prescribe anything, I give some life sort of guidelines, but for me sleep is very important, stress management is very important, teaching the patient how to balance their parasympathetic nervous system with grounding and breathing.

So not only do I address the specific issue that they've come in with, because mostly people are coming in with diabetes or hypertension... the metabolic syndrome. We end up talking about trauma that the patient experienced, that they hadn't processed, childhood trauma or other trauma, you know, that kind of thing-

And then it will be beneficial for you to keep your carbs under 25 grams and maybe, you know, you have to meet the patient where the patient is at. And every single patient is individual and you know, on the contrary, people are overwhelmed that for the very first time they are able to speak about themselves. And all the stuff that they hadn't processed or they hadn't spoken about... I mean it doesn't all happen at once.

My first consult can go over two hours and then after that it's just an hour or half an hour. But just to ring the bell in certain areas, what's your priority in life? Family, career, religion, okay, so how much of that are you actually putting effort into on a daily basis? And they go, "My family's really important to me but I'm giving them a 2 out of 10 in real terms." So that's something that bothers me. Okay, so how can we- what do you think we can do to improve that? And then so they come up with the answers, and I just guide a little bit or suggest a little bit.

What I also suggest is perhaps email this questions to your patients beforehand and give the patient time to go through that, the questionnaire, and come back to you and then you put a lot of stuff in the parking lot. There is only so much you can tackle and what we want to do is to cultivate a journey and the long-term relationship with the patient.

And my number one bit of advice would be start working on yourself, because we lose track of the fact that we are human as well, that we need that family and sleep and when to eat and relations and community and rest and we work too hard. And so what's behind why you're working so hard? Are you trying to run away from something? Are you? What is it? And so can you be brave enough to tackle those individual questions?

A lot of people make the mistake of studying or working hard towards a certain thing and they don't go back and reassess and say, "Is this still my passion?" And it can be devastating to realize that your passion has changed. I mean I had to go through that journey when I basically changed careers and it was a huge moment for me, it was a really difficult time, because I didn't know who I was anymore. I worked so hard towards this dream job.

And so I had to do a lot of introspection and a lot of brave and hard work. And work on that and feel enough and realize what all that was about, and all the wrong messaging that I picked up along the way.

There isn't always going to be somebody there to help you get started, but this hopefully will be sort of kickstart for a lot of people and then help them on their journey which I know is your goal and your passion.

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