Intermittent Fasting HACKS To Lose Weight & REVERSE AGING | Dr. Pradip Jamnadas

i said look right now just get rid of all those things i want you to eat a natural diet so eat as much as you want but of the right food and i want you to do that for approximately [Music] it's that one thing fasting that's hitting so many different things isn't it it's reducing your insulin it's encouraging autophagy you know we've not mentioned really apoptosis yet it's encouraging apoptosis stem cell production growth hormone so many different things are being activated and actually if we could get a drug to do any one of those we'd

be sort of shouting about it but but this one thing does all of them which is which is incredibly fascinating look i really want to understand because um i want to talk more about the science a bit later on in this conversation but in terms of getting really practical for people like if we if we compare fasting to let's say movements right so people if they want to move more they know they could start off with a 15 minute walk around the block you know they want to do a bit more they make it 30

40 minutes around the block uh then they might start jogging some people might want to do a 5k or a 5k walk or even a run a 10k some people want to do a marathon right so there's different grades of movement and so what are the different grades of fasting you know where can people start you know super super simple what are the benefits of that level and then how can people progress up depending on their state of health depending on their goals you know i think that would be quite a useful way at looking

at fasting and making it really practical for people yeah great question so my general advice in my office and all my nurse practitioners do the same thing with our patients is look first thing you need to do is cut out all the sugars because if you go into a fasting with your regular diet pattern you can have a very nasty experience you're going to feel very hungry you're going to go through withdrawal from sugar you're going to feel terribly hungry sweaty you may even actually have worse symptoms so the first thing we're going to do

is look we explain to the patients that your body is not supposed to consume so much sugar you know we consume about about more than 10 to 20 teaspoons of sugar a day in one form or the other so the first thing i tell my patients is look you need to get rid of all artificial foods sugar is manufactured sugar is artificial sugar is a poison for the body you need to cut out all sugar all processed foods processed foods anything that is made in a factory anything that has a barcode on it is suspect

anything that's been pulverized anything that has been made into a powder get rid of everything you need to eat foods in their natural whole form and that's the first thing you do so forget fasting right now the first thing you're going to do is just change your diet i want you to eat whole foods so i have a chaat in my office that's the anti-inflammatory diet and it contains all the whole foods i said when you look at the food in your plate you need to be able to recognize it yes this is what this

is this is what is and this is a lot of meat and chicken and fish i said no problem as long as it is grass-finished meat organic chicken organic eggs and you can have some some turkey but you must have vegetables in their normal natural state and first thing you need to do is do that so get rid of all the bread all the bagels pastries all the things that are coming in a box spaghetti included pasta included i said look right now just get rid of all those things i want you to eat a

natural diet so eat as much as you want but of the right food and i want you to do that for approximately two to three weeks no fasting right now no no fasting right now so that way they get used to that idea yeah that i'm going to first just change my diet and then after two to three weeks then i bring them back inside and i say okay so now that you've been doing this how do you feel is it dark i really didn't feel much now i said now you're going to learn to

skip meals so step number two is skip meals wake up in the morning i'm not hungry for breakfast skip it come round to lunch have your lunch have your dinner next day uh have breakfast but skip your lunch um the next day skip your dinner so learn to just skip meals and look you felt fine nothing bad happened you were perhaps a little hungry you got over it by drinking a glass of water drink lots of water during the day time so i do that for another two weeks or so see i'm doing it gradually

just like your athlete you can't go to your 5k right now you first need to build into it so for a couple of weeks i make them just skip meals randomly then i sit down with them and say now this week five days a week one should have only two meals and these two meals are going to be within six hours of each other so that you're going to have 18 hours that you're not going to eat at all and only drink water no calories in those 18 hours whatsoever you can have water black tea

black coffee but no calories whatsoever and they say oh gosh that's great and they do that for about two weeks so for two weeks monday to friday two meals within a six hour window period so they're 18 hours they are fasting they do that for two weeks weekends i let them have fun because they're with their family so i said you can have breakfast you can have lunch dinner but no snacks in between so most you're gonna have on weekends is three meals on the weekends then they do that for another two weeks then i

say okay now is when you're really gonna start your fasting monday wednesday and friday i want you to skip that second meal also now you're only gonna eat one meal on monday wednesday and friday that's it rest of the days during the week you're gonna have your two meals weekends you can still have your three meals so i gradually get them into that and most of the time patients are able to do it this year when i go there when i try to make them go to once a day eating or time restricted feeding within

a six-hour window from the get-go um my failure rate is much higher so i make them do it gradually yeah and then they self-empower themselves and then eventually i come to a three-day water fast which we can talk about yeah yeah the biochemistry of that i mean i love that you know i love chatting to fellow clinicians uh i i love chance of researchers as well i must be honest but clinicians like yourself you know you've got the real life experience not just what does the laboratory study say what happens in the lab now that

you're dealing with real patients who are probably quite scared and you know that that sort of protocol you just took us through just to make it really clear for people you know what types of patients are you recommending this in you're a cardiologist of course you know you practice in america i don't know the exact differences on who gets referred to a cardiologist in america compared to here in the uk so my guess would be that people are you know sick on some level you know they've they've either got angina already uh maybe they've already

got ischemic heart disease maybe they have already had a heart attack you know you're obviously seeing those kinds of patients but then we could take it one step further which is that we know in america there was a recent study wasn't there well not that recent a few years ago now they're showing that maybe over 80 percent of americans are not in good metabolic health which is really quite incredible so i'm imagining pretty much all of your patients who come to see a cardiologist are already unhealthy are already having a degree of insulin resistance and

therefore problems with their health and well-being so you know maybe help us through that a little bit because what i want to be really clear on someone who feels that they're in good health they're of you know a decent weight they don't have any health problems is that the approach that they should be doing as well are you specifically talking about patients who are already a little bit sick no no no you're sorry no what i'm talking about here applies to just about everybody in fact it's more than eighty percent i think it applies to

more than ninety percent of it now of course the cohort that i see in my office are patients who already have coronary artery disease or they already have had a heart attack so those patients are kind of easy for me to to to convince that hey listen you already had a heart attack now you want another one well you already have had two stents and then you're going to get the third one so you need to do this and i will put you on this program okay that's fine but then there's another cohort of patients

who come to me and i do a coronary calcium score and it's high but they're asymptomatic and they've passed their stress test so let me just tell everybody who doesn't know about coronary calcium scores because this is so important and i'll tell you why really it's important so it's a ct scan low level radiation of the heart and it looks at the amount of calcium buildup in your coronary arteries so it tells you you already have atherosclerosis so there's no guessing that oh yeah you know your cholesterol your blood pressure your weight and therefore your

risk of having a heart attack in the next 10 years is such and such it's going to plug you into a formula no this is do you have the disease yes or no do the scan yes you have disease do the stress test pass my stress test why why did i pass my stress test whenever calcium in my arteries well you pass the stress test because your blockage in your artery caused by the calcium is less than 70 percent because it takes a blockage more than 70 to reduce the blood flow in it and then

you may have symptoms or you may pass i mean failure stress test can we just back can we just back it up a second for people like what is ischemic heart disease what is atherosclerosis what is a stress test because i think there will be some people listening who probably may not be familiar with those terms and i think it would be quite useful to sort of set that foundation if you don't mind yeah yeah they're very important so atherosclerosis is the buildup of plaque in the walls of the arteries and they occur everywhere in

your neck in your brain in your legs but most importantly in your heart so when the artery the walls of the arteries develop calcium in them it's atherosclerosis you cannot get atherosclerosis without calcium actually you can't but very little most of the time there's a lot of calcium with it so the calcium is a surrogate for the plaque buildup in the walls of the arteries and that calcium buildup the atherosclerosis can cause two problems it can narrow your artery down on the inside so the pipe becomes narrowed and therefore that causes ischemic heart disease it's

chemically lack of circulation lack of blood flow going down that artery therefore the muscle is deprived of blood and the patient may experience pressure tightness heaviness in the chest particularly on exertion that's called angina so angina chest pain is because of lack of circulation due to the plaque which is picked up by the calcium and a positive stress test now positive stress test stress test is where you exercise you or we use chemicals to assimilate and exercise and it can tell us the consequences the consequences of the blockage is my blockage more than 70 or

less than 70 if it is more than 70 it may reduce the blood flow in the muscle and will pick that up on the stress test the stress test can be a nuclear stress test or an ekg stress test but now if your blockage is more than 70 you are more likely to experience chest pain and the effects of the lack of circulation in the heart muscle and depending on the location of that blockage and how much muscle is getting the effects of the lack of circulation your cardiologist may opt to either put your medicines

or if you're having very bad symptoms maybe even put a stent inside which we can talk about but what i really want to stress here is that you can have a blockage atherosclerotic calcium latent blockage that is less than 70 percent you pass your stress test you have no chest pain and those are the patients that i'm seeing in my office now because they're coming in and they're getting the chronic calcium score which they would not have otherwise yeah because you go to your primary care physician's office and they say oh yeah your stress test

is good your cholesterol's fine your blood pressure's okay yeah keep going and the guy gets a heart attack within a year or two years and so what happened to me well because you already had the plaque you just didn't know it so the coronary ct scan that we do low level looking for the calcium picks up the calcium in the walls of the arteries and quantitates it on a score that goes from like 0 to 4 000 over 100 is significant between 100 and 400 is is very significant but over 400 is critical that means

you really have a lot of calcium in the walls of the arteries so these are the patients who coming in they do the scan and i see that they have all this calcium in the walls of it now i turn around to them and say did you know that you already have atherosclerosis you already got it and we have studies that show that that coronary calcium is going to predict whether you're going to have a heart attack or a coronary event or a stroke or even total mortality more accurately than all the other blood tests

put together so now i say now do i have your attention you already have see you've got to motivate the patient and this is my this is my carrot look you have atherosclerosis now i want you to do my program now i'm going to look for some parameters on your blood test i'm going to see what's causing this calcium buildup and the patient said i'm fine i said yeah but you didn't just build this up something is making your coronary calcium build up so let's find out what it is so i do a craft test

i do a full physical examination i'll do tests advanced lipid panel these are tests that i do in the office to see and then i might even inquire into the gastrointestinal health i will do a whole evaluation to see why this patient's building up this atherosclerosis and part of the treatment program is going to be my fasting program which i think is the number one program for this so those patients um are very happily motivated because i show them the chronic calcium score i said look look at your picture this is it check it out

you got this calcium another group of patients they come in the 80 percent that you're referring to have metabolic syndrome so for the for the sake of the audience i'm just going to tell everyone what metabolic syndrome is okay this is a derangement of your metabolism and basically it means that you're you're overweight your body mass index is greater than 25 and you have an increased abdominal girth all the weight is around the belly and there's actually a ratio that you can do between the waist and the belly the belly is increased and then the

hdl the cholesterol is low the triglycerides are high and um they have borderline high blood pressure now when you look at all these numbers what's the common theme that comes to mind from everything i've already said is insulin it's all about an insulin lowers your hdl increases your triglycerides increases your abdominal girth because all the fat is down there remember what insulin does insulin puts all your calories excess calories and frequent calories and because of the high insulin levels puts it well into the liver pancreas and visceral gut and that fat is totally different from

the fat that you put on all over your body when you overeat you mean i overeat just eating a lot of fats and you know okay that's different but the fats that are produced under the influence of insulin by the liver der novo lipogenesis the new fats that are created the glucose has to be converted into storage product the storage product is that fat that fat in the liver gets deposited in the liver pancreas visceral gut is very inflammatory composition is totally different you do a biopsy of it you'll find inflammatory cells in it that

are producing tons and tons of interleukin-6 and neutron across bad stuff so metabolic syndrome although you have these basic features when you do additional biochemistry on them you will find that they have increased crp level which is a blood test for inflammation and if you can do even further testing you will find that they have very high interleukin 6 or 2 minerals factors and they have small dense ldl particles indicative of inflammation so these patients come into the office for prevention or they sent to me because they have a low hdl and and these are

the patients that also do the the the fasting program so some patients are motivated to go into my fasting program and lose the weight that way because you see the weight by the way i gotta tell everybody the weight is a side effect of the metabolism that's gone wrong yeah you fix the metabolism the weight comes down as a side effect yeah it's not really a weight loss program it's a metabolic program in which one of the side effects is that your weight comes back down to the way it's supposed to be it comes back

the way it was supposed to be so um so these patients come in and and they get referred to me so i almost invariably do a coronary calcium score on them but even if their chronic calcium score is not very high the metabolic derangements are going to make coronary calcium in the future and i motivate these patients to start making the lifestyle changes by showing them that their metabolism's off now these metabolic tests are not being offered by every doctor's office and and nobody because it takes a lot of effort and the insurance companies sometimes

don't want to pay for it like the advanced lipid panel sometimes they pay for it sometimes they don't so what i did in my office i developed a program where it's a cash paying if the insurance doesn't pay for it okay this is how much it's going to cost you but get the test done it's a good investment and i have to show them that that it's going to change the life yeah so but you're absolutely right that this metabolic derangement is it's not 80 it's probably more than that yeah and it's very because i'm

seeing it in children i mean i just the other day i saw a mother bring in her 16 year old and i was like you know and i said you i'm not a pediatric cardiologist but there you go um she had all the arrangements already at the age of 16. yeah this is this is so it's so fascinating and i think you know i think i've read a study where they're saying nowadays atherosclerosis starts in some children even under the age of 10 i believe you can see in some kids which is you know you

know clearly no one wants to be hearing that no parent wants that for their child we don't really want that across society what i find really interesting is that the different groups of patients who come in to see you you know they're proper the ones who've already got established heart disease and obviously hopefully a lot of them will be motivated to go okay doc tell me what to do and i'll do it but you've also got some who are probably coming in for prevention you know what's the state of my heart what's the state of

my bloods you know is there anything i need to do and the approach i can see is is very similar but you also you know you're sort of encouraging them to go all out and cut out all of the uh highly processed foods you know you're saying all breads or pastas which which for many people is very difficult now some people in the uk at least would call that quite extreme okay um now i also have used that approach successfully with my patients so i can i've absolutely seen the value of that but i think

it's worth talking about that does everyone need to go to that extreme and i know a lot of breads these days are highly processed they've got about 10 15 different ingredients in they have a high glycemic index they spike our blood sugar whereas i know some of the kind of german breads uh like the rye bread sometimes and some of the uh like the in the uk at least the square shaped german breads often can have a much lower uh sugar response so i guess what i'm trying to get at is all patients presumably say

look i'm going to try it but they can't do the whole thing the way you would ideally want them to um you know are there some common obstacles are there some sort of common compromises you have to make with people when they can't go the whole way no no you're absolutely right i mean if you you grew up on toast and white bread and it's going to be very hard to do so it just depends on on the stats now they're coming purely for prevention they're not overweight but they do have some family history it

might be difficult for me to convince them that hey listen you need to cut out all the bread but clearly if they're overweight you know it's basically convincing the patient look you're overweight you have metabolic disease uh i can see some parameters here on the blood tests uh or you already have coronary calcium in your arteries and then explain to the the consequences of that that is not just that you're going to get a heart attack you're also at risk of getting dementia when you grow older you're going to get proof of astro disease you're

going to get renal failure such a big link between kidney disease and heart disease i said so take a peek what would you want what do you want and cancers obesity is also related to cancer so sitting down and between myself and my staff explain to the patients that listen this is not just about about your heart this is also about your whole life this is a oh really a holistic approach this is going to affect everything this is going to affect the way you're going to retire and what your retirement going to be like

and how you're going to be aware of your own retirement and you'll be able to think because alzheimer's is going off the roof too i mean we have a huge increase in the amount of dementia that's going on and and i'm one of those who believes that much of that is also vascular it's all vascular i think everything here has always your arteries you know yeah um so so what's your arterial age let's look at that and so i think that making these dietary changes and cutting out the bread uh yes you're absolutely right is

a difficult one to sell but at least even if they cut down or move to pump a nickel bread or or even sourdough bread is better because at least it has some benefit on the microbiome but at least make some compromises start start at least do something um yeah yeah and i think that that's that that's the key thing is motivating the patient to think more long-term also and not just think coronary artery disease everything that i tell the patients to do for their heart i tell them straight up front this is going to keep

your eyesight this is going to keep you from gaining dementia your renal disease this is going to help you from hopefully also decrease your risk of cancer joint disease back problems i mean name it it it really has so many ramifications so yeah so again it comes down to what we said right in the beginning of this talk and we have to motivate the patient i need to get into your brain make a change in you so that you know that this is the right thing to do and then it resonates with you yes this

is right and then see the practical results of it and it's a slow process gradual process but you know we've done this yeah we've gotten patients off blood pressure medication got them off insulin you know the biggest achievements i've had in the last few years now is getting patients off insulin and it makes me feel so good when i do that and all through this program they come in and they're already taking 25 units of insulin twice a day yeah and now they're on nothing and their a1cs are so good yeah you you love it

and i bet the patients love it as well don't they oh gosh coming off insulin coming off blood pressure medications yeah coming off cholesterol medic do you know how many patients walk into my office and and there are tons of statins and and i do a coronary study on them and the score is zero score is zero they have no choice calcium and they're taking all these statins and they're hobbling around with all these muscle aches and pains and i'll just stop the stanton so that's another thing you know empowering patients to know that you

know there's no one treatment for all that yes your cholesterol level is a little high and therefore you have to be on a statin i try to individualize the treatment for the patients based on what's doing to your body you know you have you have a decent advanced lipid panel and we can make some dietary changes here so that you don't get any more coronary cancer but you don't have to be on a statin empowering the patients to do that as well yeah what what uh you know thinking about your approach and because i've been

using similar approaches with my patients for a number of years now and i think we see a different subset because i'm a general practitioner and you're a cardiologist of course there's a huge crossover given how common type 2 diabetes is how common metabolic syndrome is and but it's interesting so you go before you approach any form of fasting you have a three week period where you you know when advertising comes trying to clean up the diets you try and reduce the processed foods that they're going to consume increase the whole natural foods which is just

going to put them in a much better state for when you then bring in your 18-hour fast so which i which is really interesting i i take quite a softly softly approach i guess i always start with a 12-hour fast which some people wouldn't even call a fast um but i think pretty much every human being should be able to go for 12 hours and every 24 hours without eating food and if you can't currently that's okay but it would indicate that you are you know you have some sort of dysfunction some metabolic dysfunction somewhere

otherwise you would be able to because some people you know say i really struggle with that and i say okay it doesn't mean that that's not a good thing for you it just means at the moment your biochemistry and physiology is not able to support that so let's let's work on that and get you to a point where you can and then yeah for the right patient i also increase it up gradually um so i find that super interesting as as kind of just to notice a difference because there's no right or wrong is that

there's just we're all trying to empower our patients and we're all kind of biased i guess by our own experiences as to what we have found uh working with patients so i found that really interesting also most of your patients men and the reason i ask that is because of course heart disease we hear a lot about killing men of course it affects women as well um but also there is this question mark that many people have over fasting as okay it kind of works for men but maybe it's not so good for women um

i have my own view on that but i i wonder if you could share some of your thoughts on that yeah so the first part was uh 12 hours versus 18 hours um you know there's two things that i can concern about when patients start fasting one is the withdrawal um and i think that withdrawal is it comes in two shapes uh there's mental withdrawal that it's i'm i'm a pavlovian reflex i have to eat at eight o'clock in the morning i've done that for so many years the other one is a true biochemical addiction

at the level of the brain so that really concerns me that that's why i do this period to come in because that gets them rid of the addiction because i think addiction is a real issue yeah if they addicted pavlovian wise but also biochemically in the brain and some of them really do go through withdrawal symptoms and they say you know i felt terrible i started sweating and i had this intense cravings and and i said god this sounds like heroin withdrawal and i think it's real so that's why i do this just skipping meals

and gradually getting into it but once how long does that take that's the question how long does that take and in my experience i've been doing this six three weeks at the end of three weeks i can pretty confidently say that the patients have gone through their withdrawals yeah and they're gonna be now okay to take on the 18 hours and that's why i do it that way and the withdrawals are very real because the foods have addictive properties sugar is definitely addictive we know that we know dairy products have taser morphine um which actually

are addictive so you crave those things that you that that doc has told you to to to skip the meals on and all that but i think that after three weeks they're done and i tell patients it's not gonna be easy for the first three weeks you're gonna get a lot of cravings you need social support you need to you structure your life you need to do your shopping during the times that you're going to be eating that meal otherwise you keep your mind busy and and you got to get your seven hours of sleep

and so yeah so that the withdrawal issue is very important that's why i do this gradual stuff and then the answer to the second part of women definitely women are not exempt from cad and heart disease and and and something that that applies to you and me is asian women too did you know did you know that the instance of coronary artery disease in indian women is actually higher than indian men but it's just that they don't get diagnosed and and they don't seem to complain that much so they don't come to to to the

doctor's office but actually i've seen worse coronary artery disease in indian women in my office than in indian men and in indians in general they have far more coronary artery disease than caucasians so it's a huge problem so i think that women are are certainly a a a population that is not exempt from coronary artery disease now the fasting programs in women there are some data to suggest that they may not benefit as much as as men but overall i think that what i've seen is that they also seem to benefit just as much um

so i i don't make much distinction between men and women they come in here i work them out the same way um i'm very aggressive with the women as well yeah especially especially women from south asia when they walk in they've got my antennas in fact any south asian that walks into my office my antennas are up because um there are what i call trophies you know they thin on the outside they fat on the inside and and they're metabolically very deranged and there are specific things that i tell them about fasting and dietary recommendations

for their diet and the reasons have to do with vitamin k2 as well which i'm finding absolutely fascinating yeah we'll be back to the conversation in just a moment now many of us struggle to find time to eat all of these incredible whole foods that's why i'm a big fan of good quality whole food supplements like this one that's been in my own life for over three years now it contains over 75 whole food source ingredients vitamins minerals pre and probiotics and can help us support our energy focus digestion and our immune system athletic greens

are giving my audience a fantastic offer one year's free supply of vitamin d and five free travel packs with your first order you can see all the details at athletic queens dot com forward slash live more or simply click on the link below now back to the conversation you've mentioned in your books you mentioned this conversation that chronically elevated insulin is problematic for a whole variety of different reasons yes for the developments of type 2 diabetes so putting on weights also you know a lot of people aren't aware that it increases blood pressure increases fluid

retention increases uh a type of cholesterol called vldl very low density lipoprotein which can be problematic and so for a variety of reasons we want to lower that so there's two broad ways i'm getting that we can do that one is through a diet that does not constantly push up insulin and the other way is with a form of intermittent fasting or you know bringing in some type so if we if we start off with food and diet you mentioned low carb earlier on in this conversation of course we know how divisive the diet landscape

currently is in your experience if we're thinking about a diet food choices that don't spike insulin too much what are the kind of principles you like your patients to follow yeah and i think this is where um you know there's always a lot of difference in opinion there's low carb versus high carb and i actually think that there's a huge difference even within carbohydrates so the the problem is not generally the carbohydrates but the processing that makes the biggest difference so if you look at the glycemic index which is um you know which looks at

carbohydrate containing foods sees how much insulin tends to go up and glucose tends to go up they tend to go up together of certain foods what you see is that unprocessed carbohydrates tend to cause a lot lower spike in insulin than than processed foods you take cereals like cheerios and stuff they're really really high you take a very refined product like white bread just very very high then you look at something like boiled potatoes and it's just extremely low they're both carbohydrate-containing foods um so there's a big difference even within carbohydrates beans beans are carbohydrates

they have a different type of amylopectin they have amylopectin c versus amylopectin a their digestion is completely different they're still carbs so trying to simplify it to just carbs is difficult because you could eat a lot of beans and who gets fat eating beans like very few people are you talking about like black beans kidney beans these sort of things all beans yeah the type of carbohydrate they contain is amylopectin c which is harder to digest and therefore leads to much lower blood glucose levels much lower insulin levels um but insulin is sort of that

key so even within carbohydrates so so people think well one of the things is to cut carbs which is just a reasonable thing but cutting the refined carbs does a lot better because you have to understand that a lot of countries a lot of cultures have had high carbohydrate intakes and in the past have never had a big problem so china for example was classic in the 80s it was eating 300 grams a day of carbohydrates almost all white rice and there's almost no obesity this is 1980. then of course recently they started eating a

lot more processed foods a lot more sugary foods now their obesity is just exploding but it was not just the carb why'd you this is really interesting for me so white rice is a refined carbohydrate why do we have societies with high volumes of carbohydrates who are not putting on weights and who are not getting type 2 diabetes and that example you use of china that's really interesting 300 grams of white rice a day you would think would spike insulin and would um you know cause people to get sick but it wasn't and it was

and what if you know one of the theories i put forward in my first what was this idea that maybe in the west in the modern world in which we now live where people are chronically stressed they're chronically underslept they're chronically under active and they're eating a lot of highly processed foods all together that's creating the perfect conditions for high levels of insulin resistance and i thought well maybe the low carb diet has a particular utility in modern stressed out cultures i i don't know have you got any comments on that and how do you

explain that in the 1970s they were eating this in china and not getting sick i think there's a few things one is that the amount of sugar they were eating was just almost zero yeah so sugar which is fructose is metabolized quite differently than glucose so when you metabolize glucose all your cells in the body can use glucose when you metabolize fructose only the liver can use fructose so the fructose goes straight to your liver and there it gets converted and causes fatty liver causes all kinds of things when you're eating too much fructose um

so it can get converted back into glucose but for a lot of reasons it just gets turned into fat through de novo lipogenesis you get fatty liver you get insulin resistance which causes hyperinsulinemia so the fructose is actually much worse for you than the glucose in my opinion because you know if you are 150 pounds you have 150 pounds of body that's using glucose versus sort of five pounds of liver that can metabolize fructose so the fructose is much much more obesogenic i think than the glucose so therefore the practical side is that sugar and

sweet things like that are just much more fattening than starchy foods so maybe you're saying then in china back then because they're not having much fructose yeah almost zero but therefore they can actually the bodies can handle the 300 grams of white rice each day whereas on the background if a lot of fructose which which is of course how many of us live these days too much sugar too much fruit juice all these kind of things maybe with a background of that suddenly the white rice starts to become problematic uh yeah i think so i

think the fructose uh really makes that that much worse but the other thing is um that there's different reasons why and two they weren't eating all the time right they weren't eating constantly it's not like they're eating eight times a day of white rice and the third thing i think that's sort of always overlooked because it doesn't fit into this neat little square is that there's different reasons why we eat like there's the hunger the nutrition part of thinking which we think is important but in this day and age is probably the least important of

the reasons that we eat there's the habits right you eat because it's time to eat that's really the only reason and you eat because it's delicious so if you take any diet that is monotonous so no matter what diet it is so you can eat say say you love pizza but i give you pizza breakfast lunch and dinner okay very soon much sooner than you think you are going to be so sick of pizza that if i continue to feed you pizza you're just gonna say okay i'm gonna eat as little of this pizza as

i possibly can until i'm no longer hungry because i just don't like to eat it it's the same thing with white rice if you eat white rice and vegetables every single day three meals a day which is you know what they're eating in china like different types of you know vegetables with white rice pretty soon you're gonna be like i will eat the rice because i'm hungry as soon as i stop being hungry i am stopping eating because i know the hedonic effect of food the pleasure giving sense of food goes away when it's it's

completely monotonous so you can eat all that and you know you're not going to overeat it because you don't want to you just want to make sure you're not hungry and therefore any monotonous diet always works because you've just very quickly run out of things that you want to eat yeah so what we've done of course in the modern age is we've introduced all kinds of varieties of food which keeps us eating beyond these we're full sort of stage i've got my nutrition i'm done i don't want to eat anymore we never get that state

because we're always like well you know we want to keep eating and then you get around it by snacking because even if there's lots of good things to eat so you go to a buffet you know all you can eat restaurant you know after a certain point you have to stop like you can't keep going it's you know if you've eaten everything and somebody says hey why don't you have a bit more of this pork chop you'd be like oh that's going to make me throw up right it's the same pork chop as you ate

like 20 minutes ago but you're now full so the the point is that if you if you take away the sort of pleasure giving part of food then you're going to be able to control a lot of overweight obesity which is what the right rice was right it was monotonous it was just every single day was the same thing like i can tell you i i i ate rice a lot growing up because my my parents were immigrants they came from from hong kong we ate rice probably every single day so yeah i like rice

all right but you know until you're full then that's it like yeah you know i i don't want to eat more than i have to because i've eaten too much of it already so so that's why it's always you know people say oh therefore carbs are good or you have the kempner rice diet from the 40s hey that proves that carbs aren't the enemy it's like no no no it's very complicated like you can't just simplify things into like this food is good and this food is bad right so there's a lot that goes into

sort of understanding it and satiety plays a big role in that that is why the things that are most successful at controlling weight are hormonal agents that control your appetite so nicotine is a classic example it actually suppresses your appetite people notice this when they stop smoking that their appetite goes up and it's probably because it was chronically suppressed same thing the cemaglotide the drugs that some of the drugs that are used now but anyway so so it means that the carbohydrates are not the only thing that matters it matters um the type of carbohydrate

so is it amylopectin a amole vitamin c how often you're eating it because it's not just how high you spike it and and how refined it is going to affect how high it spikes the foods you eat it with are also going to make a difference and this is always very interesting to me because you can take the same foods and your that's not what's important the hormonal response is what's important if you take the same food at breakfast versus dinner you're going to have a different insulin response to it so you're going to actually

have a much higher insulin response at nighttime versus breakfast same thing with something like vinegar and this is very interesting actually i think so when you take sushi rice for example which is vinegared rice um when you take an acid or lemon juice with bread or vinegar with bread for example you can take say 100 grams of bread and you can measure how much your glycemic index goes up and when you take it with the acid it's like fifty percent sixty percent of what it was without the acid which is fascinating because of the same

100 grams of carbohydrate so say you take white rice versus vinegared rice the glucose level and the insulin level goes up to about 65 69 something like that versus 100 so you have much less effect and there's an interesting reason why that is and it's because there's in terms of digestion of starch is suggested by a hormone called amylase there's salivary amylase and there's pancreatic amylase so the assumption so you eat bread the saliva contains amylase starts breaking down that starch because remember starch is a chain of glucose you need to break it into little

pieces so that you can absorb it the saliva contains amylase that immediately starts to work it and we had assumed always that most of the digestion is through the pancreas it turns out that up to 80 60 to 80 of the digestion can be salivary amylase because salivary amylase is deactivated by low stomach ph so we assume you chew it boom it goes into the stomach and all of a sudden salivary amylase stops it stops breaking down the starch but in fact because of the bolus of food the ph of the stomach actually never gets

down there and that doesn't get low enough to deactivate salivary amylase so if you take something like bread with vinegar like they do you know olive oil and vinegar for example turns out that you don't break down the same amount of starch and therefore your glycemic index goes uh much lower your insulin spikes go much lower and it's because of the acid in the food lemon juice does that fermented food does that which is lactic acid vinegar which is acetic acid does that so there are things that you can take with the carbs that will

also affect it if you take carbs first versus last in the meal if you take it with protein or with fat it's going to make a difference but there's so many things that make a difference other than just cutting the total number yeah i love that and i think that officially qualifies as a hack you know the term hack is you know thrown around a lot these days but that seems like a really practical thing that people can do within the context of their own diet just to lower that glucose and lower that insulin response

in the body the other thing of course they can do is think about the food order and i know you released a video recently on your youtube channel about this why is the order in which we eat foods important when we're thinking about glucose and insulin yeah and it's again it was the same sort of thing where they did a study where they had people they ate carbs first and then waited 10 minutes then had their fat and protein versus taking the fat and protein then waiting 10 minutes and then eating the carbs and again

same number of carbs same type of carbs right same food same amount of food in the carbs exactly yet the rise in the insulin was like 50 of what it was and remember the insulin is what's telling your body to hey store this this energy store these calories away so the less of this insulin you have trying to store it away the more you're going to leave out in the body for you to use this energy and it's going to keep you fuller longer so that's that's the the food order so basically the the whole

hack would be just shift your carbohydrate intake to the last part of the meal instead of the first part of the meal and that's going to do two things one it's going to make you less wanting to eat the carbs because you're already full from the fat and protein and two the amount of carbs that you take even if it's the same is going to have less of an effect on you so it's it's it's so so you know this is what i mean when i say it's a complicated topic and people who try and

simplify it to total calories or total carbs always wind up missing a few things because there are ways to get around it because you know we have eaten carbs in the past without without gross you know worldwide obesity epidemics right yeah this is something i've i've done for a good couple of years now and more recently with the kids my kids are 12 and 9 at the moment and i will if i'm cooking dinner i will serve them their protein source and their vegetables first and when that's finished or almost finished then i'll put on

i don't know the sweet potato mash or whatever else you know whatever whole food carb we're serving with it and you know because it's very hard for me as a parent knowing the science knowing the impact not to try and implement it because it's pretty straightforward to do actually and it's something that i think anyone listening to this or watching this right now can can experiment with themselves you know eat the carbs last and you know there's there's a really good video on your youtube channel that i think will help people understand the science of

that as well um jason moving to fasting intermittent fasting what if someone's kind of heard what you've had to say so far and saying okay all right um i'm interested in trying intermittent fasting where would you encourage them to start and before you answer i also want to say one of the things i think is so great about the practice of intermittent fasting is that it doesn't really matter what dietary tribe you belong to you can still practice this and get benefits right so i think it cuts through straight away through all that noise um

so yeah maybe maybe some tips for people on on where they might want to start yeah i think that the first place to start really is just to go back to sort of uh you know eight hours ten hours of eating sort of thing um if you wanna eat sort of breakfast at eight nine o'clock in the morning and finish by like six o'clock in the evening and then let the rest of the time be fasting you know you're talking about a eight nine ten hour eating window it may be 14 to 16 hours and

that's relatively easy to do and of course it's something that people have done for for many many years so cutting out the snacks cutting out the late night eating and then you know so if you cut out the eating after dinner and push your breakfast a little bit later then then you're automatically going to get that that period of time and that's a great place to start and then you can experiment you can go longer or shorter depending on what you like um but i think that's that's probably a good place to start off with

that's going to be safe for everybody um you know there's no there's no problems with with anything you're still going to be eating a relatively normal um you know meal schedule and so on but you know there's so many or there used to be at least so many sort of uh myths about fasting about how it was so damaging to you and all this i think you know it's important to get that right information as well people used to think oh well you know it's it's gonna burn muscle and it's like you hear this all

the time and i'm always like okay if you're an elite athlete sure maybe maybe that's something you have to be mindful of but for most people who are not elite athletes um you're just sort of regular people you know this idea that it's going to burn muscle is still very much ingrained you see it out there lots of people talk about it and it's like do you really think that our body is just so stupid that we would store calories as glucose and body fat at the minute that you don't eat anything you're going to

burn muscle like you think that we survived as a species to become the dominant species on earth because our body is so intrinsically stupid like it's sort of like storing firewood you know for the winter and then as soon as it gets a little cold you chop up your sofa and throw it in the fire like what like what like why are you storing body fat if you plan to use that that that muscle it's like ridiculous and i think it's a it's a huge misunderstanding of the physiology so i have a video about the

five stages of fasting and there's a period of time in there that actually is called gluconeogenesis so when you think about the physiology of fasting there's a lot of good things that happen but essentially your body goes from eating food then it starts using glycogen which is sugar it's it's basically chains of glucose that are stored in your liver and then after glycogen then there's a short period of gluconeogenesis which is protein and that's where people say well that's your that's where you're breaking down muscle you have to say no protein is not the same

as muscle protein is a lot of things there's lots of excess protein on our bodies skin for example is protein connective tissue the thing that binds it all together is protein when you break down proteins your body is going to break it down and then rebuild whatever it is that you need so if you need muscle you will build it if you don't need it you won't build it like the only thing that builds muscle what builds muscle and loses muscle is not how much or how little you eat or protein you eat it's the

exercise that you do like i'd love it if i could eat and build muscle but i don't like it doesn't happen ever as much as i wanted to and it's the same thing when you're breaking down protein it's not necessarily muscle if you're using the muscle it's not going to get broken down but what you are going to do is break down the skin the connective tissue the stuff that you don't need and this is this process called autophagy where your body is actually going to break down organelles in the body because it's not necessary

and it's a process of cleaning out the unnecessary stuff so people who did intermittent fasting we have people lose you know 100 150 pounds they haven't sent anybody for um skin removal surgery because that was protein that was removed not fat and that's all anecdotal i know it's not sort of proof but we have a lot of people who say well my skin has tightened up too it's like you don't get that with just body fat loss that's protein loss if you if you look at the amount of protein on the human body in somebody

who's overweight it's it's far in excess they have more protein than somebody who's who weighs less it's not just the fat it's all the stuff that helps to support the fat that the blood vessels the skin the connective tissue right and that all also has to go with that so yes there is a period of breaking down proteins during the period of fasting sort of around 18 to 24 to 30 hours something like that but it's not necessarily a bad thing it doesn't mean your body is breaking down muscle you will lose muscle when you

don't use muscle so you're saying start off for people maybe a 10 hour eating window as you say let's say 8 a.m till 6 p.m is your eating window out with that what's in your view because you take a lot of people through these fasting programs i know in your clinic what are they permitted to do outside the eating window in terms of drinks uh and other things that's the first question and then going beyond that it's like what benefits then might people once they start there and go okay this is pretty easy i can

do that i'm feeling better lost a bit of weight i'm sleeping better i feel lighter what are the benefits or why should some people consider going further because i think in your clinic am i right and saying that sometimes you take people into 36 hour fast 48 hour fast those sort of things so maybe just yeah just just just walk us through that if you if you will yeah so you know classic fast is water only but really you don't have to be that strict there's no rules like uh you know when you're talking about

fasting there's two main variables one is the length of bath and two is what is allowed during that fast and you can put you there's lots of things so tea for example is something that i recommend for a lot of people um you can drink coffee and then those really don't have too much effect on you know your body there's no calories and you know green tea and uh it really doesn't have much effect on the other hand the coffee and stuff it's gonna have the coffee and tea they both have things like stimulants like

caffeine and that may keep your sort of energy uh you know your your metabolic rate a little bit higher so yeah maybe there's a little benefit from those although the effect is relatively small so teas coffees herbal teas those are all great to do then you get into things that are more clearly food so things like bone broth for example and then people even take like small salads and stuff within that fasting window you know if they get very hungry for example and those are you know people think well you know i just broke my

fast right i have to start all over that's not what happens because what happens is that when you're fasting you're trying to force that insulin level down so if your insulin level is going down your body is going to switch towards using your your your stored calories not not the food if you break that fast with say you know oh i had you know some bone broth yeah your insulin is going to blip up for a little bit but it's a very small amount and then it's just going to start going back down again it's

not going to have a huge effect so even if you take something during that fasting window it doesn't mean that all of your progress has been lost you have to start from scratch again so you don't have to worry so much but generally i tend to tell people you know just stick with like cheese coffee if you put a little bit of cream in the coffee because that's what you're used to go ahead it's not going to make a huge difference but don't put like the whole you know carton of cream in it then then

you're talking about food more than anything else and then the other thing is in terms of the benefits of fasting why continue with it um there's a lot of reasons like if you think about the physiology of what happens during fasting there's a lot of good things that happen people always assume that they're going to be tired uh during fasting but that's not actually what happens so if you if you if you don't eat there's a very sort of stereotyped response that is insulin is going to go down but certain other hormones are going to

go up and one of those hormones is the sympathetic nervous system and growth hormone so both of those go up as you fast sympathetic nervous system is part of this uh sort of uh parasympathetic is sort of relaxing sympathetic is sort of stimulating it's a sort of fight or flight response so it's it's it's uh the hormones involved they're mostly nor adrenaline and adrenaline so you actually activate the sympathetic nervous system when you don't eat and this is sort of basic first-year medical school stuff it's it's it's a number of hormones called the counter-regulatory hormones

you get a spike of this counter regulatory hormone in the morning um around 5 a.m 4 a.m 5 00 a.m and it sets you up for the day it's pushing the sh the the the calories the energy but into the system so that you have energy for the day ahead so that's why you don't necessarily have to eat the minute that you get up because your body's already started fueling yourself from its stores and because you're having higher levels of sympathetic nervous system you're going to be able to concentrate better you're going to have more

energy as you fast not less energy like think about it uh you know if you have a lion who just ate it's sort of sleepy just wants to lie there and digest but you have a hungry wolf is it sort of like falling over because it can't concentrate no the hunger is what makes it dangerous because it's dialed in it's concentrated and it's got energy to burn it's just getting its energy from its stores not from its food and that's because that you and it you know again it's not some voodoo magic psychology it's just

physiology your body is ramping up at the time that you're fasting well that's great you're going to have more energy i've had people come in you know women and their husbands would be like i can't keep up with her anymore like she walks so fast i can't even i have to tell her to slow down and she's like it's because i have so much energy it's like yeah because now you're releasing that energy yeah you've now finally allowed your body to access the stores of energy by allowing insulin to fall by fasting you're allowing your

body to access this huge store of calories this 100 000 calories that you've had stored away that you've never been able to access before because insulin is always blocking you now you have access to this energy they're like well okay let's use it let's use it your body's pumping up the sympathetic tone some people actually can't sleep because because they're so pumped up when they're fasting but then they can focus better we know that people you know in terms of their mental abilities are do better with fasting so it's a fascinating uh process but a

lot of good stuff there it's it's just crazy how many people have never ever experienced anything like that because of what we were talking about right at the start of this conversation where you know over 50 percent of the us population who don't work in shifts are consuming foods over 15 hours a day so they're nowhere near able to actually experience these things that you're talking about and i think another thing which i often think about with fasting is that humans have been fasting for donkeys years right if it was dangerous how would we possibly

have survived this far now on that i think a couple of caveats and i know you deal with a lot of patients with type 2 diabetes do people in your opinion need to be careful if they are taking blood sugar lowering medications or injecting insulin i think we should just sort of briefly mention that in case people jump straight in yeah absolutely so remember that when you're um fasting and your body's going to be using glucose stored glucose whether it's in your blood or whether it's in your liver if you're taking a medication in addition

to lower your blood glucose you could possibly go too low and yes it could be very very dangerous so you if you're on medications you should always speak to your doctor but for a long time people used to say well that's why type 2 diabetics can't fast it's like no that's why you have to be careful because the thing about the fasting is that it is a way to help lower your blood glucose if you're lowering it with fasting and you're taking your medication then you'll go too low but it doesn't mean that you should

not fast it means you need to take less medication it means you're over medicated so you need to adjust that medication not that the fasting was wrong because they you know this is a natural way to lower your blood glucose like what could be better than that yeah but we we don't see that as doctors do we you know it's like no it's it's a given that you stay on the medication oh no this is dangerous or adding in fasting it's like well hold on a minute it's just you can think of it as a

third medication and just think oh if i'm going to add this one and maybe i need to take this one down or take this one off but it's not it speaks to this wider problem that we don't as a profession in my view give things like fasting or changes in food quality the same priority the same level of importance as you know tinkering this medication by 10 milligrams here do you know what i mean it's kind of like no absolutely and it's it's very frustrating it is because um for example you'll have um if somebody

is on insulin for example and their blood glucose goes down so what is the advice that we as a profession give well eat something right it's like okay well sure at that one specific time yes i agree but in general if you're going down it means you're over medicated because i'm giving you this insulin to get your sugars low and your sugars are going too low so you're over medicated so you need to reduce the dose but we don't think that way because we think okay well what you should do and this is i've heard

actually dietitians say this all the time you need to eat to cover your insulin it's like what so if you take insulin your sugars go low then you eat what do you think is going to happen you're going to gain weight if you gain weight what happens to your type 2 diabetes it gets worse why don't you instead not eat take less insulin and then you're going to lose weight as you lose weight your type 2 diabetes will get better but you're absolutely right like we've gone in the wrong direction thinking that the the medications

are what's good for us and everything else has to fit around that and it's it's part of the problem is medical education because again i've gone to so many meetings and these are given by the heads of you know diabetes associations and stuff right and they'll go okay the number one two and three uh treatments for type two diabetes is you know diet diet diet right okay great then they spend the next 59 minutes out of that 60 minute lecture telling you about drugs so the message to all the doctors these are training doctors and

established doctors is that yes we will give you lip service about diet and lifestyle but what we're really here to talk about is meds right and that's wrong that's an absolutely wrong thing because think about this simplistically right type 2 diabetes is largely a dietary disease and we're using drugs to control a dietary disease well you're not going to get as much effect as you think you will because you're not focused on the root cause which is the diet eating less is also something that might be helpful right yeah so this is another field i've

just got fascinated with um and that's the immuno metabolism i don't know if you've heard anything about that word last five years that it's really kind of popped up um and people have started looking at this but metabolism metabolism is basically breaking down of the major components of our diet so the protein carbohydrate and fats into energy and building blocks that our cells can use and people might hear things about metabolic rate or i've got a good metabolism these kind of things that people say um and you know metabolism and the immune system are really

intimately entwined and i don't know why it's taken us so long to figure that out because immune responses are energetically very costly you know there has to be sort of triaging of resources to be like right we're going to fight this infection and turn on all the inflammation turn on all the antibody producing and all those molecules that are being produced and the proliferation of immune cells that takes a lot of resources so it needs energy it needs building blocks is this why we feel tired when with fire skin infection because the body's diverting resource

to making all that stuff that's going to exactly and you might find that you need to kind of build yourself back up again after you've been sick um particularly if you've been sick for quite a long time or if you have an ongoing illness your nutritional needs might be very different from somebody who doesn't have that so in immunometabolism is the field that's trying to understand how metabolism can shape immune responses and vice versa so this happens at the level of the individual immune cell but also can happen in the environment of a tissue and

an environment of our whole body and this is something that there's not really any kind of absolute concrete um understanding yet in this area but we know that when uh an immune cell is fighting an infection it goes through a metabolic switch and it goes from being in this kind of resting state to suddenly sucking up lots more um glucose to fuel uh proliferation the immune cells are making armies of themselves building antibodies requires you know the building blocks of proteins all of this kind of thing is happening and that metabolic switch is known as

the warburg effect this is also what's happening to cancer cells but immune cells do this when and it's perfectly normal when they're fighting an infection or fighting any kind of um um problem and then it's switched back off when the immune cells go back to normal and there they don't have this huge need for metabolites anymore but what people are starting to to wonder is can the overall environment of a body influence um the metabolic switches inside our immune cells and switch them on aberrantly when they're not needed so we know that diabetics with poorly

controlled blood sugar so they have elevated blood sugar and their body this creates an environment that causes some of our immune cells like neutrophils to not work so well so it affects so immune cells have nutrient sensing um switches inside them so they can sense what nutrients are are available and they're taking in that information and then that affects how they can work now what is not known is can we feed someone different um macronutrients proteins carbs or fats and influence how their immune system is working so can you switch unwanted immune responses off or

on based on the different macronutrients that your body's metabolizing i think this is where the field of immunology is going to be headed in terms of treating chronic diseases because we know that people with chronic diseases like metabolic syndrome type 2 diabetes heart disease or people who are carrying too much visceral fat that the whole environment of their bodies is metabolically different and this might be causing the immune cells to act abnormally and become more pro-inflammatory for example wow super interesting yeah a lot of research to come in that area exactly and i think we

just don't know enough to say specifics yet but i think that's you know for so long we've been focused on the micronutrients but actually it's the macronutrient so you could adjust someone's diet give them different proportions of protein fat and carb to maybe alter their metabolism and alter immune cells that were going wrong so somebody who had a chronic flat inflammatory disease we could kind of steer that around and incredibly exciting isn't it on the other side of it what you said about eating less um another thing that i bring up in the book because

i wanted to get people away from just thinking about you know a vitamin supplement for their immune system is that the immune function is impacted by over nutrition and under nutrition so if you're not eating enough or you're eating too much this is going to send your immune system awry and i should context that by saying if you're doing that consistently and then we have this field of research coming out about fasting and immune function i remember being at conferences decades ago and they were talking about fasting and how it would regenerate um all sorts

of parts of the body it was kind of mind-blowing and now we kind of see it more in the mainstream and we have all these kind of forms of different diets um and this again is causing metabolic switches in the body that then when you go on to refeed after someone has had a period without food you get increasing in growth hormone you get production of fresh new immune cells from the bone marrow and the stress of the lack of eating kind of causes some of the older immune cells and ones that might be more

likely to malfunction to be deleted so you're kind of replenishing your immune system and we start to see in experimental models of autoimmune disease that this is you know highly therapeutic yeah it's fascinating that it's not necessarily just what we're eating it's you know how much or how little it's are we fasting are we not fasting all these kind of different components that all play i guess they'll play a role in the signals the body is receiving because i guess that's all it is isn't it the musician is trying to interpret the signals you're sort

of going okay what does that mean is it is it sort of safe or is it unsafe do i need to take action yes or can i just stay calm everything we do even our thoughts our words our sleep our stress they're all giving a signal in some ways our immune system exactly do i need to respond or is it okay exactly yeah it's me yeah it's that simple isn't it it's core yes yeah yeah it's it's this decision making that's ongoing and constant it's integrating all these different inputs to decide and i think the

thing with the sort of so-called western diets that that you know we talk about as being having a negative impact on our health and it's just it's just really tasty and we just want to eat it all the time it's salty it's sweet it's delicious it's everywhere we can quickly override any lack of hunger cues just to to eat we kind of pathologize being hungry it's like you're not ever allowed to be hungry you have to have 10 snacks in your bag in case you might not be able to reach some food and then we

have millions of incidences of eating across a huge portion of our waking time and part of the research i was involved in several years ago was looking at postprandial inflammation so when we eat there's an inflammation a subtle inflammation that happens in the body and this is quite normal we have plenty of checks and balances in place to keep that in check and actually dietary fiber is one of the best ways to kind of seal that up again and prevent that from happening as is having a period of um time without food in between meals

so eating enough and the right things at one meal that you do not need to eat then till the next meal um it's actually quite good for over overall gut health but the whole body health i i i'm sort of super fascinated by this research as well and you know not only do many of us eat too much we eat too often in the day and as you just said there you know that the act of eating is inflammatory yeah so that's a response to eating is that your body will become inflamed as you say

nothing to worry about it's sort of that's part of the process but i guess you know and you know i know uh sachin panda's done a lot of look at this professor panda um and i think when when he started his app in 2015 i think it's called my circadian clock i i i can't remember the figures off hands but it's something like 20 30 years ago most people were eating three times a day in the u.s i think you could probably infer in the uk as well and then in 2015 when he was measuring

and people were impulsing into the app i think the top 10 percent of people were eating 15 times a day and it was yeah you know so that if we think about that let's say let's say i'm eating 15 times a day and let's say in theory it is all whole food right it's all nice uh health what what is considered you've got to be careful with the language but what is considered sort of helpful foods for our health you do have to ask the question is eating them 15 times a day helpful that's that's

like 15 bouts of inflammation whereas if you had the same sort of food over you know it's not a perfect analogy but three times a day over five days you're still getting 15 bouts of inflammation but that's over the whole week yeah as opposed to in just one day and i i really do think societally culturally there's a problem with how much we're being encouraged to eat even healthy foods like you can buy healthy snacks here and healthy snacks there but you're you're sort of inflaming yourself each time and i don't know what what would

you make of that yeah no i think that's a real uh issue i think it's not well enough understood in the scientific community to really translate into a kind of clear health message for people but from the research i was involved in and from work like what sachin panda has done and others i definitely think we need to look at the incidence of eating as well as um you know the the stretch of time that we're eating i think some of the studies show that we're spending 18 hours a day eating it's just like the

whole time we're awake um and i don't think that we are designed to cope with that on a long-term consistent basis you know going back to the traditional diets i you know my grandparents weren't eating all day every day um because that just wasn't how it was constructed in different cultures or eat in different ways but certainly it's not common to eat all the time and i i want to fuse the tradition with the modern life somehow because i think that's the key that we need we can't go back to times gone by but we

can bring bits that we've left behind and kind of integrate it into what we have to work with right now somehow when i i find a very effective and powerful recommendation i use in my patients is uh to try not to eat for 12 hours and every 24 hours so you know basically eating all your food within a 12-hour window which you know really was the norm for pretty much yeah everyone maybe 30 40 years ago i mean yeah you know we we might stop eating at 8 p.m and maybe we wouldn't have breakfast till

late i mean i'm i'm not talking about an extreme fast i'm just saying i said i think it's quite i certainly know when i uh managed to stick to that consistently i sleep better i feel more energetic yeah and i think there really is this idea that you know you need time for the body to regenerate a little bit if your gut is constantly having to use up energy to constantly digest food that's going to impact your immune system it's going to impact you know the resource it has for something else yes exactly there's some

you know the the guts lining as well there's a kind of um it's energetically costly because it's there's a turnover of those cells quite regularly and things like the short-chain fatty acids we mentioned earlier that are produced when our gut bugs digest fiber they are really nurturing to the growth of and repair of the the cells that line the gut barrier and those are kind of the interface cells between what's going on in the guts and what's being put in the bloodstream that could exacerbate that inflammation and we know that certain things like saturated fat

high fructose diets fiber poor diets as well as other things like stress and extreme exercise can alter the integrity of that gut barrier and exacerbate this sort of inflammation that you see postprandially um and i know that some of the work that tim spector recently published um looked at postprandial inflammation and looked at also people's microbiomes and found that the same food did vastly different things in different people which is why we have to kind of have a bit of intuition of our own bodies and how we're feeling how do we feel after we eat

and not you know just be eating something because our friends are eating it i know we have our kind of eat well guide and the public health messages which are kind of good to give the whole population a safety net against certain diseases but i guess we don't all have access to personalized nutrition but we all have a very personal response to food and we can't just say don't eat that because that's inflammatory it might be in you and it might be not the same as me yeah it is it's you know as an ideology

like these public health guides it's tricky actually because i get what you're saying i get what the idea is to give a bit of a safety net and i guess the way i sort of feel more these days is have we sort of disempowered individuals by doing that sort of by saying this is the way one should eat when it's kind of it's always been passed down hasn't it from you know parents to child from grandparents to grandchild it's like this is how you eat and you know i'm not expecting an answer from you appreciate

you know you're a lecturer and you you may not wish to get drawn into this but i'm just sort of sharing my perspective is i sort of get that but i think we've lost touch with ourselves like definitely i think you know the conversation i had this morning here was with someone called pippa grange who is an amazing psychologist she works for the england football team she's you know all kinds of high-powered business but we were really talking about um kind of intuition but spending time understanding yourself and really sitting with how you feel so

making that relevance so what we're talking about yeah this idea that trying to tap into oh when i eat this sort of meal oh i've got more energy i sleep better my gut feels better i actually personally think and this is probably different from 10 years ago was the doctor probably evolved the more patients i see but i sort of feel that's i think where the power lies for people is to yeah get a bit of guidance understand some principles yeah but then sort of within those principles kind of figure it out for yourself experiment

and see how you feel there's no there's no better tool than actually figuring out yourself hey when i eat that i get bloated afterwards i don't sleep well but when i don't have that or i have this i feel fine i think that is very powerful but i think the problem is with many people are too busy to actually tune into how they're feeling definitely i think that's something i've learned as i've got older but i can definitely see how there was points in my life when i was too busy to really yeah you know

and and i'd be eating on the go um years ago when i lived in london and that just became really normal and i remember speaking to my um uh great grandmother and she was like in our day it was you know it was unheard of to eat and be on the bus or be walking around you sat down to eat and she was outraged by all the young people eating on the go and just kind of got points because now i just avoid eating on the go because i i don't like how it i feel

you know it that's rushed and i'm not really chewing my food properly it's mindless it's not a very nice environment sitting on a bus or somewhere i just wait till i get to the other end and given that's not always possible but i think we have become you know we've definitely pathologized feeling hungry like yeah most of us are not going to kill over if we don't snack in between our next meal or maybe maybe you might keel over because your blood sugar balance has kind of gone awry because you're metabolically sort of i don't

like the term broken so much but because there's there's some sort of yeah dysfunction there metabolically that we can hopefully fix but that may be why you need to eat every two hours yes yeah maybe if the the metabolism is working more obviously yeah you wouldn't need to let's get some more practical things um i think you've really helped people understand the immune system how important it is so food so far it's been potentially think about how often you're eating how much you're eating how you're eating but also this diversity you didn't mention saturated fats

um let's just quickly go through the macronutrients then like yeah because there was a really nice bit in the book about protein and immunity which i found really interesting um but saturated fat is is a very hot topic of conversation and uh how can i put it the twitter diets wars yes definitely you're clear up yeah i i i do these days i'm just like okay i'm over it really yeah i don't find it particularly helpful um but also when we talk about saturated fat there's so many different types of saturated fat it gets quite

a nuanced discussion but i wonder if you could let's talk about protein maybe we can talk about fats and carbs and actually yeah how you see them impacting the immune system exactly so i think carbs is the quality and the quantity so these are where we're getting the fiber to feed our microbiota so um thinking of that diverse colorful produce that we're trying to eat 30 different plant foods and over the course of a week um carbohydrates are fueling our immune responses um and then protein i think protein malnutrition is probably globally one of the

biggest factors that has a negative impact on our immune system because it's it's protein breaks down into amino acids and these are the building blocks to make so many other proteins in our bodies and the immune system is a huge sink for that because it needs you know antibodies are made from protein the communication molecule so we need protein for the fabric of our immune system exactly yeah and i think you know that's probably one of the key things like i said globally that impacts our immunity what's sort of less understood is which particular amino

acids these building blocks of proteins are more or less important for different aspects of the immune system i think that's something we'll see coming out in the next few years under this kind of immuno-metabolism field um i think he beautifully addressed animal versus plants uh in the book where you said you know animal proteins are typically more complete yeah but plant-based proteins a lot of cultures have actually learned how to combine them yeah to give you that completeness and i thought that was very inclusive and very empowering because people you know people these days are

choosing to eat in very different ways and of course choosing how you eat is a very modern it's quite a privileged phenomenon the first place to be able to choose the dark you wish to follow yeah um but i thought it was really nice how you did that what are some of those examples of combining so i think um i think rice and beans yeah and you find these in sort of different uh cultural diets as well and the complete proteins the complete proteins are the ones that contain all of the amino acids that are

considered essential we cannot make them ourselves and then there's certain amino acids that we can make ourselves and there's some that are conditionally essential so in certain situations they become essential so most animal products tend to um you know generally speaking contain all the essential ones whereas most plant products tend to only contain some or other of them but you can piece them together and i think anyone who's switching out all animal products for plant-based uh protein sources should really make sure they get some sort of nutritional advice to ensure that they're not lacking in

any of these amino acids and study traditional diets i guess or traditional cultures who eat that way you know there is a lot of kind of ancestral wisdom there that we've noticed humans before that yeah we've sort of forgotten maybe it's the human condition you know like when our parents try and tell us stuff and we're like no we'll do it anyway um and then we're like oh yes they were right that's what they were trying to tell us yeah i think we all know that yeah exactly yeah so what's the deal with fats then

so fats um i think for a long time we kind of thought of fat as one thing but it's not it's lots of different things um there's the unsaturated fat so there's the mono and the polyunsaturated fats so olive oil is probably the best example of a monounsaturated fat and there's lots of um epidemiological research around why it's important for health and it has lots of these phytonutrients that i mentioned earlier included in it and my own personal bias because of my hybrid italian family is like you know olive oil is life so it's all

that i use and um yeah hold my hands up to that um so it's it's something that's um really important to include uh in your diet i think people get afraid of cooking with olive oil but it's for the short-term sort of home cooking it's been shown to be stabilized by the presence of these phytonutrients so it's it's a good healthful oil to use and you know people have been using it for millennia and uh it's associated with some of the most healthful diets in the world like the mediterranean region um then the polyunsaturated fats

are kind of interesting because you have the omega-3 and omega-6 so some people might be familiar with these omega-3 supplements are quite popular now um and i would say if you're not eating oily fish then you should really think about an omega-3 supplement because these are they're making up the the cell membranes of our our cells but their immune system is using these as a resource to produce different um molecules that it uses to do its job and um this includes production of inflammation but also resolution of inflammation and resolution of inflammation was something that

was really neglected in the field for a long time it's only maybe 10 years ago that we started to understand oh it's an active process inflammation just doesn't go away by itself simply the act of having inflammation in the body having the presence of certain inflammatory cell types causes the switch to the next phase which is the pro-resolving um resolution of inflammation which is healing and repair and this is where our immune cells utilize these omega-3 fats from their cell membrane to produce pro-resolving molecules that help dampen down this and and heal and repair the

the body that that is super fascinating so you know we we were saying at the start that inflammation is a normal process you know it's but it's it's meant to be short-lived so it's meant to be there to help you find something like a you know broken ankle yeah sorry sprained ankle you don't get red hot swollen for a few days and then it resolves the the chronic inflammation the chronic unresolved inflammation that's behind you know type 2 diabetes high blood pressure yeah a lot of cases of depression all kinds of autoimmune diseases is this

sort of chronic unresolved inflammation and you're saying that omega-3s help to resolve inflammation yes which is which is you know it's like it's quite nice to actually be able to draw a direct say oh that's going to help me you know in in collocations switch it off i guess yeah to a certain and you have to also consider whatever stimulating the inflammation in the first place needs to be somehow removed or contained as well there's a lot of studies in things like heart disease depression i think probably um rheumatoid arthritis is one that springs to

mind because there's you know dozens of um clinical trials now that show that high doses of omega-3 is really beneficial to the overall um patient's quality of life and you know their pain and disease management but yet the nice guidelines are still not suggesting that we treat people with this it's still that they're welcome to explore something like a mediterranean diet so for me rheumatoid arthritis is the one that holds the strongest evidence but it's just challenging to get that into clinical practice i think there's also things like allergies where omega-3s the evidence is really

quite mixed but we have a sort of picture appearing where what the mother is eating when she's pregnant and the fish which is a great source of omega-3s is really important to help prevent allergies in the unborn child so again not a really strong um clinical message yet but i think that's some something that we're going to see coming out in the next few years yeah and i think you know this is one of the big problems at the moment is with how information is communicated um we can easily get overexcited by certain things but

at the same time i also think we put the brakes on a lot of things as well of course we often need more evidence but i also think sometimes with some things when the risk of harm is low we should really be starting to think about well look and when you when for example we say mixed evidence that implies well some evidence is suggesting it may work and some are suggesting it it's not so it could be that in certain populations it works brilliantly exactly and another population that doesn't work at all but no we're

going to have a global recommendation that you don't do it because we don't have the evidence yeah i just don't think it's i really think we need to think about a better way sometimes to communicate somewhere else with the public it's really hard especially you know the thing with pregnant women and and fish because there's mixed messages about how much fish pregnant women should mercury because of mercury but yet we we're starting to see a picture where having omega-3s are really important during pregnancy but pregnant women might decide to not eat fish at all during

pregnancy rather than the kind of gray area of you're allowed so many portions but not this fish and only so many times a week um and in which case then maybe a supplement would be suitable but that's not again it's it's very difficult to communicate um this kind of information into very clear public health messages it says saturated fats you have written about this in the book i think you cover it really well um as i say there's lots of different kinds of saturated fats and i think sometimes i i find it confusing in the

literature as to it's a specific type or they often it's an animal study with a high sucrose high saturated fat diet so you can one might be confusing sort of the high sugar and the high fat exactly combination and i sort of think some people seems to do okay with a little bit of saturated fat in the context of a natural sort of more traditional diet and i think that's where and as you yourself said at the start it's very hard when we just go to individual nutrients and try and say good or bad exactly

it's kind of a lot more nuanced yeah so we do know that saturated fat can be something that causes the gut barrier to open up more than other um foods and that in itself can cause this sort of transient post-eating inflammation but we also know that eating it in the context of a fiber-rich diet is going to kind of counterbalance that and i think no food is just 100 saturated fat every food has a mix of different nutrients so we're not just eating saturated fat on its own um but you can eat foods that are

higher or lower in saturated fat and for some people it may be beneficial to eat a lower saturated fat diet for other healthy people maybe it's not even something that needs to be on your radar because your overall pattern is quite bad and then it also comes down to doesn't it like what's your current state of health so if you have for whatever reason had a lot of insults to your body whether it was stress poor diets inadequate movement insomnia maybe you work night shifts for 20 years or whatever maybe at that point maybe the

gut is a little bit more leaky than um than we would call physiological or normal or optimal maybe in that context foods can start to become problematic on the background of that compared to someone who's got their their health and their microbiome yeah in a completely different state yeah exactly i really i so strongly feel that that nuance is getting lost in health communication i really think it gets lost on social media a lot of the time where things have become black and white yeah it's like and i don't know i i i am heavily

influenced by my experience as a clinician seeing patients i've just realized that it's very hard to say one thing for sure that is applicable in every single situation yeah yeah and i guess that's where you know we're not going to be able to deliver personalized diets to everyone but we can help sort of nurture intuition and yeah and steer people towards the helpful sorry interrupts if you are enjoying this content there's loads more just like it on my channel so please do take a moment to press subscribe hit the notification bell and now back to

the conversation the fact that poor diet is such a major issue globally for health really highlights the um the craziness of medical practitioners getting so little training on nutrition during their during their you know residencies etc it's a major issue how much poor diet feeds into mental health problems is yet to be established and that's a really important question but i suspect it varies enormously from individual to individual and it should be always said that you know something like depression is a very multi-factorial disorder there are so many things that drive into it but if

you think about the risk factors for mental illness they're very often things that you can't readily change they're things like family history and early life trauma and life events and poverty and disadvantage and interpersonal violence these are things that are often very challenging for societies to address so we need to be looking for the things that we can modify particularly if we want to think about prevention because half of all mental disorders start before the age of 14. so we want to be able to prevent as many cases as we can so if we know

that diet and physical activity are both modifiable risk factors for depression in particular which we absolutely know from very extensive data from around the world then this is where we should be targeting um our interventions as as the low-hanging fruit yeah it has so many thoughts going through my head at the moment you know you mentioned diet and physical activity are modifiable risk factors for depression but they're also modified risk factors for obesity they're also modified risk factors for other conditions which therefore in my head you extend that thinking further i said well well how

could these two things modify your risk of a whole variety of different conditions maybe all the different conditions aren't quite as separate as we think they are maybe there is a common underlying driver such as inflammation you know i really think about this a lot the more science that emerges in various fields of health and medicine the more we often find that the lifestyle factors that we are promoting to help reduce a likelihood or we even help treat those conditions are quite similar absolutely and i think this recognition of certainly the common mental disorders such

as depression as another of the chronic non-communicable diseases is a really important one because we certainly think on the basis of the research that they all have common drivers but apart from anything else it just makes so much sense to be tackling this and i mean we're really pushing for this lifestyle psychiatry or lifestyle medicine as a fundamental principle in psychiatry because if you think about depression you think about how common it is and recognize that if you are depressed your risk for heart disease and obesity and a whole lot of metabolic problems goes right

up if you have those conditions in turn your risk for depression goes right up and then if you look at the serious mental illnesses such as psychosis and schizophrenia we know that that patient group has a massively reduced lifespan compared to the general population because of their lifestyle behaviours and the impact of the drugs that they are given and we also know that if you tackle their lifestyle behaviours and support them to have a healthy diet and do exercise it actually can mitigate nearly all of that uh obnoxious impact on their metabolic health and then

finally if you go and look at the um the the two intervention studies the smiles trial that we led and the one that came after us in south australia where they did a detailed economic evaluation of both of them and we showed that there was a massive cost saving because the people who certainly in the smiles trial who got the dietary support compared to the social support there was an average cost saving of about three thousand australian dollars and that's because the participants lost less time out of role and they saw health professionals less often

and the healthy med study in south australia found very similar so what it's saying is if you take this lifestyle medicine approach to supporting people with mental health problems in this case depression but it will also be the same in schizophrenia based on what we know so far you're going to get uh huge benefits across the board it's not just targeting a particular molecule a particular you know brain pathway it's it's targeting the whole person yeah and and so it makes all sorts of sense now in 2015 the updated clinical guidelines for the treatment of

mood disorders were published in australia by the royal australian new zealand college of psychiatry i quite a bit of impact uh input into that and they said step zero if you have a patient with um depression step zero should be basically lifestyle medicine it should be diet exercise sleep hygiene smoking cessation substance 2015. that was in 2015. and see that has not been translated that's right that's right and we really need to change the way we we train practitioners and i think you know obviously the pharmaceutical industry has had a big part to play in

pushing a sort of a you know a pharmaceutical approach to treatment and certainly this is not an either or question you know we absolutely everyone in the smiles trial was on well most people were on other forms of treatment but it's saying that this should be the starting point the the fundamental and if clinicians take it seriously and they give diet and exercise advice as a prescription and they say this is actually really important we think that that will uh help people to change their behaviors yeah felice i think that last point is something i

keep trying to hammer home um when i'm talking to healthcare professionals and which is this whole point that first of all some people are very uh close to the idea that food can make a difference in mental health i was um giving a talk in bristol for the royal college of gps to 150 doctors there and at the start i asked them how many of you will discuss a patient's nutrition or that all their food and someone who comes up with a mental health problem and roughly five percent of the room put their hand up

this is only this is after the smile this was 2018 i think actually i think january february 2018. and then i i literally gave a 20 minute talk just an overview of some of the research and some of it i knew was your summit but i've quoted yours but i didn't realize it was yours um and at the end of it i said how many of you gonna do it now and they almost all put their hand up and so it's really that slightly frustrating whereas there is research out there guidelines are being written but

they're not being translated to clinical practice and um this led me a few years ago with a colleague create something called a prescribing lifestyle medicine course that you know we're delighted that the world calls your gps as a credit for the second year running and we we've trained to think about a thousand clinicians now doctors pharmacists we've had a few psychiatrists cardiologists because this is not just a general practice problem this is a problem across medicine and again we are we're not training them in nutrition we're training them in a lifestyle medicine approach how you

evaluate their patients how you can start to input various things from their symptoms and start to deliver a personalized lifestyle prescription and you know 95 of attendees love it and say it significantly influence the way that they practice because we're not being given this information and i i like you share that passion that lifestyle medicine likes our psychiatry these things you know if you think about it the the worst case scenario here worst case scenario is that someone changes their diets they they don't feel any better there's no downside right that's exactly right well let's

dive into that research because i think the smiles trial which is you know i remember seeing that when it came out thinking oh my god this is the first time that i had seen a randomized control trial showing how diets can improve symptoms of depression you know using the same level of evidence that we would expect from a pharmaceutical drug and that was the really exciting thing let's dive into what happened in that trial why you thought of it what the results were but also for the members of the general public who were listening nutritional

research is quite complicated to do isn't it and you've mentioned terms like observational studies epidemiological studies intervention studies could you could you just briefly explain what those are so people understand the difference yeah and this is i have a chapter in the book that talks about this because it is so important that people understand this concept of the fact that correlation doesn't equal causation and doing research in general is really difficult doing nutrition research is just horrendous but um so observational studies or also called epidemiological studies are where you collect lots and lots of information

from people that you believe are representative of the population or representative of a particular group of the population and you use statistics to put those data together and to test hypotheses now we led many many studies in adults including that first one which was my phd then we went on and we looked in adolescence a primary age of onset really important to to look at this in in young people then in pregnant women and in children early in life and then older adults and we were joined by many other people from around the world and

from all of those observational studies we can say that adherence to a healthy diet seems to reduce the risk of depression by about 30 percent but to know whether that is actually a causal relationship whether diet is causing the mental health you need to do experiments where you actually change diet to see if you can change mental health and that's an intervention study now the obvious problem with doing something like that in nutrition is that you can't blind people to the to what they're getting they know what they're eating they know what they're eating you

can't have a placebo diet you know and there's no information to say that one particular form of healthy diet is better than another particular form you can't ethically put one group of people on a junk food diet and see what happens so you've although tim spencer did that to his son you know which is which is actually episode one of this podcast it's the very first conversation i was with the tim and he explained that he that's exactly what he did to his son like any good research clinician would scientists would do but you're right

you can't ethically do that but so you have to do the best that you can and you also have to to triangulate the data so you have to look at the human data you look at the animal studies and the animal studies are really useful because of course you can tightly control diet and then you can chop their heads off at the end and see what's going on in the brain and that sort of thing but with the human data i designed it when i was a very early post-doc the smiles trial and um it

took me a couple of years to get funding for it but we got the funding but they slashed the budget by 35 so we really did it on the smell of an oily rag you know it was a really really difficult and challenging study to do we really struggled to recruit people and i think yeah this is really interesting because we we had hoped to recruit about 180 patients with major depressive disorder after three and a half very long hard years we'd recruited 67 now i think that's for two reasons one is that people in

general were skeptical that diet was going to have an impact on something as serious as major depressive disorder but really importantly clinicians they were just completely skeptical so none of them sent their patients to us to enroll in the trial so that was really challenging um but what we did in that study was we we recruited people with major clinical depression and we randomly assigned them to get either social support or dietary support for a period of three months now the social support we already know that that's helpful for people with depression that's just going

and talking to someone you could be talking about the football or your grandchildren or whatever but it we know that it's helpful and it's called a befriending protocol they often use it in psychotherapy trials as a control condition and then the other groups are a clinical dietitian for three months and that dietitian just worked with those people to help them to gradually make positive changes to their diet to set some goals to do it in a way that was feasible and achievable for them and that was things like swapping out their you know refined carbs

their white flour white bread etc for whole grain versions increasing the amount of vegetables and fruit in their diet starting to eat more legumes so your lentils and chickpeas etc having some nuts and seeds eating fish getting some olive oil into their diet but also really importantly reducing the intake of you know the junk and processed foods of sweets and cakes and chocolate and fried foods over a three month period and at the end of the study because we only had 67 people we had no expectation whatsoever that we would see a significant difference between

the groups on the depression outcomes we just thought it was incredibly unlikely and i sat with the statistician and we did the stats she did the stats and it was you know you don't unblind the groups until the end we just knew it was group a and group b and there was just this massive difference in the depression scores after three months and we were just completely blown away how big a difference well to put it into a i guess a meaningful context more than 30 percent of the people in the dietary group achieve what

we would call full remission where they just weren't depressed at all anymore and that was compared to about eight percent in the social support group so hold on we just got to pause there because you know i'm asking you the question for the listener i'm very familiar with the trial um that is absolutely remarkable you you were talking about people who have got moderate or severe depression who literally they were doing exactly what they were doing if they were on treatment i believe they stayed they were already they stayed on everything they were doing but

it was split into two groups and if you change your diet within 12 weeks you've got above a 30 remission rate in symptoms of depression that is absolutely staggering no wonder you got so much attention after that trial because not only the results amazing the fact that you everything you have to overcome the skepticism recruiting patience all this kind of stuff you know and you didn't know until the end do you remember where you were when do you remember absolutely when you got the results what would tell me about it well hilariously the the statistician

was sitting there and she you know did whatever the statistician does with the magic computer and she oh no there's no difference and we sort of went oh well that's what we expected and then she said oh hang on i haven't done you know xyz whatever it was and she went hang on hang on and then she went back and she went oh my god we really just could not believe it um and then of course we unblinded it and we went that's that's the diagram so that's extraordinary so initially you knew there was a

big big big improvement but you didn't know yet was it the social support group or the diagram yes that's exactly right oh wow and then of course there's a few really important things that came out of that study the first thing is that most people were able to make positive changes to their diet that's really important because so many clinicians i think are very skeptical about patients ability to take dietary advice and act upon it and we found that people loved this it was something that was under their own control unlike so many other things

in their life secondly the degree of dietary change correlated very closely with the degree of improvement in their depression so the more you change your diet the more you would agree exactly exactly third we did a very detailed cost analysis of the diet that we were recommending compared to the cost of the diet that they were eating when they came into the study our diet was a whole lot cheaper so it put to bed this idea that it has to be expensive to eat a healthy diet and then lastly and i think this is possibly

the most important finding in the trial was the economic evaluation showing that massive cost saving because it benefited people across the board now the really cool thing is a few months later that study was more or less replicated but in a group based setting by the group in south australia they found very similar people were able to change their diet the degree of dietary change correlated with the degree of improvement they saw a big difference between the groups and it was highly highly cost effective so that's two clinical trials that have shown this so i

think it's really exciting and we just need to now get uh this translated into clinical practice yeah just a couple things i want to pick up on that first one was when you mentioned that a lot of healthcare professionals think you know our patients aren't going to be able to make that change you know and it goes back to what you said right at the start if we as the clinician prioritize the nutrition or the lifestyle change i think the patient is going to prioritize that if we spend nine out of the 10 minutes of

our lengthy consultation talking about a pharmaceutical approach and as the patient is walking out saying hey if you can improve your daughter and go to the gym that will be helpful as well a patient's going to go out thinking oh it's all about the drug yeah he told me about the lights i think as i was walking out but you know what i can take this drug and i'll be fine whereas if we spend 9 minutes out of the 10 or 90 of the time talking about the diet and nutrition change that might be impactful

and only one percent on the pharmacy so that i think that impacts what a patient thinks and so i absolutely concur with that i really think we need to do better as healthcare professionals at prioritizing those conversations albeit i recognized there were time constraints and i recognized that healthcare professionals particularly in this country are really dealing with incredible workload time pressure so i recognize it's hard but the second point is you know people were able to make those changes and it was cost effective and that is one of the biggest criticisms that gets leveled at

this whole lifestyle medicine movement is well it's for the middle classes you know um it's too expensive uh low socioeconomic status is a big risk factor for these things and of course it is and we will touch on that so that i think that's super important but generally speaking do you think that it is possible to eat well without you know blowing your whole budget we know that it is because we did the really detailed um investigation of this and i mean you know the sorts of things we were recommending to people were very simple

there were things like a whole wheat biscuit with a tin of tuna and um some sliced salad or you know a tin of beans you can buy a tin of beans or a packet of dried beans so incredibly cheaply and they're just brilliant what sort of beans are you talking so like lentils or chickpeas or you know any of those any of the legumes they're really fantastic super super cheap tinned fish frozen vegetables nothing wrong with those and really convenient and we really focused on suggestions that were very feasible so things that wouldn't take much

time you know making up a big pot of stew at the end of the week in the slow cooker which you can get really cheaply and just you know there's many ways that you can do it very very inexpensively you certainly don't have to be having organic food and you know organic blueberries and things like that so i think that's a really important conversation and a bit of knowledge that needs to be uh transmitted but of course one of the key issues we have is that there's so many people with vested interests including big food

who who really benefit from keeping the waters very muddy about what constitutes a healthy diet and that has led people to be exceptionally confused now i know that in the uk and in the u.s something like 75 of junior physicians do not feel qualified to offer dietary advice to their patients and a lot of that has got to do with the misinformation and the mixed messages that have come out of the diet gurus and big food as well about what ease and isn't a healthy diet and what the evidence says about that so i do

agree that there's a massive challenge in clinical practice to tackle these things in the scope of a you know a 15-minute consultation and it may be in australia we're advocating that um there is a medicare item number for people with mental disorders to be able to go and see a dietitian a clinical dietitian because we know from the meta-analysis that we've done that if you use a clinical or a nutrition professional to deliver a dietary intervention you get a far better outcome and that's because they know not just what people should be eating but how

they might get there how they might achieve that so i think that that's one possible solution to the issue of you know um having limited time in clinical practice you can also have shared appointments where you you know a clinical practitioner might see a number of patients at once with the same information and then they've got peer group support so there's different ways potentially of going about it yeah absolutely i just want to highlight the point there um that's on the on this course that we run where we teach doctors it's primarily doctors other healthcare

professionals as well we and out actively encourage referrals to nutrition professionals but but i don't think that negates the need for doctors to know absolutely how powerful these interventions are because here's the thing if we don't know about it we're never even going to think to refer to a nutrition professional in the first place and i'm really pleased the feedback we're getting from the doctors who've attended our course is it is increasing their referrals you know if they've got a clinical dietitian nearby great if they've got a nutritional therapist nearby great whatever you know whatever

services they have available to them they're able to refer out they start off in let's say that 10 or 15 minutes saying hey look have you thought about diet as an approach and if a patient's engaged in this they might give some preliminary advice but also make that referral on to a nutrition professional who can actually go through that in detail um so i think i think that's a that's a really really good point one thing i i really want to go into the foods that were in the smiles trial what foods were these participants

given and then why do you think that these foods had an impact on moods great question that we don't have the answers for so uh we base the dietary advice on um the best science available and that of course the the mediterranean diet has this by far the strongest and the largest evidence what do you mean by a mediterranean diet because a lot of people don't say there's many you know and it this is not a prescriptive diet but it's basically a diet that is um much higher in plant foods so vegetables and fruits legumes

that's your lentils and chickpeas etc nuts and seeds so all these sources of dietary fiber and we can talk about why that we think that is particularly important in a little while but also healthy fats so these are the mono and the polyunsaturated fats from fish and olive oil etc you know healthful forms of protein but we also included recommendations for um three or four uh palm-sized servings of unprocessed meat per week which is at odds with the traditional mediterranean diet and that was on the basis of a study that i'd published where i saw

very unexpectedly a very clear u-shaped relationship between red meat intake and depressive and anxiety disorders and even bipolar disorders in this large population based sample of women so women who had less than the recommended intake which is this three to f uh four small serves a week or more than the recommended intake when we took into account their overall diet quality they were twice as likely to have a clinical depressive or anxiety disorder okay i mean this is this is super fascinating especially with the growing movement to move to vegan diets um which is you

know exploding worthy around the world in terms of popularity a lot of people are doing it for um ethical reasons um and there's a lot of as you well know a lot of controversy in what i call the the social media diets wars it really highlights how um how complex nutritional research is because people seem to have the same paper and there's five different interpretations and then people write their blogs about them and then joe public is like well what the hell do i do because i this expert who i respect saying this this expert

who i respect are saying the complete opposites and i think that that confusion is causing big problems with patients i see that all the time they're just confused with doctors exactly and you know i i'm sort of trying to keep on top of the research and even i get confused sometimes i think well hold on a minute i thought that and then now this trial is suggesting that and it's you've got to take that balanced approach but let's dive into some of these foods so red meat right is red meat from what you have seen

i mean i mean that's an overly simplistic question i i'm sort of i'm trying to bring out basically do you think red meat is good for our mental health i have no particular opinion on it i think our study was a really unexpected finding it was a very clear finding and it's sort of concordant with other epidemiological studies where you see a link between vegetarianism and poor mental health but we just don't know whether it's a causal relationship it could well be explained by third factors that we haven't measured or haven't accounted for so i

would not hang my hat on that i do hear a lot of clinicians saying that they quite commonly will see young women who are menstruating who are vegetarian and they're really in a terrible state and they have um they get a lot better when they reintroduce red meat into their diet i have seen that many times i really haven't um i guess this is one of the reasons why i'm very diet agnostic and i have the same i have certain preferences in certain conditions if i'm honest because i've ultimately as a doctor who never got

trained in this stuff at medical school i was getting very frustrated at just prescribing pills all the time for problems and i thought there must be something more i could do and i sort of of my own back would read the research and think well i think changing a diet is probably going to be helpful and there's no downside to doing this i'm going to at least do that as part of my approach and i would see a lot of improvements in various conditions and i do see that sometimes but again there are many people

out there who have quite a bit of red meat and seems to do really well with their mental health other people i see you know they transform their diet from a heavily processed western diet they go whole food vegan and they seem to be thriving as well and i think well hold on a minute different diet seems to do well for different people and i do think the microbiome is possibly the the sort of core explainer there but so rhetoric you have no opinion on yet you have seen some studies suggesting that if you're not

having any it might negatively influence your mental health and it may be very much an individual thing i mean personally i don't generally eat red meat because of the ethical and the environmental concerns but my daughters who are menstruating i do encourage them to have a small amount but i really wouldn't hang my hat on that and if you look at the second intervention study the uh the healthy med study they were promoting a far more traditional mediterranean diet that had very very low meat intake and they also got a really positive effect now i

think one thing that you know we're seeing in the u.s these advocations are very very extreme diets these ketogenic and these carnivore diets and all the rest of it and i suspect that the the standard american diet or the sad is so awful just so utterly terrible that almost anything you do to change it is better what's interesting for me is that there seems to be a lot of short-term benefits from a whole variety of different diets and i i think you're right when whenever we stop having that unhealthy highly processed western diet anything tends

to be better there are some trials i understand and what i can see showing that particularly in type 2 diabetes ketogenic diets can certainly in the short term look very very promising in terms of blood sugar markers long term i guess so i can only talk about my own experience i guess as a clinician i have used on numerous occasions with someone who's got you know type 2 diabetes in the short term i often use a diet low in refined and processed carbohydrates i don't particularly i've said it before i don't like the name low

carb diets in general because i think it's too broad and i think we've probably unfairly demonized fat for 30 40 years i think we're doing the same to carbohydrates by saying a low carb so really cut down a low and refined and processed carbohydrates but then what i try and do with those patients to say is explain to them that insulin resistance is driving their type 2 diabetes so in the short term this is going to help you just get on top of things but then i i try and repair things so whether it's with

increasing their muscle mass which is going to improve insulin sensitivity help them improve their sleep which is going to improve insulin sensitivity you know help them manage their stress levels which is going to improve insulin sensitivity and as that insulin sensitivity gets better i start to increase more and more of that especially the fiber and a lot of you know things like sweet potatoes all these kind of nourishing carbs that we know are great for the gut microbiome and so i also think there's there's something in short term um versus what might be the right

diet for longevity and i i don't know the answer to that but i think about this a lot because i think a lot of patients follow these diets because actually they're not feeling great and then they either read a blog or they see a clinician who has a certain bias and they try a diet i feel fantastic i think hold on a minute i used to feel sluggish and i used to struggle to lose weight i had joint pain and now i've changed my diets i just feel incredible and so you know that's not science

i i totally recognize but in some ways you can't blame people for who are suffering it's they're not getting help absolutely they're going to do it right absolutely and i think that's a really important thing though is we don't know whether it's what people are eating or what they're not eating when they change their diet and this is true like with the smiles trial we don't know if it was because they increased their vegetables and fiber etc or because they reduced their junk and processed foods they did both at the same time but if we

look at the epidemiological literature what i think is fascinating is that healthy dietary patterns and unhealthy dietary patterns are not related to each other they're not just the opposite of each other there'll be lots of people who have really particularly like kids have lots of healthy food at home but then they have lots of junk and processed foods when they're out and about that is still problematic for mental health there's other other groups that is so key so again that is really really key because i think people think i can eat what i want but

if i have a bit of broccoli now and again i'm being healthy that's right and and the evidence does not support that in all of the incredibly extensive studies that we've done now we see that healthy diet and unhealthy diet wherever you sit on that scale they're both independently related to mental health outcomes so if you are having lots of healthy food but also having lots of junk and processed foods it's still going to be a problem similarly lots of older people will not be going out and having macas and you know lots of junk

and processed foods but they'll be having a very limited kind of a white diet whether at home or in a nursing home or what have you and that's also problematic so they're not just the opposite of each other we have to tackle both yeah key key points in terms of the diet that your participants in the smiles trial went on you mentioned what those foods are and you've also mentioned that we don't know what it was about it in my last book the stress solution there's a chapter on fibre and how that can help you

know with the gut microbiome and therefore stress levels i quote some of your research i quote some of john cryan's research in there what's really interesting for me if we think about that diet and and i i sort of i think i wrote a paragraph on this i said for me whilst we're waiting for more research there are a couple of things there which really spring out to me that could be making a difference you had fatty fish in there i i believe there's fatty fish in the diet what's there yeah fatty fish and lots

and lots of olive oil as well yeah so there were some omega-3s from the fatty fish you've obviously got all the benefits of olive oil so either of those independently you could you could make a case for thinking was it that that did it yeah but then the big one for me as well as that was this whole point you were encouraging a very diverse range of foods and so let's talk a little bit about diversity of foods and let's talk a little bit about the gut microbiome and why that is so important it's so

critically important and it's so interesting you know we can see that medical science has been transformed a little bit in like what how physics was transformed when they discovered the ultra small particles this knowledge that these bacteria that have co-evolved with us have such an important role in our health is really giving us some new insights that we can act on to i think improve a lot of health outcomes the bacteria in your gut in particular very very simply speaking they break down the fibrous foods that our human enzymes can't break down so fiber is

found in plant foods things such as vegetables fruits whole grain cereals legumes your nuts you beans and lentils etc so all sorts of different types of plant foods have dietary fiber the gut microbes break that down by a process of fermentation and in that process of fermentation they produce many many many metabolites and it's the production of these metabolites that seems to be so important and we know that they for example interact with every cell in the body through these particular receptors they influence gene activity i mean really importantly most of what we know so

far comes from animal studies so we always have to be a little bit cautious but there are more and more human studies and we're doing many studies in our center that is you know looking at this if that conversation resonated with you here is another incredibly powerful one that i really think you're going to enjoy give it a click and let me know what you think there's a lot of foods that actually impair our health defenses our circulation our stem cells our healthy gut microbiome the ability for our dna to protect our bodies from the

environment and also our immune system your body can't handle some of those foods that we have gotten used to eating