Foodloose Recap transcript

Written by Christopher Kelly

June 9, 2016

[0:00:00]

Christopher:    Hello and welcome to the Nourish Balance Thrive podcast. My name is Christopher Kelly and today, I'm joined by my chief medical officer, Dr. Tommy Wood.

Tommy:    Hi!

Christopher:    We're here in person in Iceland. It's quite exciting. We sat in Tommy's mom's house in the conservatory in a very windy and quite cold Iceland. We're going to talk about the Foodloose Iceland Conference that we attended yesterday. Tommy was one of the speakers there and there were some other very exciting people and some really interesting presentations, and I wanted to sit Tommy down and get some of his thoughts on what everybody else said.

Tommy:    If people listened to the previous podcast that have had Guðmundur, who is the CEO of the Icelandic Health Symposium which ran the Foodloose Conference, we've talked a bit about it. They put together a really amazing day actually. It was in the Central Icelandic Concert Hall right downtown Reykjavík, which is a very impressive building, in the main hall. There was great food all day.

Christopher:    It's incredible. I've been to a few conferences now and I've not been to one that good. That building is a world class conference center and the acoustics in the hall that we sat in -- how many people does that hall see?

Tommy:    It fits about I think 1200 to 1500 if you've got them full up to the rafters.

Christopher:    Right, so it's like a properly acoustically-sorted center. Yeah, amazing, really, really high quality conference, and then the catering was great. I've been to some conferences recently and they break for lunch and you go outside and there's this line of people that get to the food and then they leave without taking anything because they've got sandwiches.

    It's like the standard caterers that they have for the conference center and they've not really talked to each other, whereas this was -- it was all gluten-free, sugar-free. It looked like it had been prepared by a chef. It was really high-end catering.

Tommy:    It was some award-winning chef whose name I can't remember who was actually winning competitions and then was brought in to cook their food.

Christopher:    Yeah, it's phenomenal. So why don't we start with Aseem Malhotra?

Tommy:    Yes. He came on to the scene probably about two years ago actually and he was best known for -- he did this piece on the morning news, at the national morning news where he was talking about how fat isn't harmful in the diet, so he's particularly focusing on a Mediterranean style diet so with nuts and olive oil and things like that and removing processed carbohydrates and sugar from the diet.

    I've watched that piece. This was just after I moved to Norway, so I watched it on YouTube and there's this guy who's tall, slender, handsome, Indian guy who's talking about this stuff. And then they bring in this slightly overweight, haggard-looking National Health Service dietician to tell us that he's wrong. If you look at the two in comparison, I'll definitely want to believe the guy who actually looks like he's healthier and in good shape. I definitely trust his opinion.

    Since then, he's on the news all the time actually talking about health. He's become a big part of Action on Sugar, trying to get sugar tax introduced. Some people might see him -- if you've heard of the Run on Fat movie, they've just done another movie based on the actual Mediterranean diet. It's actually the later work of Ancel Keys where he gave up on his low fat quest and then started to move towards the Mediterranean diet and high fat diet. They filmed it -- I think that's going to come out in the next few months. It was done by the same guy who made Run on Fat.

Christopher:    That's Donal O'Neill who's the producer of that movie. I'll link to that in the show notes for this episode.

Tommy:    He's mainly involved in public health stuff now. I think he still does some cardiology, looks after some patients, but he's mainly on the political track as a voice. He's part of the National Obesity Forum and the Public Health Collaboration, which are these two groups in the UK.

    There are a lot of people that I know -- a lot of my friends are on those actually, doctors mainly, who try to change the dietary guidelines in the UK. They just came out with their recent recommendation, which is that people should just eat actual food and if that food happens to have fat in it, well, that's actually not a bad thing. The UK has lost its mind this week because of that.

    He's really the up-and-coming star in the area. He talked about sugar, lots of data about the effect of sugar on health --

Christopher:    It was a shock and awe presentation, wasn't it? A lot of bulletpoints and statistics.

Tommy:    I've seen him speak before. If people find it difficult to follow that kind of presentation -- it's difficult to hear him speak, but he's very passionate and he's very eloquent. He can overcome the pure volume of data that he's throwing at you.

[0:05:07]

    I always enjoy hearing him speak, but he follows a very traditional presentation style, so there's a lot of information that if you're new to it would be quite difficult to take in.

Christopher:    The thing I remember from it was the image of McDonald's in Guy's Hospital --

Tommy:    Yes. He's talking about how the fast food industry -- or there are lots of fast food available in the UK and also in the US, although there are some places that are changing that, and he gives this sign which has a McDonald's -- there's a sign in Guy's Hospital, "McDonald's 200 meters", and that McDonald's was in the building that I lived in when I was a junior doctor, so that McDonald's was right beneath my flat for two years.

Christopher:    It is pretty bad. It's pretty bad. Do you think his analogy -- so he started talking about or comparing sugar to tobacco, which I don't think is a fair comparison actually, but what do you think?

Tommy:    I think in terms of the actual health risks of sugar, I think they are nowhere near the health risks of tobacco in smoking because there are plenty of people who are completely metabolically healthy, and they could have some sugar and it really wouldn't harm them in any way at all.

    I think the main comparison is the tactics that the industry uses to try and get them to the market, so they're very good at marketing to children. They're very good at creating this all-pervasive everything in moderation, and that message came up at the conference as well. People were asking, "Everybody has talked about removing sugar and low carbohydrate diets. Can't we just eat stuff in moderation?"

    That's definitely the message that's getting out there and I think that's where it's come from, so they're basically getting public bodies on the side usually with some kind of financial support and then you have very prominent people, politicians and doctors, saying actually, you know what? Sugar is fine in moderation as part of a healthy diet.

    There are people like Aseem where they're saying actually, just this huge pervasive nature of this processed food especially sugar just in our environment is inherently damaging through the access that we have to it, but they can slowly discredit him because there's always somebody with a big name who can say, "Actually, he's wrong" or "I disagree."

    It was the same with the tobacco companies a few decades ago when they were paying politicians. They were going and very famously lying to congress about the health effects of tobacco and smoking. I think it's the tactics that are very similar and you can immediately compare the health effects.

Christopher:    Right. And then people are accusing him of being a leader of the Nanny State. They have this concept in the UK they call the Nanny State where the government is poking their noses in a little bit too far into people's private concerns. He's right. It is pervasive or ubiquitous, the sugar.

    He showed some pictures of petrol stations. We call them petrol stations. I suppose you call it a gas station in the US. Just the whole place is a candy store. It's like a huge candy store. He also talked about a newsagent in the UK called Smiths that's been around forever. I can remember that one when I was a kid as well and he was right. When I used to go in there as a kid, it was just magazines and newspapers, and again, now you go in there and it's a huge candy store.

    The reason I don't think it's a fair comparison with tobacco is because there's a real danger of passive smoking where there's no danger with passive sugar consumption.

Tommy:    We've talked about this and I think if you're a baby in the womb and your mom is smashing Mars bars, then I think you're being passively affected by that, so maybe in that context.

Christopher:    Right. You get bored and then you have this huge hypoglycemic episode the second you leave the room.

Tommy:    Absolutely. Babies are born with mothers with severe gestational diabetes and the problem is that we're seeing that started to cause epigenetic programming and those babies are at such a huge risk of different types of diabetes and obesity much earlier in life.

    If your grandmother did that to your mother, it gets passed down the line, so those metabolic problems then are appearing earlier and earlier in life because people are being exposed to the same environment but also because of what happened while they were being grown.

Christopher:    We did The Paleo Baby Podcast with Lily Nichols and I should link to that in the show notes of this episode because that was quite interesting too as well because she's been working with women with gestational diabetes, so I'll link to that.

    So after Aseem -- it was supposed to be Gary Taubes that came first on the lineup. Gary flew in that morning into Iceland and I'm not sure where he was coming from, somewhere in the US, I believe.

Tommy:    He's based on the West Coast at the moment. He was talking about that.

[0:10:01]

Christopher:    Is it possible that he flew in from [0:10:01] [Indiscernible]? That's where we came from, from California to Iceland. It's a hell of a journey and he probably stopped somewhere on the East Coast, so, crazy. He must've been super jetlagged and really tired. He missed his opening slot and Aseem took it. When that talk finished, the speaker, the emcee -- what's her name again? Maryanne Demasi?

Tommy:    Maryanne Demasi.

Christopher:    She was saying, "Oh, I do believe that Gary Taubes is in the building," and it was pretty funny, but it did build tension. He didn't fail to deliver, did he? He is an extraordinary speaker. I've never seen anything like it.

    He has incredible presence on the stage and then he gave this presentation without pausing or hesitating or using the word "er" or "um" or anything. It was just continuous, rapid fire, really, really impressive, making eye contact with the audience all the time, not really looking at his slides, only when he was going to read a short passage, really, really powerful.

Tommy:    Yes. He was an exceptional speaker and he's really good at telling a story and trying to tie things together. You can see why so many people have listened to him, is because he's very convincing actually.

    He's put together a really nice story of the alternative hypothesis of obesity, which is basically flipping the conventional thought on its head and it's not that people are obese because they overeat. It's people overeat because their fat cells are overly accumulating energy and then they need to eat more to get energy they need for other bodily functions. It's essentially what he was talking about and that the accumulation of fat cells is driven by insulin.

    He talked about the history of this alternative hypothesis, which was largely from the Second World War when the language of science was German and this is what people were starting to think. And then obviously after that, after the Second World War, everything switched over to English and we basically started from scratch.

    I think we're seeing them in a number of different areas where a huge body of science was done either in Germany or in the Soviet States in the last 100 or 150 years, basically in Europe and the Western world. We're reinventing the wheel now and they did this work a hundred years ago.

    And so, when we started to do obesity research tinkering with single genes in animals and trying to pretend that it actually has anything to do with humans, we basically just started with the assumption that it was caused by overeating and then everything is based on that assumption where actually, if you go back and look at some of the other factors that are involved, we basically started -- everything is based on an essentially incorrect assumption. You can almost pull down a hundred years of obesity research in one go.

Christopher:    I thought it was really interesting the way he talked about the history of how we got to where we are today. He made the comparison with physics, which is where Gary Taubes really came from. He talked about how you don't just learn a theory. It's almost got a name attached to it like Einstein's Theory of Relativity.

    As a physicist, you learn about the history of that theory because it's important. It means something and you don't really do that in nutrition science, and Gary Taubes came to this. He tells a story about how he was an investigative journalist and was really interested in bad science. Somebody said to him, "Well, if you want to see some bad science, you should check out nutrition. You'd love that," and that's how he got into it.

    He did a really good job of building up to that kind of -- he builds suspense really well in the presentation. By the time he starts talking about insulin, I'm like, "Oh come on, Gary, just tell me why people get fat." You're really hankering for the answer. Amazing. I don't know how long he talked for. He must have gone well over an hour and no one was timing him.

Tommy:    Actually, that was the same for all speakers. Everybody was given -- the day overran hugely, but it was nice that there was no pressure and people just talked as long as they actually needed to, but apparently when they were setting up the schedule, he said, "I physically cannot talk for half an hour. I can talk for a minimum of 50 minutes."

Christopher:    Oh really?

Tommy:    Yeah. So apparently, he was just like, "I can't tell my story in 30 minutes. It's impossible." I think he's clearly given that talk a great number of times, but then when we see the stuff that came later in the day -- he's obviously built up a very good story about the truth behind the dietary guidelines and how that may have affected the obesity epidemic and how that affects how we get fat.

[0:15:11]

    But actually, when it comes to applying that knowledge to help people go in the other direction, I don't really think he has very much experience in that and you see that. We did a panel discussion at the end where people were asking for advice about things like that and then it very clearly becomes obvious that he's like -- there were two different questions here.

    One is how the dietary guidelines and the science was done wrong and how that affected our health, and then there's how to reverse that and it was quite clear that that second part was not his forte. Teaching people the history is really good, but then how you put that knowledge to reverse it was something that he just hadn't done nearly as much of.

Christopher:    And I thought he behaved very much like an investigative journalist still. I kind of had him in my mind's eye as slightly arrogant, as someone coming from the outside who figured it out and was just thinking everybody was stupid for not realizing the same thing, but when I saw him yesterday, he seemed like an investigative journalist. He was very inquisitive. He was asking Tim Noakes questions and asking some of the other doctors, the cardiologists, questions. That was quite a surprise to me.

    Travis Christofferson is kind of the same. He's technical. Travis is a molecular biologist, but he's also an investigative journalist and he's extremely inquisitive. It's really nice to see that. I'm sure he would change his mind again if he were to be proven wrong, but do you think he is wrong? Are you a fan of his insulin hypothesis?

Tommy:    I definitely think he's on the right track. He's almost still conforming to the idea that obesity is purely due to an energy balance problem. It just that it comes from the other direction that you're being forced to overeat because of hormonal issues and that's purely due to insulin and carbohydrates, but I think it's a bit more complicated than that and there are other things involved.

    And so, he gave this example of all these -- he was saying that obesity isn't purely to do with affluence and the availability of these nutritionally poor, energy-dense, carbohydrate-based foods, which obviously we have around us nowadays because if you go back 100 to 150 years, you'll see all these populations around the world particularly parts of the US and then some specific islands and places like that, these are people who are in abject poverty but still a good proportion of the population are overweight and obese. He blames it solely on the carbohydrates that they're eating.

    Obviously, what I spoke about much later about all the other things that are important for health, these are people who are chronically stressed, not sleeping, they are in abject poverty and these are people who cannot do the things that it takes to do to be healthy and the body is in such a hugely stressed state where if you're not sleeping properly, you completely dysregulate all of your appetite hormones, same with chronic stress.

    So yes, the fact that the only food they had were refined carbohydrates is a part of that, but if they weren't in that situation to begin with, then I don't think it would be that much of an issue. So he's blaming purely the food when these are people who are in such terrible living conditions that that has to be the trigger in my mind and then the food is just a part of that. So I think he's definitely right in part, but I just think it's more complicated than that and we have to accept that.

    It's very similar with -- there's a paper that came out in Nutrition Journal -- I guess it's almost two years ago now and it was somehow created by Nina Teicholz because she's in the acknowledgments and it's very much in line with her book, The Big Fat Surprise, in terms of the dietary guidelines and how that correlates with the obesity epidemic. They look at population data in the US, the NHANES data, which is basically where you call people up and you ask them how they ate in the last 24 hours and then you actually assume that that has anything to do with their health outcomes.

    Basically, they show that people are eating more carbohydrates since the dietary guidelines were introduced and then they try to say that this reduced the proportion of fat in the diet, but the fat didn't change. It's just they added more carbs essentially. And so, they use this to show that since the dietary guidelines came with practice, people did what they were told and they ate more carbs, and they actually ate more calories in total because they just added carbs on top, but what's actually the case is that data is so unreliable.

[0:20:06]

    People are underreporting by up to a thousand calories a day and more than 50% of the NHANES data has been calculated to be physiologically implausible. So basically, what people are saying they're eating, they're just not eating, and this is particularly important. The more overweight people are, the more shame there is involved with eating, so the more they underreport their calories and underreport their intake.

    So this group of people who are gaining weight, they're the people who want the data on there, the people on whom the data is the most inconsistent. So this is all part of a very interesting story but actually, we just don't have the data to support it.

    It's a nice idea that the dietary guidelines just suddenly screwed us, but I really think that there's so much else that's involved and that's a lot to do with the food that is available to us and all the other stuff that's involved in modern life. There are lots of things that happened since the 1970s and 1980s that coincided with the obesity epidemic and now the Type II diabetes epidemic as much as just an increasing availability of carbohydrates, so it's a really interesting story and I think it is a big part of what's happened, but I think there's more to it.

Christopher:    Do you think we're ever going to solve that problem? Because we have metabolic ward studies now but even those, if we're going to say this is a bit more complicated than that and any solution that just involves one variable like insulin is probably going to be wrong and the stress and the sleep and all the rest of that, then even if you put someone on a metabolic ward and you're quite confident about understanding what's going on with their metabolism, you still don't really know how that would be different from their real life.

Tommy:    You can't answer that question because people don't live in a metabolic ward.

Christopher:    Exactly.

Tommy:    It's really nice. You can have Kevin Hall who'll spend millions of government dollars trying to disprove the insulin hypothesis by doing very, very accurate, detailed measurements and make his own decisions, which is why we've talked a little bit about this before, but that literally has absolutely nothing to do with what a person does in real life.

    So we can try to understand the physiology, but there's so much more psychology and environmental influences that will then completely change that, which is what probably we'll never be able to measure.

Christopher:    Yeah, slightly depressing, but that's life, folks. Next up, it was Dr. Axel Sigurdsson. Did I say that right?

Tommy:    Axel Sigurdsson.

Christopher:    Sigurdsson, okay, and he's an Icelandic cardiologist. Is that right too or is he originally from Sweden?

Tommy:    He's Icelandic.

Christopher:    He was an interesting guy. I think you know him better than I do. Why don't you tell us a little bit about him?

Tommy:    He's an Icelandic cardiologist and he started writing leaflets particularly about diet and lifestyle for his patients that are Icelandic maybe 10 or 15 years ago just as like a small blog literally at the beginning of the internet.

    And then he transitioned to a website based in English which is called docsopinion.com, which some people might have seen, which is based mainly around heart disease and the effects of heart disease and lifestyle factors, different diets, and a lot to do with how to understand your cholesterol numbers like what your LDL cholesterol means, whether that's actually bad, maybe better things like your triglyceride to HDL ratio, stuff like that.

    He's just a really solid, sensible guy and that's why I really like him. He's purely, purely evidence-driven and he's never been dragged into the emotional side of things. When he's talking about low carbohydrate diets or people with cardiovascular disease, he says these are the things we see. I think there's some benefit there, but that doesn't mean that that's the only solution or that we've definitely proven that they'll stop getting cardiovascular disease because that data doesn't exist.

    And then people are like, "Well, how can you say that? How can you be ambiguous?" And he's like, "Because all I can do is tell you the data that exists" and that's very frustrating to people because he can't give you a yes/no answer because he's so balanced. I know some people don't like that, and it's the same with statins.

    He was asked about statins and he says that he does still prescribe statins, but mainly for secondary prevention so people who've already had a heart attack, to prevent them from having another heart attack where the evidence is slightly better and probably more so in men because the men seem to do better on statins than women do. I could tell that there was some pushback about that just because he was prescribing statins at all, but --

Christopher:    I must admit, my opinion of him did go down.

Tommy:    Yeah, and that's the standard reaction, but the thing is we are not cardiologists and we don't work with these patients day to day.

[0:25:06]

    I think the scenario when they're coming into play is when you have somebody who comes into your clinic who has had a heart attack, is in bad shape, and you talk to them about the lifestyle stuff, they're like, "You know what, doc, just give me a pill."

    And then actually, regardless of what you think of the trials, which are hugely flawed and hugely biased and always overstate the importance like the benefit from the drug and understate the negative sides of the drugs, there is data that suggests that they may be beneficial, so a good doctor who can't get the other stuff to be done, can't get the lifestyle interventions in place would prescribe statin.

    That's the state of the evidence we have currently. I certainly don't question that because I know he's read literally everything. He knows all the data and he's very clever.

Christopher:    Yeah, and you have to understand the context and that's something that I've come to appreciate recently when I interviewed Jason Fung for the Keto Summit, was up until that point, I really didn't understand Jason's context.

    He was talking about a 75-year-old patient who had been in his office that morning, 400 lbs, Type II diabetes in danger of maybe losing a leg or a kidney or something like that, and what am I going to do for that guy. You might talk to him about hyper palatable food. I don't think so. You need to do something --

Tommy:    He just needs to stop eating.

Christopher:    He just needs to stop eating for two years literally, so yeah, the context is important and it's not like Axel is prescribing statins for all.

Tommy:    No, absolutely, and he did talk about how they are overprescribed particularly for primary intervention, so he made that point. It's not that he's doing the traditional job. He's just now using them as a targeted intervention where they may actually be beneficial.

Christopher:    And it was interesting to me that I met a local businessman called Helge [0:27:00] [Phonetic]. Hi, Helge! You might be listening to this podcast. We had lunch together. He discovered a low carbohydrate diet through this friend that went to the doctor and was told, "Okay, you've got two options. You can either have a low carbohydrate diet or you can have a statin drug," and I thought that was incredible that the doctor has said that to him.

    He said, "Okay. I'll try the low carbohydrate diet" and immediately, he lost 25 kilos or whatever over the course of the next few weeks. At the beginning, he was like, "No way. This is quackery. I can't understand it. This could never work." And then of course he did the same and also lost 25 kilos. I think it's been incredibly progressive. I've not heard about that in any other country.

Tommy:    Yeah, and I think this is part of what we've talked about with Guðmundur on the last podcast and that's something that I think he's been quite instrumental in and Axel has been instrumental in, is there's this group of doctors particularly online where they've got like 20% of all the doctors in Iceland and they're continuously posting stuff to do with lifestyle, medicine, diet, and how that affects health. There's a lot to do with cardiovascular disease, low carbohydrate diets.

    And because it's such a small, tight-knit community of doctors in Iceland, you actually have access to almost the majority. The hall we went to yesterday was full of doctors and again, you probably have 5% to 10% of the doctors in Iceland where they all know about the conference, reading about the conference in the newspaper. So because it's such a small community, you have direct access to these people, which means it's much more likely that they're going to change their mind because there isn't this huge body of resistance.

    So I truly do think that if there's ever going to change anywhere, it's going to change here and it's going to change because of people like Axel and Guðmundur. In Iceland, you can call up your mate who's a dean at the medical school and say, "You know what? You need to teach your doctors about nutrition," and they're like, "Yeah, fine. Just come and do it," and stuff can change like that overnight as long as people are receptive, and I think that's really starting to happen.

Christopher:    Yeah, that's phenomenal, I think. So who was next? Prof. Tim Noakes, wasn't it? Tim was great.

Tommy:    I was so, so excited to meet him and it was really great to listen to him talk.

Christopher:    Yeah. I didn't think he would remember me. He's been on my podcast before, and I'll link to that, but I didn't think he would remember me because surely he has done hundreds, if not thousands of podcasts with random people from the internet that's been arranged by his personal assistant.

    He looked at me. I shook his hands and I don't think he initially recognized me, but the moment I started speaking, the light went on and he goes, "Oh yeah, as soon as you spoke, I knew exactly who you were." He's just such a lovely guy. You see these pictures of him and he's got his cookie smile there in the picture I'm looking at. That's really what he's like. He does it all the time. He doesn't stop smiling. He's a very likeable guy.

    So what was the hypothesis? I can't remember much about the presentation now.

Tommy:    He talked about insulin resistance and he started with some data from himself back when he was 30 or something. It was looking at --

[0:30:09]

Christopher:    It's from the '70s.

Tommy:    Yeah, so they were trying to --

Christopher:    This is a guy that's published 750 scientific studies, which is pretty amazing. This was one of the really early ones where they looked at ketones and glucose and insulin.

Tommy:    Yeah, so what they were trying to prove is that you need carbohydrates to fuel marathon running. And then as a comparison, they did a very low carbohydrate diet, so they had three different days where one day they ate normal carbs. Maybe they ate it for two or three days beforehand, and then they ate a low carbohydrate diet beforehand and then there was another day like a control day. The interesting thing that he saw was that his fasting insulin on the control day was almost 30.

Christopher:    [0:30:59] [Indiscernible] 40. He couldn't say the exact number.

Tommy:    Yeah, which is incredible. Then he was looking back and he was like, "So I was doing all this running and I was eating all these refined carbohydrates and I was insulin-resistant already back then," and then he was already on the track of becoming a Type II diabetic, which he obviously is now which he has to control with his diet. And then he obviously talked about his book and the law of running.

Christopher:    He's rewriting that book, he said. He said the first four chapters had been ripped out. They're in the bin.

Tommy:    Yeah. It was brilliant because he was talking -- I sat next to my mom actually and he gave some quotes from the beginning of the book about how important carbohydrates are and she looked at me and she's like, "Wait. This doesn't sound right." And then he was like, "All of that is nonsense. It's all wrong. I had to tear all of that out of the book," which I've heard about before. He's actually done it in public apparently when he was talking about the book. He physically tears the chapters out.

Christopher:    He's an amazing guy. I wonder why there's not more people like him that have seen that they were wrong and fessed up and said, "You know what? I was wrong about all that crap." He seems to be the only one doing that and I can't really understand why. We were talking about this last night. We don't understand where his funding comes from. He's been excommunicated from the university and --

Tommy:    Yeah. I have no idea how he makes money anymore. He's still technically an emeritus professor, but that's not usually a paid position. It just means that you have some professor's rights at the university you used to be based at. He's been excommunicated. He can't do anything to do with the medical students or the medical school.

    Apparently, they're saying that if any medical student mentions a low carb diet -- so the dean of the medical school came out directly against Noakes saying he was wrong. You need carbs for whatever. So then if any medical student mentions a low carb diet, they're immediately brought up to the dean of the medical school because they have actively spoken against the dean of the medical school because they've said something that he disagrees with, so I don't know. I'm not sure how he does it, but he's obviously got his book. He probably has some people who support him I guess in his message and his work.

Christopher:    It was the Noakes Foundation. It's what was written on all of his slides. He talked about a new book that he's just finished writing called Making Little Superhumans or something.

Tommy:    Raising Superheroes?

Christopher:    Raising Superheroes, that's it. So I was thinking about reading that book and then talking to him about that for the Keto Summit because I think that's really interesting.

    Obviously, he's in a spot of bother at the moment for something he said in public concerning weaning children onto high fat diets. We were talking about it this morning and we think he's been forced to say something he didn't really mean by the brevity of Twitter even if you've got 128 characters and we were trying to think of a way that we could say this.

Tommy:    Yeah. How do you tell somebody -- and I guess the problem -- the issue that they take is that he gave nutrition advice and stuff that they question and he did it via Twitter. People do this all day every day. There are hundreds of doctors in nutrition on Twitter and they do this stuff all the time, which has questionable legality. In 140 characters -- they've changed it now, right?

Christopher:    Did I say 128? Yeah, 140.

Tommy:    No, no, no. It's a little bit -- actually, if you include a link or you include somebody's Twitter handle, now it doesn't count. It just changed last week. Now, it doesn’t count, so you can actually have 140 characters of actual text as well as all the other guff that goes in.

    Anyway, how do you tell somebody in 140 characters to wean their kid onto actual real food that they have cooked themselves from single ingredients?

Christopher:    Right. You can't. You can only link to something.

Tommy:    Yeah, so he just said, "Wean onto to low carb, high fat," which I don't think he really meant because there's no reason why your kid can't eat fruit.

[0:35:09]

    In South Africa, they call it the Banting Diet. That's how they phrase it based on William Banting. I think he just got a little bit lost in translation then it was picked up by some nutritionist, some nutrition associations, and then he's obviously gone into trouble that he's gone into and it's been really nasty. He's really been dragged through the mud.

Christopher:    And I think he had to cut his trip short to go back to face the music there.

Tommy:    Yeah. He was going to stay for longer, but they keep on putting off this tribunal or whatever hearing, and so he had to go back for that again.

Christopher:    It was quite dramatic, the style of his presentation as well. There's that one slide with a bunch of information like how carbohydrates are essential for marathon runners and all of that, and then he would slap on top of it another slide that didn't entirely cover the original slide showing why it was wrong. You could see that he'd gone for that style.

Tommy:    Again, he presented some really nice old work and that's what I think is really important because back when science was good maybe 20 or 30 years ago -- because everything else -- well, not everything. So much stuff that's been done recently is just nonsense.

    Back when physiologists were really meticulous and they didn't have to worry about funding, they didn't have to worry about just publishing as much as possible, they just didn't live in the same environment and they could just do good work, they didn't have to worry about statistically mining their data to try and find something interesting that were then some editor or journal would like it, then the physiology was really good.

    Actually, he presented some old data about how carbohydrates aren't essential and how eating carbohydrates especially increase the level of triglycerides in your blood. That's what he focused on a lot, was the triglycerides in the blood. It was another kind of shock and awe tactic presentation, but it was very polished and I enjoyed it a lot.

    He's very strict about carbohydrate restriction in the setting of insulin resistance. He's like if you're insulin-resistant, you can't have any carbohydrates, but -- and I didn't expect him to say this. He was like there are lots of people who are insulin-sensitive and then carbs are fine. He did actually give that message, which --

Christopher:    In fact, he showed a slide with the double arrows, didn't he, where he talked about people on one side of the scale who would be fine with excess carbohydrates and those people would be insulin sensitive and probably athletes and then the unfortunate insulin-resistant people of which he is one are just going to kill themselves if they eat carbs.

Tommy:    Yeah. We've talked about this off mike a lot and there were lots of things that cause insulin resistance which aren't just dietary, but if the only thing that you can fix is your diet, then definitely you're going to have to restrict carbs in that setting.

    But there are also plenty of people who eat lots of carbs and they do just fine, so that has to fit into the theory. You can't just say that no human can eat carbs because we don't have the evidence for that either. So he covered all layers of the spectrum, which I actually enjoyed.

Christopher:    He's also a very evidence-driven person. If he hasn't read all the literature on a subject, he refuses to answer.

Tommy:    Yeah. So again during the panel discussion, he was asked about ketones as an alternate fuel for the brain and I think it has specifically to do with Alzheimer's disease, but he basically said, "I haven't read all the papers about ketosis and Alzheimer's disease, so I can't really give you a good answer," which is really nice when people actually admit that they don't know something. That's really important.

Christopher:    Yeah. You know, when I hear that answer, I bet he has. He's read more than most people, but he's still not at the point where he's willing to comment.

Tommy:    Yeah, absolutely.

Christopher:    So next up, it was Denise Minger and Denise Minger, I'm sure -- in fact, I know. You can have too much of one thing in your conference. You can put a lump of sugar in your coffee and it makes it sweeter and better, and then you put another lump in and it maybe makes it a little bit better, but there's certainly a plateau there and more sugar in your coffee does not make it better. There are diminishing returns.

    I think they thought the same about this conference that if they just had people talking about low carbohydrate diets, then eventually it'll just become too one-dimensional and not as interesting. So they brought in Denise Minger to give the opposing view and she did a talk that I've heard before actually, the carbosis thing and she's written about this on her blog. Maybe you should explain the hypothesis.

Tommy:    Actually, it was me who recommended it. It was me and I wanted that for exactly that reason just because I think it's really important. She started with -- she had a slide with a question and everything.

[0:40:08]

Christopher:    Yeah, "Why?"

Tommy:    "Why?" and I think it's really important. When there's this continued low carb, "carbs are evil" message, it's important even if you can't practically apply it to most people. It's really important to know that very good data exists of people on very low fat diets actually seeing benefit for whatever reason. That data exists. We can't say that if all you eat is sugar, you'll get sick because there are actually diabetics who about 80 years ago, all they ate was sugar for days and their diabetes got better. That actually happened.

    People just need to know, and again, this comes back to history. You need to know some of this old science. And as we move into the future, we need to be able to understand both sides of the story and how they come together, so that's what she talked about. She talked about all the low fat proponents. Actually, she only talked up to Ancel Keys.

    Everybody talked about how Ancel Keys came in and made fat the devil, but there were four or five doctors before him, people like Roy Swank with MS, Lester Morrison who was mainly looking at heart disease even though he's a gastroenterologist. These guys were doing this stuff well before Ancel Keys came on to the stage, so she was giving us the new version of the history of the low fat diet, but also actually showing that these people did studies which were actually for the time very well performed and well controlled studies and have actually saw benefit in their patients just to show that there's not always one way that has to be the same for everybody.

Christopher:    And it was the Rice Diet. I should link to this Rice Diet and Denise's article.

Tommy:    Yeah, Walter Kempner's Rice Diet.

Christopher:    Walter Kempner's Rice Diet. It's absolutely ludicrous. It was unlimited white sugar, unlimited fruit, unlimited white rice. It was like 2000 calories of sugar per day, but incredibly low fat. I just can't imagine -- this diet must have been hideously unpalatable says the guy that eats a high fat diet that most people would think I was being hideously unpalatable, but there were some really interesting pictures that she had.

    I've never really seen that in a study where they've got before and after pictures of these people that came in with obesity and all kinds of other problems and they show these old black and white pictures of how they looked afterwards.

Tommy:    And people losing huge amounts of weight. I know that Jason Fung has particularly focused on the Rice Diet and said that actually, probably what happened was people were hugely calorie-restricted because the diet was so miserable, but actually, the same thing naturally happens on a low carb diet that you can actually calorie-restrict.

    Actually, there might be some benefit there. That's maybe why they saw some of these benefits, but it was quite impressive, some of the results that she was showing.

Christopher:    Do you respect the quality of that data though? Earlier on, we talked about how all the nutrition science was junk. What makes you think that this data was any better?

Tommy:    I actually haven't read these studies. I will ask Denise for them or to show me where the references are so that I can read them. I'm sure there are flaws in there and I'm sure they're not as meticulously reported as maybe things can be nowadays, but similarly, the environment of science back then was very much -- there wasn't this kind of push to find statistical significance, which maybe people would find frustrating now, but it's very much, "This is what we did. This is what we saw."

    I definitely believe that these people were eating what they were told to eat. The actual calorie intake was maybe a little -- maybe we don't know. And then I believe that they've accurately reported the results because that's what people were very good at back then. Here's where we started, this is what we did, and then very good at reporting what they saw because that's the only metric they had. They couldn't really dig into it any deeper because they didn't have the methods that we have now and I think there's some benefit to that, so I would be tempted to believe the data that she presented.

Christopher:    I cannot persuade you to speculate on the mechanism of how a pure sugar diet could cure Type II diabetes.

Tommy:    I think at least part of it. At least part of it is probably going to come from calorie restriction. Maybe some of these people were eating 5000 calories a day of sugar. It's perfectly possible.

    I think what's happening is when you have a mixed diet -- so I have talked about insulin resistance as just being a cellular response to stresses in the diet, and those stresses come from in my opinion inflammation oxidative stress and total cellular energy load, inappropriate cellular energy load, and that includes both the total amount of energy and then where the energy is coming from.

[0:45:11]

    When you metabolize carbohydrates, they purely come through glycolysis and enter the electron transport chain of Complex I and that's very different from fats. Polyunsaturated fats are somewhere in the middle and then long chain fully saturated fats almost come 50/50 into Complex I or Complex II.

    What happens is if you have fat and carbohydrate coming in at the same time, they basically inhibit each other especially fat inhibits carbohydrate metabolism and saturated fat especially is very good at driving insulin resistance because of the way it generates reactive oxygen species within the mitochondria and where the electrons come from, from FADH2 into Complex II more than into Complex I.

    Now, that's just a normal signaling mechanism. It's not necessarily a bad thing, but when somebody is insulin-resistant, that kind of competition in the electron transport chain causes a backlog which then causes insulin resistance which then causes all those metabolic processes to break down.

    What I think is happening is if you remove that element of competition and you bring down the total calorie load, I think it takes the load off the cell and you could either do that by dramatically reducing carbohydrates or by dramatically reducing fat. And actually, just by removing that level of competition, you take the brakes off and these people will have had very poorly functioning mitochondria that can't uncouple.

    So if you just have extra energy that you don't know what to do with, a healthy body, a healthy mitochondria would just offload that by uncoupling it. The protons will just spin through the inner mitochondria membrane and you'll just lose that as heat, but if somebody is already really sick, they can't do that. The mitochondria are incapable of doing that and then it causes backlog. So I think you fix that just by getting rid of that competitive element.

Christopher:    So you don't put butter on your potato.

Tommy:    You don't put butter on your potato.

Christopher:    Right. You have your butter, you have your potato, but not at the same time.

Tommy:    Yes, you could. I think theoretically, if you spread them out enough, you could. One day you can eat just carbs and the next day you could eat just fat as long as there was enough time for those to make their way through your system. I think that is possible, but you just can't handle them together.

    There's something called the Randle Cycle and the Reverse Randle Cycle, which is basically how fat and carbohydrate metabolism are the level above the mitochondria in the cytosol, actively compete with one another. You're also helping it out, so you're helping it at multiple levels.

    It's just that in those kinds of people who are metabolically broken, if we can call it that, they just can't handle that for whatever reason, all the things that have happened up to that point, so you basically fix them by just removing one or the other.

Christopher:    Just at the end, Ivor Cummins stood up and he asked the same question that I asked Denise the first time I saw her give that talk, which was when you're looking for an engineering solution to a problem, there are always options which are in theory possible, but in practice impossible and so are useless, and this is one of them. So you can't really get people to eat pure white sugar and bananas and white rice. They're just never going to stick to that diet.

    One of the beauties of low carbohydrate, high fat, moderate protein diet is it's effortless. You can have effortless weight loss. Gary Taubes talks about this, how he gets mobbed by old ladies that thank him for taking away their hunger and their cravings and all these other problems and it's totally effortless for them. They're not having to think about restricting their food particularly.

Tommy:    But if you think about the other side of that -- so maybe nobody is on a pure white rice and sugar diet, but if you look at the more recent work of Dean Ornish -- I guess the real proponent of that nowadays or like the most public mouthpiece is Michael Greger, who are very whole foods, plant-based diet people. Actually, you're taking that low fat diet and you're actually adding nutrition to it because you're actually eating lots of vegetables, lots of legumes.

    They're actually getting really nutrient-dense diets, suggesting lots of spices, turmeric, getting lots of polyphenols and all this other stuff from the diet, and they see these same miraculous results. They just do and you're doing the same thing. You're removing that level of metabolic composition and we just have to accept that.

    Denise talked about the fact that there was one person who she knew, who was working with a doctor near her who started low-carb Paleo and just kept gaining weight, couldn't do it even though they were doing the diet right. Then they switched over to a super strict, low fat, vegan diet and all the weight fell of them and they felt amazing.

    So if we go back to Michael Greger, I've read his book. You might have seen his videos on nutritionfacts.org, which are just these amazing --

[0:50:05]

Christopher:    Oh, that guy.

Tommy:    Yeah, exactly, so this amazing, cognitive dissonance, cherry-picking kind of studies basically telling you why fat is evil and you can't eat meat and it's full of toxins and it's going to kill you. The videos, they're just hilarious more than anything because actually, if you look at the data that he's reading, you're like, "Michael, I just don't see the same data that you're telling us about. It's not there."

    But I really enjoyed his book even though the vegan tinge is in there. Actually, it's really sensible and he doesn't even say that nobody should eat meat. He's just like, you know what, eat a lot of plants. So in that context, eat a lot of plants, eat a lot of good stuff, and if you're going to eat meat, just make it really good quality stuff. On that side, you'll probably reduce your fat intake and then you'll go on the other way, and people get a lot of benefit from it.

    And then in a very similar world, you have Rich Roll. You have Ray Cronise. These are the guys talking about essentially the same diet and they're seeing these same results. Ray Cronise has a lot to do with cold thermogenesis as well. That's a big part of his protocol. I truly believe that these people are seeing a benefit and there is a metabolic reason for it and I think we can explain it.

    The problem is they automatically assume that the other end of the spectrum, the low carb diets can't work or they're unhealthy because they're not the diet that they recommend, which isn't the case. I think you can go in both directions and one might work for one person rather than another.

    The vegan diet is definitely going to support the gut microbiome better. Whether we know what the outcome of that is, we probably don't yet, but you're definitely going to have a lot more fermentable fibers and things like that than the average low carb diet, which I think is a problem with a lot of low carb diets, so it's possible to get benefit from both sides.

    The problem is that just because people have become proponents of one, they automatically assume that everybody else is wrong, but I don't think that's the case.

Christopher:    And Denise was another -- she was a really good presenter, wasn't she?

Tommy:    Yeah.

Christopher:    She spoke beautifully. They fitted everyone with these Madonna mikes where they hook behind your ears and you've got the little mike next to your mouth. Denise didn't take one of those, did she? She stood up at the lectern and put her mouth really close to the mike and did the whole presentation that way. That seems like a much harder strategy to me, but she really pulled it off and did it really, really well.

Tommy:    She's obviously given it a few times before. She's very polished. She's very self-deprecating and funny and --

Christopher:    Yeah, she is. She is very funny, very humorous, very likeable. So yeah, I did enjoy that even if her information is useless.

    So who's this guy that was next?

Tommy:    Yes, they had me finish it.

Christopher:    I'm so happy for you. It was really, really good, definitely. After all of that low carb talk, I sat there thinking, "Oh God." If all these people are new and it's their first time they're really thinking about what it's going to take to be healthy and live a long time and maybe be a good athlete, then how can you talk for this long without mentioning all the other stuff?

    It's not just about low carb, high carb, or even any type of food thing. There are so many other things that are important. And so, your talk really -- I don't know. I thought yours was probably the most important talk there.

Tommy:    Thanks! This was something that Guðmundur asked me to do to tie things together and talk about some of the other stuff. Well, maybe I offered to do it because everybody else was, "Why would I stand up and talk about insulin resistance when Tim Noakes has just done it?" That's just idiotic.

    I've spoken in front of an Icelandic audience before and I felt like I knew the kind of information that they were looking for. It was practical answers to some of the things that maybe they've heard about, but that information isn't just generally really easily available in Iceland.

    Also, there's a little bit of a language barrier, so you can use a lot of technical language and Iceland is very good in English, but not all of them are. I'm very used to it. My family is very good at speaking in English. If you hung out with doctors and academics, then they're very good at speaking English because they've often studied abroad and things like that.

    But some of the general population, when you're throwing really technical information at them, they don't really follow you and I've fallen into that trap before, so I try to stay away from that as much as possible and just present some really basic data and basic ideas just to give a real overview and give people some practical takeaways.

Christopher:    Now, it's nice actually, your style where you're just, "Here's this thing, stress. Here's this thing, sleep," and you gave me just enough technical evidence-driven backgrounds, contexts, and then you quickly transitioned to this, "Okay, so how do I act on this? Just tell me what to do."

[0:55:08]

    I really enjoyed that, having the practical implications and the instructions embedded within the content rather than just waiting until the end like a big, long summary and I've forgotten what you said earlier. That was really good. So what did you talk about? What were the things?

Tommy:    I talked about four things that I thought were really important. Actually, it was really nice and I got to make fun of Tim Noakes a little bit because during his talk, he said, "Yeah, of course there are other things that are important for health like lifestyle, blah, blah, blah," and then at the start of my talk, I was like, "So Tim Noakes said there were some things, some blah, blah, blah things that were also important. That's what I'm going to talk about."

    I talked about movements and not exercise, but actually mainly just moving frequently and the benefits of that, why sitting for long periods of time is maybe a bad thing, but the other side of that, why too much exercise can be bad and is an extra stress that the body doesn't need, so that was the first thing. It started slightly conventional.

    And then I talked about stress and how that's very different from person to person. It's not the stressor. It's how your body responds to it, so there is no such thing as stress. It's just how you respond to a stressor, which technically is in your control. In some of those things, the answer is simple, but it doesn't mean it's easy to do it.

    And so, we talked about job stress and how job stress increases heart disease and then also how diet stress, stressing on a diet has been shown to dramatically increase cortisol without having -- you can study women and you look at how restricted they feel in their diet and all it does is it makes their weight fluctuate more and it makes their cortisol higher, but they don't lose weight. They can exercise more and they also don't lose weight. They're the same weight as women who aren't actively restricting their diet, just eating however they feel they should eat.

    So actually, just worrying about what you eat can have a negative impact on your health and I thought that was really important because we've heard all these mixed messages by this point because we've got the low carbs and then Denise Minger turns up and then people are like, "Well, what the hell should I eat?"

    The problem is it's really difficult to synthesize the stress data because stress is such a nebulous concept, so it's really difficult to quantify it, but you can actually look at people and different types of stresses and then you can look at their different inflammatory cytokines and we know how those affect our cardiovascular parameters and we know how those affect long-term health.

    Actually, if you can piece it altogether, you can see that it's really, really important for health. It's just you can't do a huge, randomized control trial of it because how do you fix an intervention and get everybody to do the same thing? You just can't do it.

Christopher:    Exactly, so think about me standing up there, giving Gary Taubes -- imagine if someone said to me, "Here's Gary's deck. He couldn't be here. You give his presentation." That would be pretty stressful for me and it'll be awful actually, but then maybe the opposite, you could switch shoes and say to Gary Taubes, "Here's a mountain bike. I want you to ride that 25 miles an hour down a single track" with big step-downs and rocks of 14 inches or more. He would probably find that quite stressful, whereas I do that every day. So yeah, it's very difficult. Again, it's like one of those things like how the hell would you design a study that would --

Tommy:    Yeah. You just can't do it. You just have to make people realize that there are these stresses in their lives and that actually the things that you can do are meditation, mindfulness, and we know a lot of people that benefit a lot from that.

    Also, you just identify your stresses, talk about them, or try and figure out ways to respond to them in a different way. Again, it's not necessarily that you can give people simple fixes, but you can help them realize that they are essentially in control of that. And then if you give them that control back, then they can start to get on top of it.

Christopher:    One of the things I find as a great stress reliever is thinking about the fact that it's always going to be okay. If you're listening to this podcast, I've really got no doubt that the same is true for you. You're always going to have your basic needs. You're always going to have shelter. You're always going to have food. You're always going to have water. That's really all you need when you've got those basic needs. Everything else is really not that important.

Tommy:    But the stress is always increased based on what -- so if your baseline is really well fed, really well looked after, really warm, loving family, then other things that are much smaller -- so for somebody else who can't afford to feed their family, some of those stresses that we might find in our lives that are very stressful, that might just not even register on their scale.

Christopher:    "I just don't think that people are listening to my podcasts."

Tommy:    Yeah, that's true.

Christopher:    So that's the qualifier. If you're listening to this podcast, you don't really have to worry about losing your job because you'll just find another one and it'll almost certainly be more exciting than the last one.

[1:00:09]

    The social isolation piece that you did I thought was just really wonderful. Of course, we owe that credit to Bryan Walsh. I interviewed Bryan and we talked about social isolation and I got an incredible amount of positive feedback on that especially from the practitioners and naturopathic doctors and other types of doctors.

    He's such an innovator and he's thinking about things that nobody else is and he's thinking about them so critically. He just blew my socks off when he came on to my podcast and talked about social isolation and I thought it was great. He picked up some papers I don't believe I had seen before and he talked about the risk to health from social isolation, so why don't you talk a bit about that?

Tommy:    Yeah. I guess if we're going chronologically, the next thing I talked about was circadian rhythm. We've talked about light and circadian rhythm. I just want to bring it up just because I think it's so important. Basically, it's just talking about the fact that your circadian rhythm basically on a daily or hourly basis changes some of the genes, particularly mitochondrial genes to do with energy metabolism and lots of other stuff.

    So basically, your circadian biology determines how you respond to food. If you're sleep deprived, that instantly makes you insulin-resistant. If you eat late at night, that makes you insulin-resistant the next day. So if you're eating out of phase and getting light out of phase, that increases your risk of obesity and insulin resistance for multiple different reasons.

    Actually, when we're talking about food, circadian biology basically determines how you respond to food and it determines a lot of your hunger cues and your food intake. So if people are busy worrying about food, they really need to worry about their circadian rhythm because that's what determines how they respond to food.

Christopher:    It's particularly just ironic. You were saying that nobody pulled you up on this, which was quite unbelievable, but here in Iceland, it's nearly June and there basically isn't a nighttime. It sort of gets dark 11:00 for a few hours and then it's light again. Sunrise is officially 4:00 a.m. I believe, but --

Tommy:    Yeah, but it's the same with --

Christopher:    It's just dark, as dark as it gets. And then of course probably half the people in the audience were hospital shift workers, so -- thanks for that, Tommy.

Tommy:    Yeah. I did get some questions about that. Afterwards, we talked about the fact that this is very possible. There's a podcast by Chris Masterjohn that I haven't listened to, but I've seen some of the stuff that he was talking about, basically some snips in melanopsin genes which basically determine how you respond to changes in light cues and circadian rhythm.

    Some people are very robust and can deal with having a circadian rhythm out of context with the light cues and that really doesn't cause any problems, and some people really, really affects them. So it's very possible, my theory, that -- we haven't really been able to find if anybody has studied this -- is that actually the further you get away from the equator, the more robust your system is at dealing with those huge changes in light cues because obviously in the winter, it's dark all the time and in the summer, it's light all the time.

    So it's very possible that we've adapted to that, but it is in general hugely, hugely important. It's like a step up. I think it's a step up above food because actually sleeping properly, particularly getting good quality sleep is one of the things, and getting access to light at the right times of day actually basically just tells you or determines how you respond to food.

Christopher:    So back to social isolation.

Tommy:    Back to social isolation, basically the podcast that Bryan did was awesome. I loved it. If people haven't listened to that, you should stop listening to this and go and listen to that.

    Basically, he tells a story at the beginning about when people are part of a community and have a goal in life, they have a role be it a doctor or a farmer or something like that as part of a community, that puts your immune system in a certain state and then when you're isolated, that changes because you need to be more vigilant if you're attacked or you break a bone or something like that. You increase inflammation, certain types of inflammation in that setting.

    I obviously credited his name and talked about stealing his story because it's a really nice story. It illustrates it very nicely. First, I showed some data. Basically, the risk of almost every modern disease and overall mortality increases by around 30% actually. It seems to be the same in almost every meta-analysis and this is from millions of people. There are huge amounts of data on this. It increases the risk of those diseases by about 30%.

[1:05:02]

    Actually, there was one study of 300,000 people, a meta-analysis which calculated that the increased risk of mortality from social isolation was the same as smoking 15 cigarettes a day, so this isn't a trivial thing.

    I think people are increasingly socially isolated because of technology and social media, so you think you have all these friends and you're connected, but in reality, these aren't the people that you can rely on and these aren't people who rely on you and you don't have a direct meaning and role in their lives, which can actually then determine how your immune system functions.

    I then showed data from a paper which basically looked at again genetic expression in people who either live a hedonistic life or a eudaimonic life, so basically they lift themselves or they live for a greater good, which sounds a bit airy-fairy, but in those people, you can actually see lower inflammation in those that have meaning and a greater goal in life.

    This is published in the PNAS, which is a very, very, very well respected journal, one of the best general biomedical journals around. Actually, they publish in all fields, so this is really high quality, interesting data. You can actually see that based on how you live your life, that changes your genetics. It changes your level of inflammation and higher immune system is regulated and that directly changes your disease risk.

Christopher:    So what's the "Tell me what to do" part? This is the part I'm really struggling with. Everything you hear about on the podcast and in particular everything that Tommy talks about, they end up in my deck of cards that I use when doing these health sprints where I'll define a set of task for people to do in a given period of time and it's the social isolation piece.

    We have some questions, health assessment questionnaire, so I know when it's happening, I feel part of a group of friends really, those types of things. I don't have very good "just tell me what to do" things to solving these types of problems.

Tommy:    Obviously, at any point, if you join a group or community -- and I think this is why people are really enjoying CrossFits. That's one of the reasons why CrossFit has really taken off, is you become -- and I've been a part of many CrossFit gyms. You become part of this incredible community.

    I spent two months in the US when I was just at the end of medical school and I was doing some medical placements, did some sports medicine, did some infectious disease stuff. It's just part of the end of your medical training. So I went to the US and I would literally rock up in a new city and I'd turn up at the CrossFit gym and by the end of the day, I'll be having dinner and some beers with ten people I've never met before and they were all just like, "You're new in town. Let's meet some people. We'll show you around."

    That was an immediate way. I did it in every new city I went to. That was the way I made friends and I still have friends from a number of different gyms. I literally rocked up and they immediately took me under their wing. And so, it's that kind of thing. If you can find something that you enjoy doing, then you immediately become part of the community, and it's easy to do. You just go out in the real world and do it.

    I gave the example of CrossFit because it worked for me even though I don't think that that's the best way that people should train. I'm not saying do CrossFit for that reason, but actually, it's a really nice way to find a community and there are lots of ways to do that. You can volunteer or there are lots of different sports. Sports are a really good way to do it because there are groups and teams and stuff.

Christopher:    Yes. I could [1:08:56] [Indiscernible] for that. It's like when you do a masters mountain bike race, there are a lot of dickish guys shouting at you saying, "On your left." "You're ruining my life right now." It's not like that. So yeah, I can see how these team sports would be so much better.

    This is interesting. It's like the penny is starting to drop here. Bryan Walsh is being very generous with his time and he's really taken me in particular under his wing, and then to a lesser extent, even you, but really what he's doing for us is he's just contributing to some other course that's not himself perhaps.

Tommy:    Yeah. That's part of his eudaimonic lifestyle.

Christopher:    Exactly. Basically, this gift is a bowling ball with his name engraved on it, the Life of the Simpsons episode. So what did we miss there? We've talked about stress. We've talked about circadian biology. We've talked about social isolation. Was there a fourth thing?

Tommy:    Yeah. I did the movement thing and my forte was social isolation, but also, I came under my moniker of love, which was basically just like actually connecting with friends and family, being grateful for them, telling them that you love them, which I don't think happens nearly enough.

[1:10:06]

    And so, that came in with the social isolation thing as part of building a community and building relationships, so that kind of stuff came together. That was essentially it.

    And then I tied that together with two things. The first was the blue zones, which people talk a lot about. People, whenever they talk about the blue zones, they always focus in on diet because actually it's largely plant-based with small amounts of animal products. But in reality, I think their diets are borderline meaningless except for the fact that they just eat real food that's grown locally, but the rest of the thing is they are huge communities. People have a role in the community for their entire life essentially until they die. Nobody ever retires.

    They're active all day. They always have some form of stress modification be it prayer or being in the wilderness. There are multiple different ways that they do that depending on their individual community and they all have that greater goal. I think that shows how important that is in terms of longevity because those are the areas in the world where people live the longest. And then I also brought in -- I just picked up a random health plan out of our client folder.

Christopher:    Oh yeah, that was kind of embarrassing for me. [1:11:15] [Indiscernible] I was like, "Oh no! What's going to be in there?"

Tommy:    The reason I did it is because -- I look at these and I'm not the one who makes them and I'm not the person who people work with directly most of the time. And so --

Christopher:    You're the architect. I'm the builder.

Tommy:    Yeah, so I'm just behind the scenes all the time. So I go in and I look at the client folder and yeah, there's some stuff about monitoring blood glucose. There's always a dietary piece. Often we tell people they're undereating, but then the last 60% of the points are get outdoors, get your family involved, go walking, avoid blue light at night, be part of a big community.

    There are all these different things, making sure you get proper sleep. There's all that stuff which I know you've said just basically underpins. It underpins the treating the gut infection. It underpins getting on top of fatigue and reversing whatever health problem you have or whatever supplements you have to take or anything like that. If you don't do that stuff, the other stuff doesn't work.

    That's why I truly believe that if you fix -- if you go to the United States and you fix that, if you fix your circadian biology, if you move enough but not too much, if you fix your stresses and you find ways to get on top of your stress, then you don't have to worry about the diet so much. Diet is important, but it's secondary to all those other things.

    And when we're arguing about macronutrients, well, I'm looking at macronutrients in this chronically stressed, chronically tired, broken human population who don't get a chance to do all those things, and then that stuff becomes really important. The more you don't do that stuff, the more you have to worry about the dietary piece. That's why if you fix that bit, if you fix all the stuff that I've talked about, then the diet doesn't quite fall out of the mix, but then it's much easier to navigate.

Christopher:    I just care about stuff that works. That's what I'm drawn to. And if it's dietary, it's dietary. If it's something else, it's something else. Who cares? I just want to throw all those cards out onto the table. I just base the order of things, the health sprints, the iterations, having talked to the person, I try and figure out which are the problems that are most likely to be happening for them right now, the most important based on the people that we've worked with in the past and then just go through iterations.

    Yeah, I just want to make people feel good. I don't really care whether it's high carb, low carb, any of that crap. If I find new information that proves I was wrong in the past, I've got no horse in this race really. I'll just change it. All I really want to do is help people feel and perform better. That was very generous of you to mention it like that in the presentation.

Tommy:    And what I said in the presentation as well, just in this week, there's been all this amazing feedback coming back from various clients and these are people who I haven't interacted with at all, so just seeing the benefits that people are getting, but we also work with -- and you and I have spoken to quite a few people more in depth. These are people who they've worked with literally the best functional medicine doctors in the world and not seen a benefit. They've seen at least more benefit, I believe, when they've come to work with us.

    I truly believe that it's because we focus on all of it and it's not just doing the most expensive tests. It's not just taking the most expensive supplement or taking the fanciest gut cleanse protocol. If you don't fix all the other stuff, I really don't think that then the active interventions you're trying to do to fix the gut or treat an infection, whatever, I don't think they're going to work as well.

Christopher:    Yeah, and I should mention that in some cases, that fantastic feedback was coming to us from clients that I've never spoken to. Amelia and I work on all the plans together.

[1:15:03]

    We look at the test results together and we have phenomenal ways to communicate over the internet to do that very efficiently, but in some cases, it's not me that's talking to the person and it's her that's steering the building, if you like.

    And so, I think it's incredible that we've got such a great team that's able to -- and you do really want that. If you're thinking about working with us right now, you don't really want it to be just Tommy or just me because what happens if we go away? What happens if I get hit by a bus tomorrow? You don't want just a single point of contact. You want there to be a team. I think that's one of our strengths.

    Cool! This has been great! Thanks very much, Tommy.

Tommy:    Excellent!

Christopher:    Okay. Well, if you've got any questions or think of anything else -- maybe I'll just chop this part off. Okay. That's the end. Cheers then. Bye-bye.

[1:15:55]    End of Audio

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