Sam Feltham transcript

Written by Christopher Kelly

June 29, 2017

[0:00:00]

Christopher:    Hello and welcome to the Nourish Balance Thrive Podcast. My name's Christopher Kelly and today I'm joined by Sam Feltham. Hi, Sam!

Sam:    Hi, Chris! How's it going?

Christopher:    Great! Thank you. I'm very excited to have you. I've just been seeing Sam speak at the Low Carb Breckenridge Conference and that was a wonderful presentation. I hope to be able to ask you some questions about that today, Sam. For people that don't know him, Sam has been in the health and fitness industry for over a decade. Sam, can I ask you why you're in the health and fitness industry in the first place?

Sam:    I kind of started off my health and fitness career at a sports center. It was my Saturday job being a basic dog's buddy. I'm doing kids' parties to cleaning the changing room floors. It's part of that job. I was very sporty as well at the same time because I do football courses over the summer and things like that, so I've always been sporty and things, but you go to a university dreaming of a career behind a desk for some reason --

Christopher:    Is that really what you wanted? I really want to get into why exactly.

Sam:    Yeah. So I decided to do a degree on website design.

Christopher:    Okay, because your mom told you that was going to be a good thing for you to do.

Sam:    Yeah, pretty much. I did a year of that and then from there, I managed to do a year behind the desk before I got absolutely bored. I then decided to swan off to New Zealand where I trained as a snowboard instructor.

Christopher:    Oh, very cool.

Sam:    And then I did four years of doing back to back northern and southern hemisphere winters teaching in New Zealand, Colorado, Vermont and the Alps as well, kind of going back and forth between those for about four years. However, amazing that kind of lifestyle is, you kind of get a little bit jaded by moving from place to place every six months and having to make new friends. You always see similar people, but you never have a core friends group basically. Unless you've kind of got a significant other in that space, it's quite difficult. So I decided that I'd move back to London and I was trying to figure out a career that would work for me because I liked being active.

Christopher:    Clearly you're a people person.

Sam:    Yeah, that's right, and I wanted to carry on what I'd learned from snowboard instruction, which was coaching. And believe it or not, the snowboard instructing world is actually pretty clued up in terms of coaching methods.

Christopher:    Interesting.

Sam:    There's a lot of training that you do in terms of different learning styles and also particularly the training in America was very enlightening. They go really in-depth, so I've learned a lot from that. And so, I decided that I'd actually become a personal trainer. So I studied at the European Institute of Fitness in 2010 and from there, I qualified as a master personal trainer. And then I moved to London, started off as just a personal trainer and giving out the old standard advice, all the low fat, calorie-counting you like, and began to find that that doesn't exactly work.

Christopher:    This is why I really wanted you to talk about this because I think it's so important. As a personal trainer, you are the guy that has to answer to that person who's still not getting results in week six like, "Nothing has happened, Sam. I'm following your instructions. Nothing is happening." And so, I think you're the guy that's most likely to want answers, want a solution to this problem.

Sam:    Oh, absolutely. You're held accountable for the results unless the client knows that they haven't been exactly following the advice, but when they do, they're very sincere and quite candid about it. Yes, clients aren't getting results on this advice that I'm giving out, and so you end up trying to research it, trying to find out what else is there out there in the world of nutrition because they're doing two or three sessions with you a week and they say, "Why isn't this working?"

    So you end up reading a book like Why We Get Fat by Gary Taubes, which is a great starting point. It was a great starting point for me, and then you end up on Mark Sisson's blog and Robb Wolf's blog and all sorts, and this is back in 2010. Things have changed even in the past seven years since then, but that was a great introduction for me into this space. I started implementing that advice for my clients and they started getting results and I decided that I wanted to impact more lives, so I set up a fitness bootcamp business, which eventually ended up with ten locations around the country.

Christopher:    Oh wow!

Sam:    Yeah, and we ended up with a relatively popular podcast which ended at the beginning of last year, and a relatively popular YouTube channel as well which is where people might know me best from my overfeeding self-experiments.

[0:05:08]

Christopher:    Yes, I wanted you to talk about the overfeeding experiment because this is really fun.

Sam:    Yeah, absolutely. That was in 2013. We'll go into that in detail in a little while, but in 2015, late 2015, I was getting really frustrated with the number of people that were coming to us, all of our locations around the country having to basically get re-educated on diet, and yeah, I decided we've got to tackle the root cause of this, and one of those root cause is our government dietary guidelines. And so, I decided that I wanted to set up an organization that'd be dedicated to informing and implementing healthy decisions for better public health.

    So in February of last year, we launched a crowdfunding campaign to crowdfund for the public health collaboration and we ended up doubling our target in a month, which is absolutely fantastic, and then the ball started rolling from there basically. We've been going just a year now. I'd say that we've been making a fairly significant impact or at least just starting the debate going a bit more --

Christopher:    Yeah, that's really wonderful.

Sam:    Yeah, exactly. We've published a report in May of last year and you know you're making an impact or at least ruffling some feathers when Public Health England have to release a press release and call you irresponsible for some reason.

Christopher:    Interesting. I like it.

Sam:    Yeah, and I'm irresponsible for presenting the evidence.

Christopher:    Talk about the scope of the problem in the UK. That's one of the things when I first moved to the US 15 years ago, was you notice that people are generally more overweight, more obese, and of course it depends where you are. Now, in the big cities, the problem tends to be better and then you travel through some airports and some unnamed states and all you see are fat people, right?

Sam:    Yes.

Christopher:    So I came to the conclusion that maybe the problem was worse in the US, but I've not spent that much time in the UK since I've moved here, so maybe the problem has gotten worse there. So can you talk about the scope of the problem in the UK?

Sam:    In the UK, obesity is at 25%. That's been steadily increasing over the past 20 years. And coincidentally, 20 years ago or just over 20 years ago -- now 23 -- was when they first introduced official Healthy Eating Guidelines, and in that time, obesity has quadrupled, so that's rather interesting. Also, Type 2 Diabetes, there are three and a half million people with Type 2 Diabetes in the UK, which is 6% of the population, but one of the major issues with Type 2 Diabetes is its costs. Despite there being more people with Type 2 Diabetes, it cost more than obesity. In fact, it's the largest singular financial burden on the NHS at £10 billion a year, which is 10% of the NHS' budget.

    Obesity costs the NHS £6 billion a year. So in total, £16 billion, which is a significant expenditure of the NHS budget, and then pre-diabetes is at 35%, which is just pre-Type 2 Diabetes, so a lot of them over the next 10 to 20 years are going to end up with Type 2 Diabetes and increase that cost and a decrease in quality of life as well. This isn't just about money. It's about trying to improve quality of life as I'm sure you might have seen that we're getting into a situation where the generation that's growing up right now might end up with a lesser life span than we do. So the situation is serious, very serious, but it's totally fixable and we think that we've got a workable solution that can sort it out.

Christopher:    I want to go into your solution in detail later on, but before we get there, talk about your overfeeding experiment.

Sam:    I've always been a naturally slim guy, so I could eat as much as I wanted and I'll never put on weight.

Christopher:    And people hate you for it.

Sam:    Exactly. People hate me for it, of course, which is understandable. Because of that, I've always been somewhat skeptical of just the pure simplistic calorie formula just because if I can eat as much as I want and never put on weight, surely the opposite is true. People can eat moderate amounts and still put on weight due to biochemical individuality. So I went about trying to test a theory to see if I can put on weight using three different diets, but doubling the amount that I usually eat.

[0:10:03]

    So I decided to eat three different diets over 21 days with a three-month washout period in between each, so I'd kind of reset as much as I could, reset biochemically. The first one was a low carb, real food diet where it's basically you're eating eggs, steak, green beans, nuts, lots of nuts over the next 21 days at 5800 calories every single day. I must tell you, it was really difficult. At the end of the day when I was kind of eating a thousand calories worth of steak, it was -- you're having to kind of do it over about an hour.

Christopher:    Is this these many calories over your requirements?

Sam:    No, this is in total. My Harris–Benedict metabolic rate is approximately anywhere between 3000 to 3500 calories a day, so over those 21 days using the Harris–Benedict formula along with taking away protein thermogenic effects and fiber and also the exercise that I was doing, which was the same in each experiment, so I do three high intensity interval training sessions along with cycling to and from work as well, so that was all exactly the same in terms of the exercise, but my net calorie surplus after taking all of those things away was 47,000 calories.

Christopher:    In three weeks.

Sam:    Yeah. It's hardcore, isn't it?

Christopher:    Yeah.

Sam:    So yeah, I was in a 47,000 calorie surplus. By the end of this first experiment, according to the calorie formula, that should equal to 6.1 kg. I only put on 1.3 kg, but interestingly, I lost 3 cm from my waist as well.

Christopher:    That's interesting. How did this change from your diet before you started the experiment?

Sam:    It was essentially my usual diet really.

Christopher:    Which including carbohydrates, but it was still real food.

Sam:    Yeah, absolutely, but this first one was a low carb, real foods diet. That was essentially my diet, but I don't eat that much. I don't even measure the amount I eat these days. I just eat when I'm hungry and stop when I'm full. If I go a day without food, it's absolutely fine. So I did those and I only put on 1.3 kg compared to what the calorie formula predicted that I should've put on, which is 6.1, and so I thought this was very interesting.

    By itself, you really don't have anything to compare it to, so I decided to do a crossover self-experiment where I'd eat exactly the same amount, but of a low fat, fake foods diet, so refined cereal and skim milk for breakfast. I think I had some low fat pizzas at midmorning, which was my midmorning snack. And then I'd have skinless chicken sandwiches at lunch along with some zero percent fat yogurt. And then for my evening meal, it was again a low fat lasagna and a low fat garlic bread. And over that period, again, this was set 5800 calories a day again and after protein, fiber, and exercise, I again ended up in 47,000 calorie surplus.

Christopher:    And how was it getting those calories down compared to the high fat diet?

Sam:    A lot easier.

Christopher:    Right. That sounds a lot like my diet from about ten years ago. It's kind of like that. It was breakfast, snack, snack, lunch, snack, snack, another pre-dinner snack and then the eating would just continue until you went to bed.

Sam:    Yeah, totally. It's pretty much my student days as well. So it was a lot, lot easier. I didn't have any trouble at all eating all of that compared to the first experiment where I was really struggling towards the end of the day having to shovel down this final bit of steak at the end of the day, but on this experiment, I also developed a bit of sleep apnea as well, which was not good for my wife. She was rather annoyed. I had mild asthma when I was younger and that kind of came back, which wasn't so good. On my cycle to work, I found myself getting out of breath and it's not like a bike race. It's a leisurely commute.

Christopher:    No, I don't believe that. I've ridden a bike into London many, many times and it will be like the start of the -- actually, not like the start of the Tour de France because that's quite leisurely compared to the start of an elite cyclo-cross race, which is like the Normandy landings. It's ridiculous, every single traffic light all the way into London.

[0:15:06]

Sam:    It's like go, go, go like a shortage crossover and it's like, let's go! Anyway, that was interesting. Again, as I said, I ended up in a 47,000 calorie surplus, so exactly the same as the first one and I should've put on 6.1 kg, but I put on 7.1 kg.

Christopher:    Okay, that's interesting.

Sam:    So it's actually over the calorie formula. And then on my waist, I ended up putting on 9.25 cm compared to the 3 cm loss that I had on the first one. Yeah, for a guy that's been naturally slim all his life, that was the fattest that I've ever been, that's for sure. I did blood work as well on this one. On the first one unfortunately, I did blood work at the end. I also did a BOD POD as well, so I kind of compared that to my starting blood measurements and at the end of the first experiment, they were the same as the beginning of the second one, so I kind of wish that I'd done it before, but logically it probably didn't change much.

    But on this one, my triglycerides quadrupled, which was rather scary and my HDL went down by a third as well. So that was really scary in that my triglycerides had quadrupled from 0.5 mmol to 2 mmol. It's absolutely mad. Also, my BOD POD went from 12.5% to 16.5% in that time as well, which was again pretty scary.

Christopher:    Did you have any idea about how that fat was being deposited? Was it the nice subcutaneous fat that you can get a hold of or was it just still -- you look like the type of guy when I've seen the pictures that has very little subcutaneous fat, so when you pinch your belly, there's really nothing there, but obviously the fat has gone somewhere. So did you have any idea of where it went?

Sam:    Definitely it was subcutaneous as well, but I was feeling really bloated as well during that time. It would've been great to have done the DEXA scan and see if there was any hardcore visceral fat going on, but yeah, there was a lot of subcutaneous fat there that deposited itself that usually doesn't.

    Following on from that, I decided to do experiment 2b, so immediately following those 21 days where I've put on 7.1 kg, I've decided to eat a calorie maintenance. So I was literally eating 3500 calories a day, but went back to my usual low carb, real food diet. And so, I was trying to maintain the weight gain that I had and I did that for 21 days. And over those 21 days, despite eating 3500 calories and trying to take into account the protein, the fat, and any fiber that I was eating as well, I managed to lose 6.1 kg in that time as well, which is really interesting. That last kilo, it took about another month after that. It was really, really interesting to try and eat that 3500 calorie maintenance for me, but still losing weight.

Christopher:    That is interesting. And then tell me about the third phase. You did a third phase of the experiment, right?

Sam:    Yeah, that's right, so this third and final one was where I decided to do a very low fat and vegan, but with real foods of course as well. I was eating orange for breakfast and just water, and then for lunch it was rice and beans, and then for dinner, it was potatoes and water chestnuts, I think, or something like that.

Christopher:    Okay. It sounds terrible, but it is real food.

Sam:    Yeah, precisely. It was terrible because I probably never had a day in my life where I didn't have an animal [0:19:08] [Indiscernible]. So I was having vegetables and fruits in there as well and I was allowed to put in I think two tablespoons of olive oil in there as well to keep the fat at 16%. So yeah, it was 16% fat is what I was having. And over those 21 days, because of the amount of fiber that I was eating -- so I was eating about 150 grams to 175 grams of fiber.

Christopher:    That's a lot of fiber. That's good though. That might be a good thing.

Sam:    Maybe, but --

Christopher:    I should ask your wife whether it's a good thing.

Sam:    Exactly. She probably wouldn't agree with that. But just to put that in perspective for all the listeners, the recommended daily amount for fiber is 25 grams and I was eating 150 to 175, so it was substantial and a lot of gut disruption throughout. Over those 21 days, I ended up in a 40,000 calorie surplus compared to 47,000 on the other two --

[0:20:11]

Christopher:    And would you say it was tougher to get to that calorie target, eating that diet? So you're eating a lot of foods there. Potatoes for example, there's the potato hack where you're just eating a ton of one food. There's no sensory-specific satiety. It's a very satiating food and it's difficult to eat a lot of it, so you would agree then it was tough to eat that much real food.

Sam:    Yeah, it really is and it's not very palatable either because you're not really getting any sources or anything. [0:20:41] [Indiscernible] that was never shy of animal food is really difficult and certainly my cognitive ability decreased through that time for sure. But on that one, the calorie formula says that I should've put on 5.2 kg. I've put on 4.7 kg, so I was under by half a kilo for their calorie formula, but I still put on more than the first experiment where I was at 47,000 calorie surplus, but on this one, I was at 4.7 kg weight gain on a 40,000 calorie surplus. And then also my waist, I've put on 7.75 cm around my waist.

Christopher:    Oh wow, okay. That's important.

Sam:    Yes, very much so, compared to that loss of 3 cm on the first one. It's a very enlightening experiment and kind of points out that you can't just brandish all calories the same because they're going to have varying biochemical effects on different people as well. So if somebody that was obese did what I did, they'd have very different effects as well as somebody that's living with Type 2 Diabetes or Type 1 Diabetes because you've got some Type 1 diabetics that are eating themselves out [0:22:06] [Indiscernible] at 5000 calories and they're not putting on any weight. Yeah, it's a really enlightening experiment and if anybody is ever skeptical of everything I've ever done, I just highly recommend that they do it themselves and see what happens. That's the best way.

Christopher:    So this is obviously a very interesting starting point, but can you tell me about how that might have extrapolated out for first of all your clients and then talk about some of the randomized controlled trials that you've brought together on the website because I think there's a danger here that people might think that the public health collaboration is based on this n = 1. Interesting and fun experiment, but it's surely more than that. But before we get into the randomized controlled trials, talk about how this was extrapolated out into your clients before the public health collaboration.

Sam:    Yes. Once I've done all of the experiments and you start talking about it with clients and even on the blog as well, people say, "So does that mean that I should just eat absolutely tons of real foods and low carb foods specifically to lose weight?" I'm like, no, not at all. That was not the point of it. The whole idea was to show you the vastly different effects of weight gain. That was the whole idea. It wasn't about weight loss. It's about showing the different effects of weight gain with different diets.

Christopher:    And it's not just calories in, calories out. It's a little bit more complicated than that.

Sam:    Yeah, precisely. It's a really visual explanation of why my clients might have put on more weight than they wanted because it shows that different diets at the same amount of calories create different effects. And if they've been following standard government advice, which would be to have cereal and skim milk at breakfast maybe with an orange juice as well and then skinless chicken sandwich on whole wheat bread at lunch --

Christopher:    And that's going to seal the deal as long as it's whole meal. That'll seal it.

Sam:    Of course, of course. It's the stuff of life. Yeah, following that standard stuff, and then you have your brown pasta in the evening as well. A lot of my clients have been following that kind of diet and when they look at the low fat, fake food diet, they say, "I used to eat those foods on a daily basis." I was like, well, that's unfortunately the effects that it has. And as we discussed earlier as well, they're highly palatable and very [0:24:52] [Indiscernible] and there's no satiety to them either.

Christopher:    Yeah. Low fat yogurt with a bunch of sugar in it is my favorite food to overeat.

[0:25:01]

    I buy one of those family size containers and I would get back from a bike ride and eat the whole thing. I don't know how many pints of yogurt that was, but it was a big container.

Sam:    Absolutely, just be vacuum-cleaned up.

Christopher:    Yeah, it was so easy.

Sam:    Definitely. Absolutely. So it was really, really evocative for clients to help them understand maybe how they got into this situation that they are today. So yeah, it's a great resource to have and use as a case study for that. And so, as you were mentioning before, it's all well and good doing an N of 1, but that isn't going to change the public health organizations that are out there. It's not going to change their mind. They're just going to say it's an N of 1 and rightly so as well.

    So what I decided to do after that -- and I originally did this on my blog -- was to start pulling together all of the randomized controlled trials between low carb and low fat. I think I started off with 25, but as of today, there are 57 available randomized controlled trials between low carb and low fat, which are available on the Public Health Collaboration website. And of those 57 -- and I've properly made sure that the low carb diets are less than 130 grams because you sometimes get randomized controlled trials that are saying 40% is low carb and they're on like 200 grams of carbs a day and it's like, dude, seriously.

Christopher:    Yeah, and then it gets even more confusing when you get into rodent diets, so I think we saw -- and I can't remember. There was a letter or a review article where they described a high fat diet and we're pretty sure from what they said -- they didn't give a reference. So what they really meant was a high fat rodent diet, which is actually a high sugar, high lard diet, so it's basically cheesecake, but that's what it's called in the literature, so there's tremendous confusion there, I think.

Sam:    Massive, so every time somebody comes out with a study of a high fat diet in rodents, it's exactly that. It's rodent chow that is high fat, high sugar, and yeah, the media obviously don't understand that and they just say high fat is going to give you cancer or could cause Type 2 Diabetes or something. Yeah, it's rather ridiculous. Take the sugar out and see what happens.

    Anyway, in the human trials, I made sure that it's proper low carb using the definitions by Prof. Rich Feinman of less than 130 grams and for the low fat, it's less than 35%, which is the amounts the UK government use for low fat and for our dietary guidelines as well. And of those 57, seven achieved greater weight loss than low carb, seven of them for low fat. And then for low carb, 48 result in greater weight loss than low fat, but that includes the non-statistically significant ones as well.

    So when you look at just the statistically significant ones out of all 57, there is zero trials that show a significantly greater amount of weight loss in low fat compared to low carb, but there are 29 that are statistically and significantly greater weight loss for low carb than low fat. So when you look at it in that way, it's literally 29 now to low carb in terms of the randomized controlled trials when just looking at the statistically significant ones, which is what you should do [0:28:53] [Indiscernible] because the non-statistically significant ones, just so our listeners know, your range is from 0.1 kg to 0.9 kg, so scientifically they're equal so you have to --

Christopher:    When you're dealing with absolute -- so we're looking at probabilities here.

Sam:    Precisely. So yeah, in terms of the statistically significant ones, it's 29 to low carb and zero to low fat. As I say, you've got this listed on the website. They're all simply laid out with all the links and things to the source of the study, and also a PDF version as well, so if anybody tells you that there's no evidence for low carb, they're just talking out of their ass.

Christopher:    I was going to say you can print it out and stuff it up their ass, right?

Sam:    Pretty much, yeah. That's the idea. And also there as well, we've got a list of all the meta analyses that have taken place as well so that you can print that list off as well to show them the [0:29:55] [Indiscernible] analyses over the past ten years, I think about four or five, and every single one shows that there are statistically better outcomes for low carb and it's just bewildering that the government don't accept this.

[0:30:11]

Christopher:    Right. Well, that was going to be my next question, is surely this is a slam dunk and surely it's just a matter of time before the dietary guidelines are updated, so why don't you think that's happening?

Sam:    It's difficult. They're obviously on the back with all of this and I think that they're fully aware that the science clearly shows that it's a more effective option. Unfortunately, we have to let them do it slowly. The whole point of the Public Health Collaboration, the reason I set it up is to try and force their hand a little bit and present this evidence to healthcare professionals working within the NHS so that they can then look at that and say, "Hang on a minute, that's not right."

    What we're doing is that we're nurturing a network of GPs working within the NHS and we're hoping to get to a critical mass where the group of GPs that we've got is too large to ignore and that the higher ups within the NHS have to listen and have to change guidelines as well because there are too many NHS GPs that are recommending what we're saying and using our patient booklets than recommending the standard NHS advice as well. So I think there are a couple of pressures. They don't want to admit that they're wrong first and foremost, which is --

Christopher:    Yeah. People feel tremendous pressure to be consistent like once you've made a decision, people generally find that they really need to make another decision that's exactly the same as the one before. This is how drip pricing works when you get to buy an airline ticket. You made a decision to buy and then they try and drip the cost of boarding the plane and bringing your bag and bringing somebody else. So people feel the pressure to be consistent with their decision making and I wonder if that's what's going on here psychologically with the dietary guidelines, is they just don't want to change because that's kind of admitting that you were wrong.

Sam:    Absolutely. That's definitely a big part of that. They don't want to have this big moment where they say, "Look, we've messed up over the past 20 to 30 years" and I think coming up to 40 years with the low fat guidelines that we had in 1993. The other side is the finance angle. I don't know if you know, but the NHS spends £3 billion a year on looking after smoking, all of the mortality involved with smoking, all of the patients involved with smoking, but the tax that that pays is £7 billion. So in actual fact, it pays the government for people to smoke, which is to say that the net profit for the government is £4 billion for the American readers, but yes, £4 billion a year that they get back from smoking.

Christopher:    So you think the same thing might be happening with food?

Sam:    Quite possibly. As I've mentioned at the beginning, the combined cost of obesity in Type 2 Diabetes is £16 billion a year and I'm yet to find a firm figure, but the foods that are a major contributor to Type 2 Diabetes and obesity developed in sugar and refined carbohydrates are the ones that get VAT on, Value Added Tax, which is 20% in the UK.

Christopher:    Right, and it's very expensive in the UK.

Sam:    Yeah, but real food doesn't get that tax. It doesn't have VAT. You don't have VAT on meat, fruit, and veg, so they don't get a return on that. It's in the region of about £20 billion a year, the VAT that comes back from refined foods.

Christopher:    Okay. That's terrifying.

Sam:    Yeah. It makes you wonder if that's one of the reasons. Now, I don't want to --

Christopher:    You're just throwing it out there.

Sam:    I'm just throwing it out there. I don't want to put any conspiracy theories out there of things like deep, dark rooms and they're having these dodgy meetings where they decide that sort of thing, but from the numbers, it's dodgy basically.

Christopher:    Interesting. Well, I wanted you to talk about what your guidelines actually include. I was listening this morning to your healthy eating guidelines and weight loss advice for the United Kingdom, which is an mp3 file, and of course everything that we've talked about and that Sam has talked about, I will link to those in the show notes for this episode, so you can come to my website and you'll see the podcast navigation element at the top of the screen and you'll find your way to the show notes from there and I'll link to all these things.

[0:35:00]

    And so, I thought this mp3 file was really, really useful in describing what you'd actually like people to eat and my conclusion coming out of that was this wasn't necessarily a low carbohydrate diet. It seemed to me that the emphasis was more on real food than it was on macronutrients, so would you say that's true?

Sam:    Yes, absolutely. So what we're trying to do with our reports, there's a PDF of the report as well as an mp3, trying to make it as accessible as possible.

Christopher:    Okay. Yeah, I've just realized that. I didn't even notice that. I saw the mp3 and I was all over it because I'm an audio kind of guy.

Sam:    Good! That's what it's all about. It's my days of knowing about learning styles. I'm trying to cover all the bases. We're trying to break everything down into the separation conditions to give appropriate advice. At the moment, there's just one solution for all dietary guidelines, so when the UK government is handing out advice to somebody to lose weight and to eat healthily first, they give them the Eat Well Guide, it's called, and that is a low fat diet. And then when somebody wants to lose weight, they give them the Eat Well Guide again, but tell them to count calories. And then when somebody has Type 2 Diabetes, they should follow the Eat Well Guide again, but take the required medication as well, and that's one of the reasons that a lot of healthcare professionals think that Type 2 Diabetes is only a progressive disease as well because it regressively gets worse on a low fat, high carb diet of course.

    So we're trying to break it down into these individual conditions and trying to give appropriate advice for specific situations, which you'd kind of think as the first starting point for any advice, appropriate advice for specific situations. So our healthy eating guidelines is called the Real Food Lifestyle and what we say in that is that if you are maintaining personal good health, which is defined with the ranges of metabolic syndrome and if you're outside of the ranges of metabolic syndrome, you're maintaining personal good health. And as long as you're eating the minimum amount of fat, the minimum amount of protein, and the minimum amount of vitamins and minerals then you can eat whatever Real Food Lifestyle enables you to maintain personal good health. Whether it'd be higher carb or lower carb, if you're able to maintain personal good health on that real food diet then you fill your boots. Nobody can take that away from you.

    That's something that the government has missed out with all of this, is that they've given one solution to the entire country rather than trying to take into account biochemical individuality, and that's what we're trying to do. We're trying to say look, you need to eat this minimum amount of fat, this minimum amount of protein, and then make sure to get this amount of vitamins and minerals as well, but after that, whatever works for you really within a real food lifestyle. And then after that, we go on to describe the real food lifestyle for weight loss, so the real food lifestyle for weight loss is based on the randomized controlled trials. I'm much in that.

Christopher:    I know, yeah.

Sam:    I'm not crazy. And on that, we recommend that the most effective starting point as shown in the randomized controlled trials is a low carb, real food diet of less than 130 grams a day. And then within that, you have to find what carb intake works for you as well. So for some people, they might have to go below 50 grams for instance and go on a very low carb diet, but for some people, they can eat 100 grams to 130 grams of carbs a day and lose weight, so it's all about trying to give people a general good starting point and then allowing them to individualize it for themselves as well, and that's really important for us to get across.

Christopher:    Yeah, I really love these infographics.

Sam:    Yeah, you do.

Christopher:    They're really nicely done. You've said something in that audio and presumably it's in the PDF too, is that there are lots of ways in which you can lose weight, but this is the thing that you should try first. This should be the default.

Sam:    Exactly. So it's the one to try first. It's not the only way to lose weight. You can lose weight in many ways, but it's the first one because it's been shown to be the most effective for the majority of people as well. One of the things that we're trying to get government to change is to say that it can be an option alongside the current recommendations. Why can't we have that equal amount? Because at the moment in those guidelines, it explicitly says that people have to count calories and count 600 calories less and it has to be a low-fat diet as well.

[0:40:04]

    So yeah, that's one thing that we're just trying to get it so that it's at least recommended at the same time and given as an option as well just to start the ball rolling. So that's the ways in which we're trying to do that. And then in the next month or so, we'll be coming out with our Diet Advice for Diabetes report as well, which basically does the same thing, so it's a report on our concerns with government dietary guidelines for diabetes and an alternative solution based on the randomized controlled trials. So yeah, that's going to be another fun ride for sure.

Christopher:    I look forward to that. So if I went to your website this morning and I registered with my email address, will I find out that way when the report comes out?

Sam:    Yes, absolutely. Hopefully we'll get a decent amount of media exposure as well, so you might find --

Christopher:    Find out through the telegraph or something.

Sam:    Yeah, exactly. There's telegraph [0:41:01] [Indiscernible].

Christopher:    So I think all the people listening will be subscribed to your message of real food already, and so the final question I have for you is what can people who listen to this do to help you and support the Public Health Collaboration?

Sam:    Thanks, Chris. It'd be great if people can go to our website, publichealthcollaboration.org and then there they can read up on all of the different things that we're doing. And if they think that it's a worthy cause, they can click on the "Donate" page and then look at the different donation levels that we have ranging from £1 to be an e-newsletter subscriber to becoming an annual member at £50 a year. For UK members and for international members, it's £75 because we have to post stuff to people. You can just check it out there and if you can give anything to our cause, it would be most welcome.

Christopher:    Awesome! I'm in. I'm international, so I'll have to pay the higher rate, but I think that's a really great value for the hard work that you're doing.

Sam:    I appreciate that, Chris. That means a lot because we really try to keep things lean here. One of the ways that we keep lean is that I'm the only full-time employee. Everybody else want to use their time in terms of -- we've got a scientific advisory board of 12 doctors mostly working within the NHS, people like Aseem Malhotra, Tamsin Lewis, Rangan Chatterjee, and David Unwin. As I said, I'm the only full-time employee, but I only take a London living wage for doing what I'm doing, which is £9.40 an hour. We basically just try to keep things as lean as possible and then everything else goes towards trying to implement the changes that we want to see as well.

    I think we have a unique opportunity in the UK because we have this one healthcare system. We can really be a shining example because you can compare different practices, GP practices very easily and even different hospitals are implementing our changes. And when you do, you have people like Dr. David Unwin who's in the north of England, and compared to the average of his local area, he spends £40,000 less a year on diabetes drugs alone. So if we were able to replicate those results throughout the nine and a half thousand GP practices in the UK, we'd be able to save the NHS £370 million.

Christopher:    Wow!

Sam:    So there's big money to be saved here and that's just on the diabetes drugs. It doesn't take into account the social care costs, hospital visits, the surgery those patients living with Type 2 Diabetes might have to have, and the other related conditions such as heart disease and cancer as well. So yeah, it's a bit of a conservative estimate, the potential that this has. So it's going to be an exciting couple of decades, I think, because this is going to take decades to properly implement and get things to change, but we've got a lot of promise and I hope that we can be a shining example for the rest of the world.

Christopher:    Sam, you do some wonderful work and I'm in great admiration of you. I think this is absolutely fantastic. So the Public Health Collaboration is the Google search time you're looking for. I will of course link to everything in the show notes. Is there anything else that you'd want people to know about, Sam?

Sam:    We've got a conference.

Christopher:    Oh, of course, the conference. I meant to mention the conference.

Sam:    Coming up in June, so if you are in the UK or you --

Christopher:    You want to go on a holiday to the UK, which I do.

Sam:    If you want to come on vacation, you're most welcome. It's in Manchester on the 17th and 18th of June, which is a Saturday and Sunday.

[0:45:00]

    We have speakers coming from around the world like Andreas Eenfeldt from dietdoctor.com. We have Jason Fung coming along as well and Jeffry Gerber from Colorado and a lot of our advisory board members will be speaking there as well. It's just going to be a great time to bring people together in order to create change, so yeah, if you want to check that out, head over to the website and see if you can make it.

Christopher:    Awesome! It sounds brilliant. Well, thank you so much, Sam. I really appreciate you.

Sam:    My pleasure, my pleasure.

[0:45:33]    End of Audio

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