DO THIS DAILY To Reduce Inflammation & PREVENT DISEASE Today! | Andrew Weil

Dr. Andrew Weil 0:00 It's that kind of food that is at the root of a lot of our cancer, coronary artery disease, obesity, type 2 diabetes, hypertension, and so forth.

Dr. Rangan Chatterjee 0:09 [upbeat music] Chronic inflammation is a root cause of disease. It's so fascinating for me to be talking to someone like yourself who was way ahead of the game. Did you know about it before it came into the, the sort of common vernacular, and what happened there?

Dr. Andrew Weil 0:25 What first caught my attention were articles in the scientific literature in the mid-1980s that made it look as if there were commonalities in the origin of disease entities that I had been taught had nothing to do with each other, that coronary artery disease and cancer and neurodegenerative diseases, that there might be a common root there in chronic inappropriate inflammation. That is a completely new idea and hypothesis, and I have a good sense of knowing when things are right and that there's going to be evidence to support that. So I got onto that idea very early, and it excited me because if these broad categories of disease that we had previously thought had nothing in common, if in fact they have a common root, then there's a common strategy for dealing with them and reducing the risk of them, and that is by doing everything you can to contain inappropriate inflammation. There's a lot of influences on, uh, one's inflammatory status, some that you can do things about and some that you can't. Um, you know, one that you can do something about is exposure to, uh, environmental toxins. Uh, secondhand tobacco smoke is a major pro-inflammatory agent, for example. Uh, but the, what particularly caught my attention was the possibility that, uh, dietary changes could reduce, uh, inappropriate inflammation, and I developed an anti-inflammatory diet with that, that in mind. And, and long after I began to, uh, s- look at this and begin writing about this, I began to see other evidence that mental emotional health was linked here as well. And th- this, uh, the cytokine hypothesis of depression, which is a much more recent idea, uh, to me looks much more robust than the serotonin hypothesis of depression, which has led to all the use of, uh, pharmaceutical antidepressants. Um, and the idea that, that chronic inflammation and, uh, depression are link- are linked, that's fascinating to me.

Dr. Rangan Chatterjee 2:27 How do you describe inflammation or chronic inflammation to your patients or your students?

Dr. Andrew Weil 2:32 Well, I usually say, you know, we're all, we all know inflammation on the surface of the body. It's local redness, heat, swelling, and pain in an area that's injured or under attack, and that although it can be uncomfortable, inflammation is the cornerstone of the body's healing response. It's how the body gets more nourishment and more immune activity to an area that, that needs it. Uh, but inflammation is so powerful and it's so potentially destructive that if it persists, if it escapes its limits in time and space, then it becomes destructive. Uh, and in the short term, it can lead to, uh, allergy and autoimmunity, but long term, it looks as if it increases the risk of a whole diverse range of very serious chronic diseases. You know, I think that, uh, coronary artery disease begins as inflammation in the lining of arteries. Uh, Alzheimer's disease clearly begins as inflammation in the brain, and that's why, uh, anti-inflammatory agents like ibuprofen and turmeric have a preventive effect. Um, and cancer is linked here too because, uh, a- anything that increases inflammation also increases cell proliferation. Uh, the two are totally linked. And, and when cells proliferate, uh, more, the risk of, uh, malignant transformation is increased. So again, it, it's just fascinating that, uh, this is so different from what I was taught in medical school.

Dr. Rangan Chatterjee 3:54 In terms of foods and this anti-inflammatory diet that you put together many years ago, I wonder if we could sort of talk about what this kind of dietary pattern looks like. Is it more about the sort of general types of foods you're eating, or can we h- see within that some specific-

Dr. Andrew Weil 4:13 Both. Both.

Dr. Rangan Chatterjee 4:14 Yeah.

Dr. Andrew Weil 4:15 And I, I developed this by using the Mediterranean diet as a template because we have so much scientific evidence for that way of eating being associated with, uh, you know, optimum health and longevity, and it's a way of eating that, uh, in no way restricts the pleasure of food, which I think is extremely important. And I tweaked that by adding Asian influences to it because I've spent a lot of time in Asian countries, and there are, uh, foods, specific foods and, and, uh, beverages that I th- that in particularly in Japan, uh, China, uh, India that I think are, you know, very healthful. So, um, the first rule of the [laughs] anti-inflammatory... First of all, it's not a diet, you know, it's... Because diets are things that we go off of, so it's an eating plan for life. And the, the first rule is to stop eating or greatly reduce consumption of refined, processed, and manufactured foods. I mean, that simple. It's that, that kind of food, food being made by somebody else, uh, that is really at the root of a lot of our, uh, of these chronic illnesses in, in our societies of obesity, type 2 diabetes, hypertension, and so forth. Uh, so the first step is simply to try to, uh, eliminate refined, processed, and manufactured food. And then, you know, next is eating a, a variety of high-quality fresh produce, um, especially vegetables. Uh, you know, fruits, yes, but fruits are, are often concentrated sugar sources, and I think should be, we should be more moderate about that. But an array of vegetables with all different colors because those are all protective compounds. I think it is good to reduce the amount of animal protein in the diet. I don't tell people to become, uh, complete vegetarians or, you know, I, I myself eat fish and vegetables. Uh, but I think restricting animal foods is a good idea. Um, in- increasing the consumption of, uh, plant protein in the form of legumes, soy protein, for example. Um, using olive oil as a major, uh, as a main cooking oil, and being very careful about the kinds of fats that you consume. Uh, making sure that you're getting omega-3 fatty acids, uh, which are strongly anti-inflammatory by eating oily fish, um, or, uh, supplements of, uh, derived from algae if you don't want to eat fish. Um, using spices like turmeric and ginger, which are st- powerful anti-inflammatory agents. Tea, uh, especially green tea, which has, uh, many healthful antioxidant- ... properties. I've developed a, um, a, a eating, uh, forms of carbohydrate that don't raise blood sugar quickly. I, I'm not anti-carb, but I think, uh, it's important to distinguish between types of carbohydrates that digest quickly, and especially products made from flour and pulverized grains-

Dr. Rangan Chatterjee 7:10 Yeah

Dr. Andrew Weil 7:10 ... as opposed to truly whole grains that are cracked, either entire or cracked in big pieces. Um, and, uh, I have an anti-inflammatory diet pyramid, and at the very top is dark chocolate, which I think is a health food, and I, and, uh, consumed in moderation I think is very good for you.

Dr. Rangan Chatterjee 7:30 The first step when you were describing that was remove or eliminate these highly processed foods. And it just makes me think of something I, I've been sort of contemplating a lot recently, Andrew, which is this, this idea that is it more important... And I guess the, the question itself is artificial, but it's just a, I guess a, you know, a thought experiment. You know, is it more important to exclude these problematic, modern, highly processed, I guess not even foods, food-like substances?

Dr. Andrew Weil 8:09 Food-like, yeah [laughs]

Dr. Rangan Chatterjee 8:10 Or, or is it more important to, I guess we can keep those in but add in some of these so-called, you know, super foods or, you know, your dark chocolate, your berries, those sort of things. I mean, how would you look at that sort of conundrum?

Dr. Andrew Weil 8:24 Uh, I think it is more important to reduce or eliminate the, the processed stuff.

Dr. Rangan Chatterjee 8:29 Me too.

Dr. Andrew Weil 8:29 I, I think it is really unhealthy and, uh, i- on all sorts of levels. It's the wrong fats, the wrong types of carbohydrates, not enough of the protective elements. So I guess you could make up for the protective elements by adding some of those other things back, but you're not gonna take away the damage being done by the, you know, the unhealthy fats and the unhealthy forms of carbohydrates and the additives.

Dr. Rangan Chatterjee 8:52 How do you, you know, how do you see these diet wars? And, and I'm, again, I'm really interested because you've been across this field for so many years. You know, something has changed, hasn't it, in the last, I don't know-

Dr. Andrew Weil 9:05 Mm. Yeah

Dr. Rangan Chatterjee 9:06 ... 10, 20 years? Like diet is, you know, it's primetime now, you know.

Dr. Andrew Weil 9:11 [laughs]

Dr. Rangan Chatterjee 9:11 Everyone's talking about... Well, not everyone, not enough people-

Dr. Andrew Weil 9:14 Yeah

Dr. Rangan Chatterjee 9:14 ... but a lot of people within the health space are talking about diets. There are-

Dr. Andrew Weil 9:19 Yeah

Dr. Rangan Chatterjee 9:19 ... fights going on about-

Dr. Andrew Weil 9:21 Yeah

Dr. Rangan Chatterjee 9:21 ... vegan versus carnivore versus keto versus low carb. And, you know, I'm interested as to how do you see all that? As someone who's been across this for so, so long, has anything happened to modify your view? Ch- you know, tweak things over time? Or, you know, what, what's been going on there?

Dr. Andrew Weil 9:40 Well, I've s- I've seen a lot of these come and go, and I think a lot of the ones that are fashionable at the moment will go. Uh, some of the ones that are popular I think are really unhealthy. I think a keto diet is extremely unhealthy, unless it's for, you know, specific use of kids with intractable seizures, for example. Um-

Dr. Rangan Chatterjee 9:58 Well, why do you say that? Because a lot of people, even within the health space, are, are describing huge benefits from a ketogenic diet. And I, and I appreciate a ketogenic diet-

Dr. Andrew Weil 10:08 Yeah

Dr. Rangan Chatterjee 10:08 ... can be done many different ways. I mean, a lot of people can do it with lots and lots of sort of leafy green veg as well to get these phytonutrients.

Dr. Andrew Weil 10:14 Right.

Dr. Rangan Chatterjee 10:14 But, but, you know, why is it you think it's so unhealthy?

Dr. Andrew Weil 10:17 I think it ten- uh, these diets tend to be v- unhealthily low in fiber, for example. I think, uh, the restriction of carbohydrates is unhealthy. I think it fails to distinguish between, um, better and worse forms of carbohydrate. Uh, I think beans are a very healthy forms of carbohydrate. Whole grains I think are healthy. I think keto diet is also very unhealthy for the planet, and this is something that we all have to be concerned about today, is the, the environmental impact of different ways of eating. And this is, uh, you know, one of the strong arguments for, uh, reducing animal protein in a diet, especially beef, and keto people tend to be eating a lot of meat. Uh, and that I think is one of the great contributors to climate change, and we can't afford to do this anymore. So for all those reasons, I think that's not a good eating plan. Uh-

Dr. Rangan Chatterjee 11:09 On, on, on an individual level-

Dr. Andrew Weil 11:11 Yeah

Dr. Rangan Chatterjee 11:11 ... I'm, I'm only asking this 'cause I know a lot of people will ask this question.

Dr. Andrew Weil 11:13 Yeah.

Dr. Rangan Chatterjee 11:13 If there's someone listening to this right now, um, or, or, or, you know, watching this on YouTube or whatever, somehow consuming this information, and let's say, I don't know, three months ago they went on a ketogenic-type diet and-

Dr. Andrew Weil 11:29 Mm-hmm

Dr. Rangan Chatterjee 11:30 ... they're now experiencing they've, they've lost weight, they've got more energy, they've got better skin, they've got more focus. Because this is what you hear a lot, right? So if someone is-

Dr. Andrew Weil 11:39 They do

Dr. Rangan Chatterjee 11:39 ... listening to that, uh, is experiencing that and then they're hearing you, someone who they really respect, say actually you don't think it's that helpful, how would you help that individual kinda make sense of that?

Dr. Andrew Weil 11:52 First of all, a, a, a general belief I have is that, uh, in many cases, benefits, health benefits that people experience when they change how they eat, uh, are really not directly due to the dietary change, but rather to the commitment of mental energy to doing something to improve your health. Um, you know, there's no way to do that experiment, but I think it's not easy for people to change how they eat. And so to do so represents a great commitment of mental energy, and that often initiates a healing response or improves health function of the body. So I think any, uh, beneficial changes that you see following a dietary change have to be assumed to be somewhat, and maybe in large part, due to that. Um, you know, if you wanna call that a placebo response, fine, but unless we have controlled experiments to tell how much is due to the actual dietary change, it's very hard to tell. You asked also about, uh, any m- major changes that I've made in my thinking. You know, a big one was that I lived through the anti-fat era in the 1970s, uh, when we were told that dietary fat was the ultimate culprit and it was c- causing, you know, uh, he- Heart disease and all sorts of things, and this was the era in which manufacturers made low-fat and no-fat products, and in that period people got fatter, uh, and there was really no change in disease patterns. And I think that way of thinking has been totally discredited, although still if I go to a spa in many countries, the food that I'm served is ultra-low-fat food, and people think that's the way you make food healthier is to reduce the fat content and, you know, that has nothing to do with it. I think, uh, carbohydrates and the nature of carbohydrates are much more, um, relevant there. So yes, I have seen, uh, big changes in, in how we're thinking, uh, and, uh, uh, you know, I expect that there'll be more of them. But our center, uh, put together over a number of years, I think for 15 years, we had, uh, national nutrition conferences in which we brought together the leading nutrition researchers to present their findings to clinicians, and these were extremely well-attended, uh, conferences. And in putting those together, one of the things I learned is that in the community of nutrition researchers, there's a very high degree of consensus on the big questions. And we know what are good fats and what are bad fats, what are good carbs, what are bad carbs. Uh, but somehow that information does not make it through either the education of clinicians or certainly the general public, because people seem to think that it's all confusion out there, and, you know, one day they tell us this thing and then they tell us another, so you may as well just eat whatever you like, and that's not how it is.

Dr. Rangan Chatterjee 14:34 Yeah, I think that's the big problem with the diet wars, that many people who don't feel that strongly get really put off. They, they see someone they respect say, "I changed my life on a keto diet." They see someone else they respect say, "I went vegan and I felt amazing." And, and I guess there's a wider problem there, I think, which is, you know, I'm interested as to your thoughts on this, Andrew, but I, I kind of feel we as a society have put a lot of faith, maybe too much faith, in experts and other people-

Dr. Andrew Weil 15:10 Mm-hmm

Dr. Rangan Chatterjee 15:10 ... and, and it's kind of like, well-

Dr. Andrew Weil 15:11 Mm

Dr. Rangan Chatterjee 15:12 ... we need to become our own experts, right? I, I say to people, "Listen. Listen to what they're sharing, then try it yourself." You know-

Dr. Andrew Weil 15:20 Yes, exactly

Dr. Rangan Chatterjee 15:21 ... tune in. Trust how you feel. You know, just 'cause your neighbor did this diet and they felt amazing doesn't mean that's the right approach for you. I mean, how, how do you see that?

Dr. Andrew Weil 15:32 Yeah, I feel that way, and also I worry that some of these very restrictive ways of eating, uh, have a very unhealthy impact on social interaction, on ability to enjoy food or to enjoy food together with other people. Uh, uh, you know, I just see this happening all the time and, and, uh, people saying you have to eat this way, if you don't eat this way you're going to nutritional hell. I, I just, I, I have no patience for that.

Dr. Rangan Chatterjee 15:59 Yeah. So

Dr. Rangan Chatterjee 16:01 food is clearly one of these things where we can tackle inflammation. You mentioned avoiding, um, sort of air pollutants, toxins like cigarette smoke is also really important to help reduce inflammation. But what are some of the other things that we can do with our lifestyle that can help reduce inflammation?

Dr. Andrew Weil 16:19 Well, stress has a, has an effect on inflama- on inflammatory status, and I, and, and stress is another, uh, significant root of many kinds of, of, uh, health problems. I, I think... I, I would say that learning, uh, and practicing methods of neutralizing the harmful effects of stress is right up there with, uh, nutrition and physical activity, and adequate rest and sleep is one of the planks of healthy living. Um, I, I don't think it's possible to live without stress, uh, but I think you can learn to manage it and not let it damage, uh, the body or mind.

Dr. Rangan Chatterjee 16:59 What are some of your favorite sort of stress reduction practices that, that you find people get real benefit from?

Dr. Andrew Weil 17:06 Well, by far my, my favorite are breathing techniques. I think that, that learning how to regulate the breath is the most time and cost-effective method of, uh, of, of reducing anxiety, of promoting calmness. Um, and I, I've been astonished at how little scientific attention has been paid to breath. And by the way, this is something that comes from, uh, Indian culture. If you look at around the world at places, whether it's martial arts or natural childbirth or athletic performance, where breathing is stressed, and you try to find where this knowledge came from, all roads lead to ancient India. You know, this is a science that developed thousands of years ago in India and has diffused all over the world. Uh, and, and, uh, as I say, just astonishing how little scientific research has been done on breath and its ability to change physiology, although that finally is changing.

Dr. Rangan Chatterjee 18:01 Yeah, it really is. I mean, you have widely popularized the 4-7-8 breath.

Dr. Andrew Weil 18:06 Yeah.

Dr. Rangan Chatterjee 18:06 Um, can you tell us what the 4-7-8 breath is, and, you know, when did this start coming into your awareness, and when did you start talking about it?

Dr. Andrew Weil 18:14 It's a yoga technique, so again, thousands of years old, and, uh, I, I learned it from Dr. Fulford. Uh, and I've been practicing it since probably the, uh, early 1980s, and I have taught it, I teach it to every patient I come into contact with, to all of my students, uh, sometimes to very large groups of people. Um, it, it's so time efficient. It's just, you know, the method is simply, uh, breathing in quietly through your nose to a count of four, holding your breath to a count, for a count of seven, then blowing air out forcibly through your mouth to a count of eight, and repeating that for four breath cycles when you're first learning it, and doing that twice a day religiously, and that's all. And by simply doing that, uh, over time, you know, over the space of a month or two months, you really change the dynamics of the involuntary nervous system. Uh, decrease sympathetic tone, increase parasympathetic tone. The relaxation response, uh, lowers heart rate, lowers blood pressure, improves digestion. Uh, um, really amazing results and, and, uh, it, it takes 30 seconds twice a day.

Dr. Rangan Chatterjee 19:29 I mean, I love recommendations like that. You know, very, very effective but, but free and accessible to everybody, which I think is something that I always try and keep at the back of my mind when, when talking about health. What, what, what... Th- there's this theme coming up, um, Andrew, which is, you know, you mentioned inflammation before. You were becoming aware in the maybe early '80s that there's this kind of root cause of chronic unresolved inflammation that may be behind, or at least contributing in a large way to things like hypertension, type 2 diabetes, heart disease, you know, depression, whatever. It's like, okay, great. You also mentioned that you teach the 4-7-8 breath to pretty much every single one of your patients. So what, what I really love is this understanding and this idea that there are some basics of health, right? [laughs] There are some-

Dr. Andrew Weil 20:20 Mm-hmm

Dr. Rangan Chatterjee 20:21 ... there are some common commonalities. If we focus on the creation of health in the body, if we focus on reducing inflammation in the body through hopefully lots of, uh, you know, uh, lifestyle practices, we can tackle multiple different diseases-

Dr. Andrew Weil 20:40 Mm-hmm

Dr. Rangan Chatterjee 20:40 ... even though we're not targeting them specifically. And, and it's, you know, a- as you say, that 4-7-8 breath, it sounds like you use that as prevention, as prophylaxis, but also as treatment when somebody has a problem. And I think this i- is in many ways changing the way that we look at medicine because we have been taught in a, in a... Certainly I was trained what? Maybe 30, 35 years after you, but a very sort of quite a reductionist model. We're very good at giving labels to different diseases. We, we separate off the body into different specialties and that can have value, but also we, we, we forget that we're one interconnecting system, and if you change one part of that system, you also have a knock-on effect on other parts as well.

Dr. Andrew Weil 21:30 Yeah, let me give you an example with the 4-7-8 breath. Th- this is by far the most effective anti-anxiety measure that I've come across. It makes the drugs that we use for anxiety look very pathetic by comparison, and I have used that in patients with the most extreme forms of panic disorder, uh, successfully, although in some cases, it took some time of regular practice for them to get control of it. But the, the difference between treating a- an anxiety attack or panic disorder with a drug like a benzodiazepine and with the 4-7-8 breath, it's a very stark contrast. When people are panicked or in anxiety states, the subjective experience usually is of being out of control. If you deal with that by giving a, a, a medication, you reinforce the false idea that the locus of control is external, and over time, that method becomes less and less effective and often creates dependence. If when a person discovers that they have within them the ability to control an anxiety state by regulation of the breath, it's a revelation. It's totally empowering, and that method becomes more effective with repetition and creates greater independence and greater autonomy. I mean, it just couldn't be a greater contrast of those two approaches.

Dr. Rangan Chatterjee 22:55 Yeah. Completely agree. It's about putting... It's just about, it's about connecting the patient to what's going on, the feeling that they have got some control over. Otherwise, it's... Yeah, I, I agree. It's, it's not only the fact that the treatment itself has very few, if any, side effects, right? So that's [laughs] But it's also-

Dr. Andrew Weil 23:16 Right. Yeah [laughs]

Dr. Rangan Chatterjee 23:17 ... you know, it's also that empowerment

Dr. Rangan Chatterjee 23:18 and it... And I guess that kind of leads on to this term mind-body medicine, which I've heard you talk about a lot, and I think it's worth kind of really trying to understand, you know, what do you mean when you say mind-body medicine? You know, do you see the mind and body as separate? Does society see it as separate? And, you know, what does that umbrella term really mean?

Dr. Andrew Weil 23:40 I think the only way you can separate mind and body is verbally. I think they are two poles of the same reality. Uh, and I think the, uh, the reigning paradigm in Western science and medicine simply does not see that. You know, that we, uh, we have a materialistic paradigm in place, uh, that states that all that is real is that which is physical, that which can be touched, measured, um, I guess in medicine, taken out. Uh, and that if you observe a change in a physical system, the cause has to be physical. Non-physical causation of physical events simply is not allowed for in that paradigm. And this is why mind-body m- interactions have been, uh, never accorded their proper due, why research in that area has been stunted, why hypnosis has never been fully accepted as a medical modality, for example, why we can't make sense of, of, uh, wart cures. I mean, there's a whole range of things. But, uh, that, that is changing, and, uh, some of the change has come about with, uh, validating placebo responses through brain imaging and showing that there are correlations with, you know, activity in particular areas of the brain. So this makes it accessible to people. Gradually changing, but I would say there's, there's a whole range of therapies under the heading mind-body medicine, from biofeedback, hypnosis, visualization, and so forth. In general, uh, these methods are very cost-effective, time-effective, even fun for both practitioner and patient. Uh, and yet they are very underutilized in medicine, and they're underutilized because we just don't take this kind of stuff seriously. In, in my clinical experience, I have again and again seen that the, the root causes of illness are in the non-physical compartment.

Dr. Rangan Chatterjee 25:40 Yeah.

Dr. Andrew Weil 25:40 Unless that's dealt with, um, y- all the physical intervention that you do is not gonna solve the problem. It's tricky sometimes to, uh, present this to patients because, uh, many patients are very sensitive to being accused of making up their illness or imagining it, that it's all in their head, and that's not what is meant by this. I, I don't... Y- it's very difficult to use the term psychosomatic because of that connotation.

Dr. Rangan Chatterjee 26:04 I don't think we've, as a profession, we've, we've got a bit of a bad reputation in the past-

Dr. Andrew Weil 26:09 Yep

Dr. Rangan Chatterjee 26:10 ... for telling people that their IBS, their irritable bowel syndrome, is sort of kind of in their-

Dr. Andrew Weil 26:14 Right

Dr. Rangan Chatterjee 26:14 ... head or their fibromyalgia is sort of in their head. And I think, so there's a l- there's a real defensiveness from people, understandably-

Dr. Andrew Weil 26:22 Yeah

Dr. Rangan Chatterjee 26:22 ... that-

Dr. Andrew Weil 26:22 Understandably, right

Dr. Rangan Chatterjee 26:23 ... the doctor's telling me it's in my head.

Dr. Andrew Weil 26:24 I mean, IBS is clearly in the bowel as well as in the head, and, uh, you know, everything is, is b- in both.

Dr. Rangan Chatterjee 26:31 Yeah. It's, uh, it's really interesting that, isn't it? The mind and the body. And I guess now we're getting this field of research which I'm interested at as to what state this was in in the '60s and '70s. But, you know, the last five, 10 years we've got the microbiome, the gut-brain axis, lots of research showing this bidirectional communication between body, our gut, and [laughs] the mind in our brains. And, you know, did... Were you aware of this, uh, early on? You know, what, what did the research say, or did you just intuitively and through your experience know that this was going on?

Dr. Andrew Weil 27:09 I took a course in medical hypnosis at Columbia University, uh, right after I finished my internship. It was one of the most fascinating courses I ever took and, uh, certainly made me aware of the research that was out there, and it, and it totally resonated with my own interests. So it's, I've paid attention to that for a long time. I, uh, have a colleague that I worked with for many years who's on our faculty, um, who is a, uh, teaching member of the American Academy of Clinical Hypnosis, and, uh, I've sent him many patients. And I remember early on him saying to me that he thought that every, uh, dermatological patient and every GI patient should first go to hypnotherapy before they went to dermatologists or gastroenterologists because those two systems of the body have s- have the highest ratio of innervation and connection to the mind. Um, and I've absolutely found that to be true. And, and another, uh, experience I had, uh, shortly after he said that, I, the, the leading gastroenterologist in Tucson asked me to have dinner with him. He's in his 60s, and he was very depressed and said that he hoped that I had something that could help him because he said 90% of the patients that he saw had conditions for which his training did not equip him to do anything about. I mean, that's remarkable. Um, and, and I think y- this is absolutely the way it is, and it's not just for GI disorders and dermatological disorders. It applies to many other things as well. And that doesn't mean you sh- should not work on the physical problem, but you wanna also be working on the non-physical aspect of it.

Dr. Rangan Chatterjee 28:50 I mean, there's two things that come to mind there. That, that 90% statistic is, is a very striking one, and what's interesting for me is that I would agree with that actually. There's, uh, there's, um, so much of what we see we don't, uh, certainly as medical doctors, we don't have tools that work really well-

Dr. Andrew Weil 29:10 Yeah

Dr. Rangan Chatterjee 29:10 ... for them, yet I feel... I don't know what it is about... I'm not trying to get too down on my profession at all. I'm very proud to be a medical doctor. I'm, I'm pleased I went-

Dr. Andrew Weil 29:18 Oh

Dr. Rangan Chatterjee 29:18 ... through, like you, that, that conventional medical training. But I do feel sometimes that there's a, there's a certain arrogance within the profession, or there's a... I don't know what happens at medical school where you go in as a kind of open-minded, curious individual, and you come out, or many of us come out-

Dr. Andrew Weil 29:35 Yeah

Dr. Rangan Chatterjee 29:35 ... quite close-minded, thinking we know it all, and actually anything that we weren't taught has no value. And because-

Dr. Andrew Weil 29:43 Oh

Dr. Rangan Chatterjee 29:44 ... you know, a real striking moment for me, uh, Andrew, was one, it was one of my days as a general practitioner. You know, I moved from specialism into general practice. I was getting quite frustrated with just looking at kidneys, and I really wanted to see how everything linked together. And I remember one day I'd seen, I think, close to 50 patients, and I was a bit frustrated. And before I left the clinic to go home, I, I went through the whole list and I asked myself, "Okay, Rangan, how many patients have you really, really helped today?"

Dr. Andrew Weil 30:17 Mm.

Dr. Rangan Chatterjee 30:17 And I honestly thought it was about 20%. I thought, "Yeah, those 20%,"

Dr. Andrew Weil 30:20 Yeah

Dr. Rangan Chatterjee 30:20 ... I think I've really done something for. The other 80%-

Dr. Andrew Weil 30:23 Yeah

Dr. Rangan Chatterjee 30:23 ... uh, you know, I've, I've referred them somewhere. I've given them something to suppress a symptom. But I, I didn't really understand what was going on. I knew that they would be back, and I thought, "I can't do this for 30, 40 years." Like-

Dr. Andrew Weil 30:34 No

Dr. Rangan Chatterjee 30:35 ... there must be more to this than that, right? So why is it that it-

Dr. Andrew Weil 30:39 Of course

Dr. Rangan Chatterjee 30:39 ... some of us look at that with honesty and transparency and go, "Actually, we're, we're really good at this stuff. We're not so good at that stuff." And why is it that others kind of almost ignore that and just stay within that system of going, "No, no, no, no, this is the way to do it"? Do you, you know, have you got any answers there? What, what goes on there?

Dr. Andrew Weil 30:56 [laughs] Well, I consider myself an open-minded skeptic. Uh, I'm willing to look at anything believe anything, but then I need to see, uh, proof. I need to confirm that with my own experience. A lot of people that I run into in medicine and science generally, I would say, are close-minded skeptics, which is very different. And, uh, I, I, I think in medicine especially, uh, there is a tendency to be suspicious of, defensive about any information that comes from unfamiliar sources. Uh, so a- all of... a lot of the ideas of... that are out there in the world of alternative medicine, you know, anything of that sort is just dismissed as, as nonsense without even paying attention to it. The, um, the dean of the College of Medicine at the University of Arizona, who gave me the green light to start this center years ago, uh, Jim Dolan, he was a cardiologist and had, had been a psychologist as an undergraduate, which has probably accounted for some of his openness to this. Uh, when he retired, he said that the achievement he was most proud of in his career was starting the Integrative Medicine Center. And he told this, uh, said this about, uh, all the flak that he got for allowing this to happen, and he, he told a story about the attitudes of people in our profession, and I think it's interesting. The observation that aspirin, uh, was an anticoagulant and may have a preventive effect in coronary artery disease was first made, I think it was in the 1950s, by a general practitioner in Kansas, who noticed that when he, he w- he was taking aspirin, noticed that when he cut himself shaving, that his, he bled more than usual. So he thought maybe aspirin was responsible for this. He started giving aspirin to some of his friends and confirming this effect, and he wrote an article in the Journal of General Practice saying that aspirin had anticoagulant activities and might be useful as a preventive in coronary artery disease. It took, uh, something like 30 years for the medical profession to come around to that point of view, and a major reason why they didn't was that this had been proposed by a general practitioner and published in a journal that cardiologists didn't read, uh, and it was dismissed as an outrageous idea, and that's w- within the profession. So imagine when something comes from the world of traditional Chinese medicine or the world of herbal medicine, you know, that, that provokes this kind of, the same, same sort of response.

Dr. Rangan Chatterjee 33:36 When you were giving the definition of integrating medicine, I think you used the word conventional medicine within it, and you just mentioned the phrase traditional Chinese medicine, and it's an interesting thought, isn't it? When we, we talk about conventional medicine or traditional medicine, it's, again, there's a, there's a sort of inbuilt arrogance there. It's like, well-

Dr. Andrew Weil 34:02 Yes, it is. But [laughs]

Dr. Rangan Chatterjee 34:03 It is

Dr. Andrew Weil 34:04 ... you know, our system of medicine is not that old, and if-

Dr. Rangan Chatterjee 34:06 Yeah

Dr. Andrew Weil 34:06 ... you're gonna call something traditional, I think it should be at least 1,000 years old.

Dr. Rangan Chatterjee 34:10 Yeah, exactly. It's-

Dr. Andrew Weil 34:11 You know, so Native American medicine, Ayurvedic medicine, but not what we're doing today as allopathic medicine. I mean, that only goes back maybe 100 years.

Dr. Rangan Chatterjee 34:20 I mean, what is incredible is to see, as you said, with, with breathing, but there's a lot of science now coming out, isn't there, to support what these ancient healing modalities, you know, traditional Chinese medicine, Indian Ayurvedic medicine, have been talking about for years, whether it's a period of time each day without food or, you know, a period of time every 24 hours where you're not putting food in, whether it's breathing practices, whether it's, um, the fact that different organs have different genetic activity and that, they're, they're, they're more or less active at different parts of the day. I remember The Guardian newspaper in the UK covered a study maybe two or three years ago which was showing h- you know, it was about the circadian clock and how the liver is more and less active at certain parts of the day. Other organs are as well. A- and the, and the kind of conclusion was, oh, so we can then use different medications at different-

Dr. Andrew Weil 35:21 Mm

Dr. Rangan Chatterjee 35:21 ... times in the day. And okay, that may be one of the conclusions, but I was also thinking, have traditional Chinese medicine and Indian medicine not been saying this for thousands of years? That there's a different rhythm to different organs at different times of the day. And I guess for you, as someone who's been preaching this message for a good 50 years, you're now seeing a lot more mainstream support in a way that you presumably weren't 40, 50 years ago. I guess with some of these other modalities, not that they need it, I guess, but it must be quite gratifying to see, oh, these guys are kind of catching up to what we already knew.

Dr. Andrew Weil 36:03 You know, as I say, there, there are ideas in these systems that to me seem so powerful and useful, and there's other ideas that, that, [laughs] that don't seem that way. And I, I, I look at all this and I'm very selective in what I take from, from other systems. One idea that, uh, I find very powerful from, uh, Chinese medicine, uh, I have a, another colleague, an MD in, uh, New York who practices what he calls modern Chinese medicine, and, uh, he... I once heard him say that if you could summarize all of Chinese medical philosophy in one sentence, it would be to dispel evil and support the good. In, in Western medicine, all of our focus is on dispelling evil. You know, we identify what we see as agents of disease or causes disease, and we blast them with, uh, weapons, usually pharmaceutical, and we really pay no attention to supporting the good, which are the intrinsic, uh, the intrinsic resistance or defensive functions of the human body. And, and just as a concrete example of this, if you look at the way we manage gastroesophageal reflux disease, um- You know, we use these very powerful medications that suppress production of stomach acid. You know, we say that's the problem, there's too much acid in the stomach, and we stop it with a very powerful drug. Um, that's an example of dis- the dispelling evil philosophy. We do nothing to support the defensive function of the body, which is how do you make the gastric mucosa more resistant to the erosive action of, of stomach acid? And there are various ways of doing that. There are natural products that do that, adjustment of diet. I, I see so many patients who are put on these medications without any dietary history being taken-

Dr. Rangan Chatterjee 37:49 Yeah

Dr. Andrew Weil 37:49 ... without any warning of the addictive nature of these drugs, uh, the long-term problems that they cause. I mean, that's, that's the unbalanced, uh, Western approach that could really benefit from paying attention to that, uh, idea from Chinese medical philosophy.

Dr. Rangan Chatterjee 38:05 Yeah, and the system, the, the modern medical system really feeds that, doesn't it? Because, you know, as you said that, I had a, I had a flashback to, I don't know, 12, 13 years ago I'm gonna guess-

Dr. Andrew Weil 38:16 Mm

Dr. Rangan Chatterjee 38:16 ... in clinic, you know, a lot of patients waiting outside. This is much more conventional NHS general practice. And I can't remember the exact patient, but they, they'd come in, they'd still got these, uh, gut acid-type symptoms. They'd already been on, I think they started off on omeprazole, the proton pump inhibitor.

Dr. Andrew Weil 38:36 Yep.

Dr. Rangan Chatterjee 38:37 Then the doctor had changed it, it wasn't working, to lansoprazole. And then I think I had a protocol which said, "Oh, there's a new one called esomeprazole. Let's try that. That's the third line that's recommended by the local hospitals." And you just get into this maddening, uh, vortex where, you know, no one's understood the root cause of it. They've been put on one proton pump inhibitor. My understanding is that the early trials on proton pump inhibitors only looked at their use for a few weeks, three, four weeks-

Dr. Andrew Weil 39:05 Exactly, Rangan-

Dr. Rangan Chatterjee 39:06 ... at maximum

Dr. Andrew Weil 39:07 ... exactly.

Dr. Rangan Chatterjee 39:07 Whereas now-

Dr. Andrew Weil 39:08 And-

Dr. Rangan Chatterjee 39:08 ... people are on them for 10-

Dr. Andrew Weil 39:09 Yep

Dr. Rangan Chatterjee 39:09 ... plus years just on repeat prescriptions.

Dr. Andrew Weil 39:11 Right. And this is a problem that I think is really not appreciated, that I've been trying to call people's attention to, both my colleagues and patients, that when you use these powerful counteractive agents long-term, you run into a problem I call the homeostatic trap, that the body will push back against what you're doing. So if you try to block the production of stomach acid with a drug, over time the body is gonna try to produce more acid. So if you lower the dose or stop the medication, there's gonna be an outpouring of acid much worse than you had to begin with. And so people think, "Well, then I can't get off these. I have to take them." And over time you are worsening or prolonging the problem. And, uh, the same thing happens with depression.

Dr. Rangan Chatterjee 39:58 Yeah.

Dr. Andrew Weil 39:59 You give, uh, SSRI antidepressant drugs to, uh, increase serotonin at neural junctions, how is the body gonna respond to that? It's gonna try to m- it'll make less serotonin and it will drop serotonin receptors. So that if after a year of use you try to get off that or reduce the dose, depression is increased. Uh, you know, there's, there's even a name for this now, it's target dysphoria, which is lingering, lingering depression as a result of treatment. Uh-

Dr. Rangan Chatterjee 40:28 And, and-

Dr. Andrew Weil 40:28 ... and you see this with, and again and again with so many of our pharmaceutical agents.

Dr. Rangan Chatterjee 40:32 And, and th- and that's a double problem, isn't it, Andrew? There's, there's a problem that the person who initially came to the doctor with these heartburn acid symptoms that were causing them problems at work or that when they went to sleep, because we didn't address the root cause then, we gave them a pill which may, unless we have been really clear that this is a short-term intervention to help your symptoms while we deal with the underlying root cause, which is where I think those things can potentially have value sometimes for some patients-

Dr. Andrew Weil 41:02 Yep, short-term, yep

Dr. Rangan Chatterjee 41:04 ... you know, if, if, if we explain that, but we disempower the patient. They start taking the pill, think, "Oh, I've got a problem that I need this pill to fix."

Dr. Andrew Weil 41:12 Yeah.

Dr. Rangan Chatterjee 41:12 And then when they can't get off it, they think, "Yeah," it reinforces, "Yeah, I've, I've, I have that problem. I n- I need the pill or I can't function," without realizing your body is reacting. And this, it sounds as though we're talking about rare cases. I bet you if you go to any general practice in the UK-

Dr. Andrew Weil 41:29 It's all over the place

Dr. Rangan Chatterjee 41:30 ... you will have hundreds if not-

Dr. Andrew Weil 41:32 Hundreds, yeah

Dr. Rangan Chatterjee 41:33 ... thousands of patients-

Dr. Andrew Weil 41:34 Thousands, right

Dr. Rangan Chatterjee 41:34 ... at every practice-

Dr. Andrew Weil 41:35 Yeah

Dr. Rangan Chatterjee 41:35 ... who are in this situation. And it's so frustrating 'cause once they're on it, it is challenging to get them off.

Dr. Andrew Weil 41:43 Very challenging. Very challenging. And by the way, Rangan, when I was growing up in the 19- the 1940s, 1950s, uh, reflux, gastric reflux did not exist. People had heartburn, and they dealt with it mostly by taking calcium carbonate, mint-flavored calcium carbonate, which is relatively safe. And I think most people understood that heartburn was your stomach's way of telling you that you'd mistreated it. Either you ate too much, you ate the wrong things. Uh, but now this has become completely medicalized into this condition, you know, due to too much stomach acid, and you treat it with these powerful medications, and then go about your business. And as I say, almost every patient I see who is in this situation where they're dependent on the drug and can't get off, they were started on them without any questions being asked about what they were eating, uh, were they drinking coffee, were they smoking, what their stress levels was. No, no inquiry into any of that.

Dr. Rangan Chatterjee 42:39 Yeah, or how stressful their lives were.

Dr. Andrew Weil 42:42 Yeah.

Dr. Rangan Chatterjee 42:42 Were they, were they eating on the move while... You know-

Dr. Andrew Weil 42:45 Yeah

Dr. Rangan Chatterjee 42:45 ... it, it sounds so basic, but there is always, there's almost always a way to help people with those symptoms if you take the time to understand what's causing them in the first place, and it's, y- y- you're spot on, it's this medicalization of symptoms, whereas, you know, it's the body's sign. It's trying to talk to you and raise, raise... It's trying to scream at you, "You gotta do something differently," right? "You're not treating me well."

Dr. Andrew Weil 43:11 Yeah.

Dr. Rangan Chatterjee 43:11 But instead of listening, I, I guess it's reflective of just how- How busy and stressed out people are now, whether it's the, the doctors in practice, whether it's the patients in their busy, busy lives, that it's almost... I- it kind of feels like it's the perfect storm. Medicine has got these quick fix solutions for busy people who don't feel they've got the time and energy to make change, and then you end up in this really problematic and, and quite toxic situation.

Dr. Andrew Weil 43:43 Well, this is, this is the perfect opportunity for doctors to be teachers-

Dr. Rangan Chatterjee 43:47 Yeah

Dr. Andrew Weil 43:47 ... uh, and to be able to explain to patients why long-term use of these counteractive pharmaceutical strategies is not wise, that it's gonna get you into worse trouble, uh, and may produce bad effects of its own, and what the root causes of these things are and what changes you can make. Um, you know, that's, that's what we should be doing, and it is very rewarding to do that and to see, you know, good results.

Dr. Rangan Chatterjee 44:12 Yeah.

Dr. Rangan Chatterjee 44:14 You mentioned the placebo effect before and the power of the mind, and I've shared on this podcast before that my realization over the past few years has been, yes, food, movement, sleep, stress, super important. They are very, very important things to try and help everyone with. But actually, if you go one step further, I really am feeling more and more that it's the mind, it's our belief systems up here, how we view the world actually determines a lot of those behaviors in the first place. And unless we, we tackle that, yeah, we can make big improvements with food and movement and stress, but at some point to really get that long-term change, we've got to tackle what's going on up here. And you mentioned the placebo, and i- it's interesting that there's such powerful research behind the placebo, but how do we talk about it in medicine? It's, it's the most derogatory thing in the world when you were talking about trials, isn't it? It kind of, it speaks to how little credence we give or have typically given to the power-

Dr. Andrew Weil 45:16 Yes

Dr. Rangan Chatterjee 45:16 ... of our minds.

Dr. Andrew Weil 45:18 Yes. The, the two most common usages of the word placebo I hear in medicine are, "How do you know that's not just a placebo effect?" And the most interesting word there is just. Or, "We have to rule out the placebo effect." You know, we should be ruling it in. He- placebo responses are pure healing responses from within, you know, mediated by the mind, and that's what we should be trying to make happen more often. That is the art of medicine. How do you present treatments to patients to get the maximum healing response with the minimum direct physical intervention? Again, something that I began writing about long ago and, and talking about, and I'm happy to see gradually a, a change coming about in that area. Uh, but that word is so charged and so loaded and, you know, the thinking that placebo responses are imaginary and they're not as important. H- here's a little, there's a little, uh, assignment that I like to give to medical students and also to doctors in training as well, is to go into... Pick up any medical journal at random that reports randomized controlled, uh, testing of drugs and look up an article and flip to the back where there's a table summarizing the results. In the placebo group, there will always be, always one or two or a small number of subjects who show all of the changes produced in the experimental group. I- in other words, any change that we can produce in the human body with a pharmaceutical agent can be exactly reproduced in at least some individuals some of the time purely by a mind-mediated mechanism. To me, that is the most important single fact that's come out of this whole era, 70 years of randomized, uh, controlled drug testing. Uh, and that's what we should be [laughs] trying to figure out how to take advantage of and make happen more at the time.

Dr. Rangan Chatterjee 47:15 It's something that doctors who I try and ask a lot, they, they say this, and I, I'm assuming you've heard this a lot as well, you know, "Dr. Weil, Dr. Chatterjee, you know, I understand what you're saying, but, you know, patients don't, patients just don't do what I tell them to do."

Dr. Andrew Weil 47:34 Mm-hmm.

Dr. Rangan Chatterjee 47:34 And I find that language and that phrasing very telling in and of itself. Uh, what I tell them to do, I think is, uh-

Dr. Andrew Weil 47:43 Yeah

Dr. Rangan Chatterjee 47:43 ... potentially problematic. [laughs]

Dr. Andrew Weil 47:45 Yeah.

Dr. Rangan Chatterjee 47:45 And there's this kind of thing that, oh, you know, I know everything, but the patients just don't do what I ask them. And one thing I teach, um, doctors is when I get asked what's the most important thing I've learned in 20 years of seeing patients, my answer is always connect first, educate second. And I always say to-

Dr. Andrew Weil 48:04 Yeah, and also to model behavior for patients. As I said this earlier, that you have to model, you have to embody the changes that you want to see in others. So, uh, you have to model health-

Dr. Rangan Chatterjee 48:15 Yeah

Dr. Andrew Weil 48:15 ... to your patient and healthy living.

Dr. Rangan Chatterjee 48:16 But I'm, I mean... I, I totally agree, and I, w- what I, why I'm so passionate about that is I've realized that until the patient across the table from you has really connected with you, made eye contact, like really felt heard, I just don't think they're that willing or that engaged to then take the next step. Whereas if we just rush in to give the solution-

Dr. Andrew Weil 48:39 Yeah

Dr. Rangan Chatterjee 48:40 ... it just doesn't work that well. And then if you take that outside medicine, 'cause what is the patient-doctor relationship? Well, it's a relationship, isn't it? So how does it work with your partner or your wife or your children? You know, who responds well to just being told what to do? It's always about feeling seen, feeling heard, really, really having someone validate who you are and how you're feeling before you-

Dr. Andrew Weil 49:04 Yeah

Dr. Rangan Chatterjee 49:04 ... take that next step. And I... It's such an obvious thing. Again, we're not taught it in medical school, but for me, uh, Dr. Weil, that is one of the big truths that I've learned from seeing thousands of patients, and I'm, I'm interested as to your view on that. Is that something you've come across before? Would you agree with that, or w- would you modify that sentence?

Dr. Andrew Weil 49:22 Uh, I very much agree with that. Uh, by the way, one of the reasons that- I like doing the four, seven, eight breath with patients is that it establishes a very intimate connection with the patient to breathe with them. Uh, they're not expecting that, they're not used to that, and I find that facilitates further connection. Uh, also a, a practical technique that, uh, we teach to, uh, the people that we train is motivational interviewing, and this is a, a technique developed recently. It's a dialogue that you have with a patient that helps, um, you and the patient identify mental patterns that are obstacles to making changes in behavior and lifestyle, and then helping them develop alternative mental patterns that facilitate the changes you want. It's a very useful technique, and it's something practical that can be taught.

Dr. Rangan Chatterjee 50:17 I mean, speaking of Hippocrates that you mentioned before, a, a phrase that popped into my mind was it's... I think this is Hippocrates, "It's more useful to know what sort of person has a disease than what type of disease a person has." And I think that really, that is again something I figured out over, over many years of getting frustrated and not being able to help my patients as much as I wanted to. I sort of came to that truth that way, and that, I guess, speaks to the power of the mind and how we're all sort of individual. Um, you know, y- y- you mentioned the power of the mind-

Dr. Andrew Weil 50:51 It-

Dr. Rangan Chatterjee 50:51 Sorry, yeah, go, go, please.

Dr. Andrew Weil 50:52 No, you made me think. I just had a flash on being in medical school and being told by an attending physician, you know, "Go see the gallbladder in room seven."

Dr. Rangan Chatterjee 51:02 Yeah.

Dr. Andrew Weil 51:03 [laughs]

Dr. Rangan Chatterjee 51:04 That says it all, doesn't it? Says it all.

Dr. Andrew Weil 51:06 Yeah.

Dr. Rangan Chatterjee 51:07 D-

Dr. Rangan Chatterjee 51:08 am I right in thinking that you've shared a story in the past where I think you had taken some form of psychedelic mushroom potentially, and whilst you were under, uh, its influence, you were able to do a yoga pose that you had-

Dr. Andrew Weil 51:25 Yeah

Dr. Rangan Chatterjee 51:25 ... unable, that previously you were unable to do. I wonder if you could just share that story, 'cause I th- I think that really speaks beautifully-

Dr. Andrew Weil 51:32 Yeah

Dr. Rangan Chatterjee 51:32 ... to how our mind can get in the way.

Dr. Andrew Weil 51:34 To me, it's an, it's an, it's a, an example of what the potential of these agents is. It was actually LSD, and I was, I think, 28, um, living in the, in a rural area in Virginia. It was a beautiful spring day, and I, uh, took LSD with a group of friends outside, and I had been, uh, just starting to practice Hatha yoga. I had been doing it for, I don't know, a month or so. And one posture that I had a, a really hard time with is the plow, uh, where you lie on your back on the floor and you raise your legs and then try to touch your toes behind your head. Um, I got my toes within a foot of the floor, and I had a horrible pain in my neck, and I just got stuck there. I couldn't, I couldn't do it no matter how much I practiced, and I was on the verge of giving up. I, I thought I was too old, my body was too stiff. Uh, and then under the, on this day, when I, uh, was under the influence of LSD, I felt terrific. My body felt really elastic. I was, you know, wonderful. I thought, "Gee, I ought to try that." So I lay down and I was lowering my feet. I thought I had about a foot to go, and they touched the ground. I couldn't believe it, and I r- did it repeatedly. I was just so joyful to be able to do that. The next day, I tried to do it, and I got my feet within a foot of the floor, and I had excruciating pain in my neck. But there was a difference. I now knew that it was possible, and up to that point, I didn't think so. And so I kept at it, and in another couple of weeks I was able to do it. If I had not had that experience, I think I would've given up. So, uh, the, I, you know, I saw a possibility that I did not believe in, and that motivated me. And I think there's tremendous potential for, um, psychedelics in, in medicine, not just in, uh, psychiatric medicine, of showing people that it's possible to experience their bodies in a different way. I think that's very applicable to chronic pain, for example, allergies, autoimmunity. Uh, but there's other ways of, you know, of, of getting glimpses of that as well. You know, one of them is simply meeting, uh, a person who's had y- your illness and is now better, and if I can arrange, uh, for patients to meet other people who have, are well, who've had their same illness, that's a very powerful way of overriding any negative predictions they've had.

Dr. Rangan Chatterjee 53:53 You mentioned psychedelics, and sort of my feeling is that in America, at least the things and the interviews and the conversations I consume from America, a lot of quite prominent people seem to be talking about the potential value of, uh, certain psychedelics for certain conditions. And I know, I think Johns Hopkins, I think, uh-

Dr. Andrew Weil 54:17 Yeah

Dr. Rangan Chatterjee 54:17 ... lots of prestigious institutions, research institutions are now studying this. So I wonder, you know, you're someone who was, I think, studying marijuana and its effects on health in the 1960s, a long time ago.

Dr. Andrew Weil 54:29 Uh-huh.

Dr. Rangan Chatterjee 54:29 Maybe one of the first people to do this.

Dr. Andrew Weil 54:32 Yep.

Dr. Rangan Chatterjee 54:32 I wonder if you, for, for, for any listeners who are naive to this, who've never heard about this, you're a super well-respected doctor. You trained at Harvard Medical School. Could you just outline, you know, what are psychedelics? Uh, how can they provide utility for people, and why have they been demonized for so long?

Dr. Andrew Weil 54:52 Well, psychedelics are, there, there are two groups of them chemically. Uh, there are natural sources of them, and there are chemical sources of them. Uh, these are substances that I, I think have extremely low potential for toxicity, probably lower than any other drugs that we know of. Um, they can produce very dramatic psychological effects that are, that are quite dependent on set and setting, on people's expectations and on the environment in which they're taken. So the most common ones are LSD, psilocybin, uh, mescaline, which comes from the peyote cactus. Psilocybin is from mushrooms. Um, there is a drug called MDMA, uh, which is slightly different category. Marijuana, cannabis is not a, a, a psychedelic. It's something else. Um, but, uh- There was a a lot of research interest in these in the 1950s, um, and, and some really wonderful research on them. And then, uh, it all got shut down when, uh, in the wake of, uh, of the hippies and, and, uh, Timothy Leary and, uh, very restrictive laws were passed against them. And only now recently has this, uh, come about again. And it's not just in the, in the US, although I think we're farther along. Canada is, uh, you know, uh, well along in making psilocybin available for the treatment of depression. Uh, and there's actually a lot of activity in the UK with psychedelics as well, and in, uh, some of, uh, continental Europe. I, I think this is happening all over-

Dr. Rangan Chatterjee 56:31 Yeah

Dr. Andrew Weil 56:31 ... and that we're going to see, uh, very quickly that, you know, I think we'll see psilocybin made available for the treatment of, uh, drug-resistant depression and anxiety, MDMA for, uh, PTSD, which is a, a huge problem in, in, uh, in America among, uh, uh, returning war veterans. Um, so I think we're gonna see these, uh, uh, compounds made available for therapeutic use. But at the same time, there's tremendous interest in the general public in them... Uh, in the pre-COVID when I was traveling a lot and speaking, uh, whatever the subject I was talking about, whether it was healthy aging, integrated medicine, nutrition, uh, the questions I got were about psychedelics. You know-

Dr. Rangan Chatterjee 57:14 Yeah

Dr. Andrew Weil 57:14 ... where can we... How can we take them? How can we find guides for experiences? Just tremendous, uh, mainstream interest. I, I think two months ago, Vogue Magazine in the US had a cover story on, uh, psilocybin. You know, that, that's-

Dr. Rangan Chatterjee 57:29 Yeah

Dr. Andrew Weil 57:30 ... kind of mainstream interest that's really remarkable.

Dr. Rangan Chatterjee 57:33 Wow.

Dr. Rangan Chatterjee 57:34 So you mentioned before when we were talking about, um, anti-inflammatory diets, you mentioned green tea, and I know you are a particular fan of green tea. Uh, in, in particular from what I understand, it's matcha. Can you tell me about, you know, when you became aware of matcha, what happened there, and why you're so passionate about people drinking more of it?

Dr. Andrew Weil 57:57 Uh, when I was growing up, tea was something drunk by old people and sick people, and I drank iced tea heavily sweetened. Um, when I was 17, I had a chance to live in Japan with Japanese family, and I really came to love green tea. Uh, very good, and I'd seen nothing like that in, in America. And I was also introduced at that time to matcha and the Japanese tea ceremony. Matcha's the powdered green tea that's whisked into a, a froth and consumed in the tea ceremony, and I began bringing that back when I would go to Japan and turned people onto it. Nobody'd ever heard of it, uh, in, in the States. And then sometime in the 1980s, I think, this is again way ahead of its time, I formed a connection with a, uh, Japanese company that produced matcha and tried to sell it through my website, drweil.com, but it was not the right time for it. And then, uh, it- it's been quite amazing to me to watch, uh, how fashionable matcha has become in recent years. But, uh, I, I was concerned that most of the stuff that people were drinking was not good quality because, uh, matcha's so finely powdered that it oxidizes very quickly and it loses its bright green color and, and, uh, good flavor. And so I wanted to make really good quality matcha available, and I again formed a relationship with another Japanese company near Kyoto and, uh, formed a company called matcha.com, Matcha Kari, that's selling this and, um, you know, turning a lot of people on to, to, to this. I think it's a wonderful product. First of all, there's a great deal of research on the health benefits of tea in general, on green tea in particular, uh, a lot due to its antioxidant, uh, content. Uh, matcha is different in that the leaves are grown in a way that increases the content of antioxidants and, and it also has a high content of an amino acid called L-theanine that has a calming effect. And I think that modifies the effect of caffeine, uh, and makes the stimulation of, of tea, and matcha in particular, uh, very different from that of coffee. It does not have the jangling effect of, of coffee. It does not leave you with a crash when the stimulation wears off. People say it causes a state of calm alertness, um, that I think is very desirable. So I think it's a good thing. Matcha's also beautiful and, uh, and delicious, and I'm gonna have a bowl of it after we finish talking.

Dr. Rangan Chatterjee 1:00:32 There's a ritual, isn't there, in Japan as to how this is prepared, though, and I, I, I sort of feel like this, the, the matcha tea that you sell, when p- what are people buying? They're buying the powder that they then have to-

Dr. Andrew Weil 1:00:46 They buy the powder, and I don't care what they do with it. I mean, if they wanna use an electric whisk, if they wanna make a latte out of it, if they wanna sweeten it, you know, however they wanna do it. I, I like doing it in the traditional way, which is using a bamboo whisk in a small amount of hot water unsweetened. Uh, but you know, in, in Japan now, matcha has escaped the tea ceremony ritual. Uh, that's really a kind of old-fashioned thing and, and matcha's now consumed mostly by people, uh, not as part of a ritual. Although I think, um, there's a long h- association of tea in general and matcha in particular with meditation and, uh, again, very different association from, uh, from that of coffee. Um, I think m- matcha has been associated with contemplation, with meditation, uh, and the ritual of preparing it, you know, when I whisk it in a bowl, I find that to be very meditative and relaxing.

Dr. Rangan Chatterjee 1:01:41 I think what, what you're speaking to there is something that, again, I think is a missing piece in modern life and, and even in modern day ... health promotion, which is it's not only what you're doing, it's how you're doing it. So, you know, if you're taking five or 10 minutes to prepare your green tea-

Dr. Andrew Weil 1:02:03 Mm-hmm

Dr. Rangan Chatterjee 1:02:03 ... you know, it's, it's, it's not just a habit, it's, it's a ritual. It's a time to dedicate to yourself, to actually be present with a certain process. And, and, and, and, you know, I'm in- interested is your view on this, but I've been thinking recently that we do science. We, we look at green tea, or we look at the polyphenols in coffee, and we go, "Oh, this is a great thing." And so we, in our rushed lives, we, you know, we make a quick coffee, we slug it down, and we go, and then we say, "Oh yeah, it's got loads of polyphenols in, it's really good for me." And I kind of feel, have we lost something somewhere? Because for me, for example, I do drink coffee. I've, I've limited it. So I know what works for me, but I have it first thing in the morning. Now, I know people will say, 'cause I'm an early riser, I'm usually up by 5:00, people will say it's, you know, it's probably not with your circadian biology the perfect time to have it.

Dr. Andrew Weil 1:02:59 Mm-hmm.

Dr. Rangan Chatterjee 1:02:59 However, I would argue that, you know what? That hour, hour and a half in the morning before my wife and kids get up is my sacred time for myself.

Dr. Andrew Weil 1:03:09 Yeah.

Dr. Rangan Chatterjee 1:03:09 And I-

Dr. Andrew Weil 1:03:10 It's good

Dr. Rangan Chatterjee 1:03:10 ... I make it in a very ritualistic way. I s- I don't slug it w- down while doing something else. I'm paying attention to it. And I, I feel actually for me, on balance, when you take into account everything-

Dr. Andrew Weil 1:03:21 Yeah

Dr. Rangan Chatterjee 1:03:21 ... that forms a very important part of my day. And you know, I, I feel more and more we're missing this piece when we talk about health.

Dr. Andrew Weil 1:03:28 Yeah. I, I hear you. I agree with you, and I, I would extend that to eating in general. And one of the things that, um, that struck me when I, especially when I spent time in Italy and in France, is how different the attitude is of people toward eating. Um, you know, that, that in the US you're rushed out of restaurants. Uh, it's in a hurry. Uh, there's a lot of concern about, you know, "Is this healthy? Is this not healthy?" I think in, um, in continental Europe, especially in France and Italy, uh, there's so much more attention and time given to the enjoyment of food, uh, to lingering over it, to sharing, uh, eating f- in company as a social ritual, and I think that has, you know, as much to do with, uh, lowered rates of obesity, for example, as, you know, uh, the, what, what people are eating.

Dr. Rangan Chatterjee 1:04:24 Yeah. I mean, I think there was a study, a UK study, I think it was the University of Birmingham, um, a few years ago showed that actually if you eat in a rush while distracted, so doing something-

Dr. Andrew Weil 1:04:36 Mm-hmm

Dr. Rangan Chatterjee 1:04:36 ... else, watching television, you eat more at that meal and at subsequent meals for the rest of the day, right? Which-

Dr. Andrew Weil 1:04:44 Uh-huh

Dr. Rangan Chatterjee 1:04:44 ... which again, really speaks to what you're saying. You know, there, there are... It's not just what you're eating, it's how you're eating. It's the-

Dr. Andrew Weil 1:04:51 Yeah

Dr. Rangan Chatterjee 1:04:51 ... intention. It's what's going on in the mind as you're eating.

Dr. Andrew Weil 1:04:55 Yeah.

Dr. Rangan Chatterjee 1:04:55 Um, yeah, super interesting. So I, I, I feel you've, uh, you- you've definitely, uh, sparked my interest to have some, uh, matcha tea this weekend. What's the, what's the-

Dr. Andrew Weil 1:05:07 Good

Dr. Rangan Chatterjee 1:05:07 ... what's the URL? I think it's... W- w- where can we get some from?

Dr. Andrew Weil 1:05:09 It's, it's just matcha.com.

Dr. Rangan Chatterjee 1:05:11 Matcha.

Dr. Andrew Weil 1:05:11 matcha.com.

Dr. Rangan Chatterjee 1:05:12 Fantastic. Yeah. Um,

Dr. Rangan Chatterjee 1:05:14 what about your daily routine? I mean, you're someone who-

Dr. Andrew Weil 1:05:17 Yeah

Dr. Rangan Chatterjee 1:05:17 ... has been sort of, you know, really a pioneer in this field, and I think a lot of us would be interested to know, how do you... I mean, you know, how old are you now? I think it's... Is it-

Dr. Andrew Weil 1:05:27 I am 79.

Dr. Rangan Chatterjee 1:05:29 I mean, 79, incredible, and looking in tip-top health. Um, what do you do on a daily basis? 'Cause I think it would be qui- if you're, if you're happy-

Dr. Andrew Weil 1:05:38 I get up early. I, I beat you, Rangan. I got up at 4:20 this morning. I tend to get up when the sky starts to get light, and that's my best time. I, uh, do some sitting meditation in the morning. I have, uh, two dogs. I come down and feed them. Um, I usually have, I might have my bowl of matcha and something light to eat, and then I take the dogs on a walk. Um, I have a garden that I tend to. I grow a lot of my own food. I try to get, uh, walks in or swim every day. Uh, that's my favorite form of exercise. Um, I'm mentally active most in the morning. If I'm gonna write, uh, or, or do intellectual work, I like to do that in the morning. And, uh, afternoons are more for relaxing, reading, uh, spending time with friends, uh, preparing food, cooking. Um, you know, that's, that's my usual day, and I, I'm usually in bed by usually 9:00, at the latest 10:00.

Dr. Rangan Chatterjee 1:06:43 Yeah. Love it. So much to think about there. Um,

Dr. Rangan Chatterjee 1:06:48 just to sort of close off this conversation, Dr. Weil, I'm interested, um... You've seen a lot of changes in healthcare over the past 50 years. You've seen things come in, things go. You've seen things take the public interest and leave the public interest. If you look at the US healthcare system, 'cause I know that's where you're based, I know you've traveled the world, so you're probably quite familiar, I think, with other healthcare systems.

Dr. Andrew Weil 1:07:19 Yeah.

Dr. Rangan Chatterjee 1:07:19 It's very easy for, I think, many of us to criticize our own healthcare systems, other healthcare systems. But if, if you were to look at the US healthcare system, yes, there are some negatives which you've spoken about before. You've spoken about on this show. You can perhaps recap on what some of those negatives are. But are there any positives that we can take, that round the world we can learn and go, "Oh, got America doing that really, really well when it comes to health"? You know, I'm really interested as to your view on that and, you know, how other countries need to evolve their healthcare systems as well.

Dr. Andrew Weil 1:07:53 Well, we don't have a healthcare system in the US, we have a disease management system, and it's functioning very imperfectly and getting worse by the minute. And also, we a- as the richest nation are unable to guarantee basic healthcare services to all of our citizens. That's unconscionable. So those are the big black marks. I think as a result of the economic collapse of our healthcare system, now we, we're spending an outrageous amount of our gross domestic product on healthcare and have terrible health outcomes. Uh, that's unsustainable. But as a result of that, that is what's fueling the integrated medicine movement, which is much more developed in the US than it is anywhere else. I- if, if our healthcare system were not in such trouble, our institutions would not be open to this. You know, a, a lot of the, uh, people that come to, the fellows who come to us to study are sponsored by their institutions, by their hospital systems-

Dr. Rangan Chatterjee 1:08:48 Wow

Dr. Andrew Weil 1:08:48 ... who are paying for their tuition. You know, this would not be happening if, uh, the economics of healthcare in this country weren't such a mess. Uh, so, and I see this happening around the world. You know, we were not getting any people from the UK until very recently, for example, or from Western Europe. But as, as the economics of healthcare begin to deteriorate everywhere, um, there is openness to integrative medicine, and I think that's the great change.

Dr. Rangan Chatterjee 1:09:20 Do people from around the world have to come to America to do that residency or can they do it online?

Dr. Andrew Weil 1:09:25 It's online. We have had, uh, you know, until COVID, we had three residential weeks in Tucson that were scattered through the, the two-year fellowship. Uh, but in the past two years we've done it all online, and we may now go back to some-

Dr. Rangan Chatterjee 1:09:41 Yeah

Dr. Andrew Weil 1:09:41 ... uh, residential teaching.

Dr. Rangan Chatterjee 1:09:42 Yeah. I mean, we'll, we'll get a link from you. We'll put it in the show notes for people and doctors-

Dr. Andrew Weil 1:09:46 Yeah

Dr. Rangan Chatterjee 1:09:46 ... who are interested in that. You mentioned universal healthcare. Of course, that's something we do have in the UK.

Dr. Andrew Weil 1:09:51 Yeah.

Dr. Rangan Chatterjee 1:09:51 We have the National Health Service-

Dr. Andrew Weil 1:09:53 Yeah

Dr. Rangan Chatterjee 1:09:53 ... which is something this country is very, very proud of. But something I've been thinking about over the summer is, you know, I'm on a social media hiatus at the moment for four weeks, and it's really the time of year where I really feel I really get to tune into my own thoughts again and what I think rather than being influenced by what I'm reading online each day. And I've been thinking about the NHS and, of course, you know, incredible benefits of having something like the National Health Service. You know, my own father who had lupus when he was 59, kidneys failed, dialysis for 15 years, no problem, all paid for. You know, if he was in India or in another country around the world and he couldn't afford dialysis-

Dr. Andrew Weil 1:10:37 Yeah

Dr. Rangan Chatterjee 1:10:37 ... you know, I wouldn't have had those 15 years with Dad that I had.

Dr. Andrew Weil 1:10:40 Right.

Dr. Rangan Chatterjee 1:10:40 So there's, there's huge benefits. But in an era, in the 21st century, in an era where the majority of our health problems are driven by our collective modern lifestyles-

Dr. Andrew Weil 1:10:54 Yeah

Dr. Rangan Chatterjee 1:10:55 ... I'm really interested, is, is there any downside of having this kind of universal healthcare system whereby we're not really incentivized personally to look after ourselves? Because actually, if you look after yourself, you never even need to access the doctor, so you're not even getting what you put in. I, I'm just sort of... It's a thought experiment for me at the moment to figure out, is there any downside here? Do, do, do you know, do you see what I'm getting at?

Dr. Andrew Weil 1:11:21 Yeah. But first of all, I don't think it's sustainable because, uh, in the UK, as e- everywhere now, you have an aging population, uh, you have ep- epidemics of lifestyle related diseases, you have increasing costs of the high tech interventions, which is, is what conventional medicine depends on, and all of those trends are making healthcare increasingly unaffordable. So the system cannot go on that way. And, and the issue that you raise that this really does not provide incentives for prevention, uh, f- and for people taking responsibility for how they live and managing their disease risks, it's all feeding into this. So I, I can't see that this can go on.

Dr. Rangan Chatterjee 1:12:08 Yeah. For sure. Well, it's, well, it's been a, been a real honor, uh, to speak to you today. I could have spoken to you for many more hours, and I hope we get the chance to meet at some point-

Dr. Andrew Weil 1:12:18 Of course

Dr. Rangan Chatterjee 1:12:18 ... in the future when the world opens up.

Dr. Andrew Weil 1:12:20 Yes, I look forward to that.

Dr. Rangan Chatterjee 1:12:20 Um, just to finish off then, this, this podcast is called Feel Better, Live More. When we feel better in ourselves, we get more out of our life. You've shared a lot of things today on the show, and I wonder if we could just finish off with you sharing some of your most practical, most impactful tips that you've seen over 50 years make the most difference in people's lives.

Dr. Andrew Weil 1:12:43 I think really trust in and pay attention to your body's healing ability, uh, 'cause it is your greatest asset. You know, learn the basic, uh, facts about nutrition, avoid processed, manufactured food, and really pay attention to breathing and learn how to breathe. I mean, that, that's absolutely basic.

Dr. Rangan Chatterjee 1:13:05 Thanks so much for joining us. Thanks for all your work over the years, and I hope we get to meet at some point in the future.

Dr. Andrew Weil 1:13:10 Good. I enjoyed it, Rangan.

Dr. Rangan Chatterjee 1:13:12 Take care. Thank you.

Dr. Andrew Weil 1:13:12 Bye-bye.

Dr. Rangan Chatterjee 1:13:13 Take care. Bye-bye.

Speaker 1:13:14 Gut bugs, the microbiota at the interface of your digestion and the rest of your body are one of the key educators of the immune system. And again, this is something that's probably exploded in the field of, of immunology-

Dr. Rangan Chatterjee 1:13:27 Yeah

Speaker 1:13:28 ... in the last 10, 15 years. If you do not... So if you take a, an experimental a- animal model where the animals have a, uh, reduced or a minimal, um, collection of good bacteria in their gut, their immune system doesn't develop, and they're very impaired in how they can respond and heal. Um, and even things like, you know, protection from cancer because our immune system's the main cancer surveillance system. So these bugs are helping to educate and teach and mature our immune system, and this happens potentially in utero before we're born. But, uh- Predominantly when we enter the world, because we go from a relatively sterile, there is some evidence that there may be some-

Dr. Rangan Chatterjee 1:14:15 Yeah

Speaker 1:14:15 ... bugs in the placenta. Um, but we go into this hugely germy world, and suddenly our immune system has to cope with that because, you know, it, it's, um, it's got all these receptors on it to, to detect pathogens as being problematic. So it has to learn to tolerate those because, you know, most of the bugs around us are safe and harmless, and we need them 'cause they're helping us.

Dr. Rangan Chatterjee 1:14:40 And, and that's actually how the immune system develops, isn't it?

Speaker 1:14:44 Mm-hmm.

Dr. Rangan Chatterjee 1:14:44 It is by exposure-

Speaker 1:14:46 Mm-hmm

Dr. Rangan Chatterjee 1:14:46 ... to the environment around it-

Speaker 1:14:48 Exactly

Dr. Rangan Chatterjee 1:14:49 ... to the bugs around it to sort of give it that sort of ongoing education-

Speaker 1:14:53 Yeah

Dr. Rangan Chatterjee 1:14:53 ... so it starts to learn, "Oh, I respond to this."

Speaker 1:14:56 Yeah.

Dr. Rangan Chatterjee 1:14:56 "I don't need to respond to that."

Speaker 1:14:58 Exactly.

Dr. Rangan Chatterjee 1:14:59 Um-

Speaker 1:14:59 I often say that, you know, the immune system's made, it's not born. There's maybe a percentage in the genetics that we inherit, but then it's made, it's built throughout our life, and it changes throughout our life. So-

Dr. Rangan Chatterjee 1:15:11 That's a lovely idea.

Speaker 1:15:12 Yeah.

Dr. Rangan Chatterjee 1:15:12 It's made, not born. We can, we can build, and we can sort of develop it-

Speaker 1:15:18 Mm-hmm

Dr. Rangan Chatterjee 1:15:18 ... the way we want to if we give it the right-

Speaker 1:15:22 If we, yeah

Dr. Rangan Chatterjee 1:15:22 ... inputs

Speaker 1:15:23 ... inputs, yeah. And I, I often think about the inputs as a way to shape the immune system. And I was trying... I was working on a talk the other day, and I was trying to make a slide of all the inputs, some that we can control, some that we can't, that, that are shaping our immune system from birth, and then it, it's, this became a really busy, messy slide [laughs]

Dr. Rangan Chatterjee 1:15:42 [laughs]

Speaker 1:15:42 Because there was too much to put on there. But yeah, a, a lot of it happens in childhood. And in some ways I find that quite daunting as a mother, and you think, well, you know, there's sort of first three years, I would say, is when you're being colonized by all these good bacteria, and there's huge changes going on in the immune system during that time.

Dr. Rangan Chatterjee 1:16:05 Yeah.

Speaker 1:16:05 Um, and there's this sort of interaction happening. These bacteria, they help protect the gut barrier to keep it very nice and, and tight, and stop any bacteria going into the body. Because they're only good bacteria if they're in the right location, so they're not meant to cross over the gut and enter our body.

Dr. Rangan Chatterjee 1:16:24 Yeah.

Speaker 1:16:25 Um, because then they, they become a problem. Um, but one of the biggest things that they're doing to help our immune system is they're, they're eating our foods. And [laughs] I often think your diet's only as good as your microbiota in your gut-

Dr. Rangan Chatterjee 1:16:39 Yeah

Speaker 1:16:39 ... 'cause they're, they're the interface. They're eating your food. They're helping you to produce these vitamins and minerals from your diet, but they're also producing these postbiotics. Um, and people might have heard of prebiotics and probiotics, but postbiotics are basically the metabolic waste of the bugs in your gut. So they're producing stuff that is their kind of, you know, waste product of eating your foods.

Dr. Rangan Chatterjee 1:17:03 Right. Like short-chain fatty acids.

Speaker 1:17:04 Short-chain fatty acids-

Dr. Rangan Chatterjee 1:17:05 Yeah

Speaker 1:17:05 ... is the classic one. I, I used to work on these when I lived in Switzerland, um, and looking at how they influence, um, inflammation in the gut and beyond. So short-chain fatty acids are kind of a metabolic byproduct of the, the bugs in your gut, and they directly bind to, uh, the immune cells at that site. And they help educate them and teach them to sort of tolerate anything that you're throwing down your mouth, 'cause we're not supposed to, um, react to that, 'cause it should be, you know, benign things that are going in there. But they have to help strike that balance that if you did get some kind of food poisoning, they also can identify the bad bugs.

Dr. Rangan Chatterjee 1:17:47 Yeah.

Speaker 1:17:47 So they help create an environment that's what we call tolerogenic, so it's encouraging, um, tolerance of the food that you're eating, and there's a very kind of dynamic interaction between these bugs and the immune cells. And I'd say what happens in the gut is not just staying there. This, um, influence, this sort of tolerogenic influence of-

Dr. Rangan Chatterjee 1:18:07 Yeah

Speaker 1:18:07 ... things like short-chain fatty acids is also being absorbed into your bloodstream and helping regulate the immune system at, at distal sites from the gut as well.

Dr. Rangan Chatterjee 1:18:16 What, what... It helps make T-regulatory cells, doesn't it?

Speaker 1:18:18 Yes, exactly. The T reg.

Dr. Rangan Chatterjee 1:18:19 Which, as you've said before, it's the... There was, I think, I, I mean, you mentioned the term peacekeeper. I think the first time I read that, I think it was in a Nature paper in 2014, I think.

Speaker 1:18:28 Mm-hmm.

Dr. Rangan Chatterjee 1:18:28 I think, I think I used that in one of my slide decks. It's where it calls them our peacekeepers.

Speaker 1:18:34 Yeah.

Dr. Rangan Chatterjee 1:18:35 I think for the first time when I saw it in print.

Speaker 1:18:38 Yeah.

Dr. Rangan Chatterjee 1:18:38 Um, which is kind of what they are-

Speaker 1:18:40 Yeah

Dr. Rangan Chatterjee 1:18:40 ... really. And, and I, I sort of... Yeah, I mean, I, I really think we... A lot of people talk about gut health these days, but I don't think people understand the immune system's linked to-

Speaker 1:18:53 Yes, yeah

Dr. Rangan Chatterjee 1:18:53 ... you know, they think the gut's something separate. But I, I, I often teach, uh, doctors about this triad between our diet, our im- uh, our gut bugs-

Speaker 1:19:02 Mm-hmm

Dr. Rangan Chatterjee 1:19:03 ... and our immune system, and how they all sort of cross talk.

Speaker 1:19:05 Oh, definitely.

Dr. Rangan Chatterjee 1:19:06 You know, there's-

Speaker 1:19:07 Yeah

Dr. Rangan Chatterjee 1:19:07 ... there's bidirectional communication between, you know, diet and gut bugs, diet and immune system-

Speaker 1:19:11 Mm-hmm

Dr. Rangan Chatterjee 1:19:12 ... and gut bugs and immune system together.

Speaker 1:19:14 Yes.

Dr. Rangan Chatterjee 1:19:14 It's like this, so, you know, if you, if you make certain dietary choices, you're gonna improve-

Speaker 1:19:20 Mm-hmm

Dr. Rangan Chatterjee 1:19:21 ... the health of your gut bugs, which is gonna improve the health of your immune system.

Speaker 1:19:24 Yes, exactly.

Dr. Rangan Chatterjee 1:19:25 Which is empowering, right?

Speaker 1:19:26 Yeah.

Dr. Rangan Chatterjee 1:19:26 'Cause we can do something about that.

Speaker 1:19:29 Yes, exactly. And I think as a nation, we're not eating enough fiber, and also fiber in the UK has a really bad, like, image problem, I think. Like, most people, I think-

Dr. Rangan Chatterjee 1:19:39 Come on, let's give it some PR.

Speaker 1:19:40 Yeah. [laughs]

Dr. Rangan Chatterjee 1:19:40 Give us, give it-

Speaker 1:19:41 If I was, if I was to ask my husband w- uh, what he thinks fiber is, and he, he's not in any kind of medical, nutrition, wellness field. He'd, um... In fact, the other day he came home with some crackers that said, he's like, "Look, they say they've got added fiber." [laughs] And I was like, "Okay." Because we kind of think of it as being like, you know-

Dr. Rangan Chatterjee 1:19:59 Cardboard

Speaker 1:19:59 ... that there's bread, uh, breakfast cereals like cardboard with the big fiber logo on it

Dr. Rangan Chatterjee 1:20:04 Yeah

Speaker 1:20:04 ... and, um, or fiber as being one thing.

Dr. Rangan Chatterjee 1:20:08 Yeah.

Speaker 1:20:08 But again, it's the diversity. Different bugs need different forms of fiber, and it- we find it in all the plant-based foods. So it's not just the fruits and vegetables, nuts and seeds, legumes, beans, pulses, and, and whole grains.

Dr. Rangan Chatterjee 1:20:21 Yeah.

Speaker 1:20:21 And it's about trying to bring in the diversity. I think in the last few years there's a, a publication about the, the sort of th- trying to get 30 different plant-based foods-

Dr. Rangan Chatterjee 1:20:32 Yes

Speaker 1:20:32 ... into your diet because it's-

Dr. Rangan Chatterjee 1:20:34 Per week

Speaker 1:20:34 ... about, per week, yeah, because it's about the diversity.

Dr. Rangan Chatterjee 1:20:37 That also, it's, that includes I think lentils and nuts-

Speaker 1:20:41 Mm-hmm, yeah

Dr. Rangan Chatterjee 1:20:41 ... and, you know, and, you know, I, I think it's very achievable-

Speaker 1:20:44 Yeah

Dr. Rangan Chatterjee 1:20:44 ... once people have it in their minds-

Speaker 1:20:46 Exactly, yeah

Dr. Rangan Chatterjee 1:20:47 ... to, to do it.

Speaker 1:20:48 And they're very common in, in traditional diets. I remember growing up, you know, my mom would, would add lots of different, um, grains and beans and pulses to spin things out, as she put it, so that you could-

Dr. Rangan Chatterjee 1:21:00 Yeah

Speaker 1:21:00 ... make a dish go a lot further.

Dr. Rangan Chatterjee 1:21:01 Yeah, wonderful advice. Um, so so far we've said that lots of different colors-

Speaker 1:21:07 Mm-hmm

Dr. Rangan Chatterjee 1:21:07 ... lots of different diversity of plants is gonna help your gut microbiome-

Speaker 1:21:12 Mm-hmm

Dr. Rangan Chatterjee 1:21:12 ... it's gonna help your immune system.

Speaker 1:21:13 Mm-hmm.

Dr. Rangan Chatterjee 1:21:15 Eating less-

Speaker 1:21:16 Mm-hmm

Dr. Rangan Chatterjee 1:21:16 ... is also something that might be helpful, right?

Speaker 1:21:20 Yeah.

Speaker 1:21:21 So this is another field I've, I've just got fascinated with, um, and that's the, the immunomet- metabolism. I don't know if you've heard anything about this.

Dr. Rangan Chatterjee 1:21:29 I love that word.

Speaker 1:21:30 Yeah. [laughs]

Dr. Rangan Chatterjee 1:21:30 Love it. Immunometabolism.

Speaker 1:21:32 Shifting two words together. Yeah.

Dr. Rangan Chatterjee 1:21:33 Yeah, I like it.

Speaker 1:21:34 And it's only just in the five, last five years that it's really kind of popped up, um, and people have started looking at this. But metabolence, metabolism is basically breaking down of, um, the major components of our diet, so the protein, carbohydrate, and fats, into energy and building blocks that our cells can use. And people might hear things about metabolic rate or I've got a good metabolism, these kind of things that people say. Um, and w- you know, metabolism and the immune system are really intimately entwined, and I don't know why it's taken us so long to figure that out, because immune responses are energetically very costly. You know, there has to be sort of triaging of resources to be like, "Right, we're gonna fight this infection and turn on all the inflammation, turn on a- all the antibody producing and all those molecules that are being produced and the proliferation of, of immune cells." That takes a lot of resources.

Dr. Rangan Chatterjee 1:22:30 It's-

Speaker 1:22:30 So it needs energy, it needs building blocks.

Dr. Rangan Chatterjee 1:22:33 Is this why we feel tired when we're fighting an infection? Because the body's diverting resource-

Speaker 1:22:39 Yeah

Dr. Rangan Chatterjee 1:22:39 ... to making all that stuff that's gonna fight it.

Speaker 1:22:41 Exactly, and you might find that you need to kind of build yourself back up again after you've been, uh, sick, um, particularly if you've-

Dr. Rangan Chatterjee 1:22:49 Yeah

Speaker 1:22:49 ... been sick for quite a long time or if you have a ongoing illness. Your nutritional needs might be very different from somebody who doesn't have that. So im- immunometabolism is the field that's trying to understand how metabolism can shape immune responses and vice versa. So this happens at the level of the individual immune cell, but also can happen in the environment of a tissue and in the environment of our whole body. And this is something that there's not really any kind of absolute concrete, um, understanding yet in this area, but we know that when, uh, a, an immune cell is fighting an infection, it goes through a metabolic switch and it goes from being in this kind of resting state to suddenly sucking up lots more, um, glucose to fuel, uh, proliferation. The, the immune cells are making armies of themselves. Building antibodies requires, you know, the building blocks of proteins. All of this kind of thing is happening. And that metabolic switch is, is known as the Warburg effect. This is also what's happening to cancer cells. But immune cells do this when, and it's perfectly normal when they're fighting an infection or fighting any kind of, um, um, problem, and then it's switched back off and the immune cells go back to normal and they're, they don't have this huge need for metabolites anymore. But what people are starting to, to wonder is can the overall environment of a body influence, um, the, the metabolic switches inside our immune cells and switch them on aberrantly when they're not needed? So we know that, um, diabetics with poorly controlled blood sugar, so they have elevated blood sugar in, um, their body, this creates an environment that causes some of our immune cells like neutrophils to not work so well. So it affects, so immune cells have nutrient sensing, um, um, switches inside them, so they can sense what nutrients are in, a- are available, and they're taking in that information and then that affects how they can work. Now, what is not known is can we feed someone different, um, macronutrients, proteins, carbs, or fats, and influence how their immune system is working? So can you switch unwanted immune responses off or on based on the different macronutrients that your body's metabolizing? And I think this is where the field of immunology is gonna be headed in terms of treating chronic diseases, because we know that people with chronic diseases like metabolic syndrome, Type 2 di- diabetes, heart disease, or people who are carrying too much visceral fat, that the whole environment of their bodies is metabolically different, and this might be causing the immune cells to act abnormally and be- become more proinflammatory, for example.

Dr. Rangan Chatterjee 1:25:45 Wow. Super interesting.

Speaker 1:25:47 Yeah.

Dr. Rangan Chatterjee 1:25:47 So a lot of research to come in that area.

Speaker 1:25:49 Exactly, and I think we just don't know enough to say- ... specifics yet, but I think that's, you know, for so long we've been focused on the micronutrients, but actually it's the macronutrients. So you could adjust someone's diet, give them different proportions of protein, fat, and carb to maybe alter their metabolism and alter immune cells that were going wrong. So somebody who had a chronic fla- inflammatory disease, we could kind of steer that around. And-

Dr. Rangan Chatterjee 1:26:16 It's incredibly exciting, isn't it?

Speaker 1:26:18 On the other side of it, l- what you said about eating less, um, another thing that I bring up in the book because I wanted to get people away from just thinking about, you know, a vitamin supplement for their immune system, is that the immune function is impacted by over-nutrition and under-nutrition. So if you're not eating enough or you're eating too much, this is gonna send your immune system awry, and I should context that by saying if you're doing that consistently. And then we have this field of research coming out about fasting and immune function. And I remember being at conferences decades ago, and they were talking about fasting and how it would regenerate, um, all sorts of parts of the body. It was kind of mind-blowing, and now we kind of see it more in the mainstream, and we have all these kind of forms of different diets. Um, and this again is causing metabolic switches in the body that then when you go on to re-feed after someone has had a period without food, you get increasing in growth hormone, you get production of fresh new immune cells from the bone marrow, um, and the stress of the lack of eating kind of causes some of the older immune cells and ones that might be more likely to malfunction to be deleted. So you're kind of replenishing your immune system, and we start to see in experimental models of autoimmune disease that this is, you know, highly therapeutic.

Dr. Rangan Chatterjee 1:27:44 Yeah, it's fascinating. The, it's not necessarily just what we're eating-

Speaker 1:27:49 Mm-hmm

Dr. Rangan Chatterjee 1:27:50 ... it's, you know, how much or how little. It's are we fasting, are we not fasting?

Speaker 1:27:55 Mm-hmm.

Dr. Rangan Chatterjee 1:27:55 All these kind of different components that-

Speaker 1:27:58 Yeah

Dr. Rangan Chatterjee 1:27:58 ... all play, I guess they all play a role in the signals the body is receiving, 'cause I guess that's all it is, isn't it?

Speaker 1:28:04 Mm-hmm.

Dr. Rangan Chatterjee 1:28:04 The immune system is trying to interpret the signals-

Speaker 1:28:06 Yeah

Dr. Rangan Chatterjee 1:28:06 ... and sort of going, "Okay, what does that mean? Is, is it-

Speaker 1:28:10 Yeah

Dr. Rangan Chatterjee 1:28:10 ... sort of safe or is it unsafe? Do I need to take action?"

Speaker 1:28:13 Yes.

Dr. Rangan Chatterjee 1:28:14 "Or can I just stay calm?"

Speaker 1:28:15 Exactly.

Dr. Rangan Chatterjee 1:28:15 And I guess everything we do, even our thoughts, our words-

Speaker 1:28:21 Mm-hmm

Dr. Rangan Chatterjee 1:28:21 ... our sleep, our stress-

Speaker 1:28:23 Mm-hmm

Dr. Rangan Chatterjee 1:28:23 ... they're all giving a signal in some ways-

Speaker 1:28:26 Yeah

Dr. Rangan Chatterjee 1:28:26 ... to our immune system-

Speaker 1:28:27 Exactly

Dr. Rangan Chatterjee 1:28:28 ... is, do I need to respond or is it okay?

Speaker 1:28:31 Exactly, yeah. It's, it's always-

Dr. Rangan Chatterjee 1:28:33 And at its core, at its core-

Speaker 1:28:33 Yeah

Dr. Rangan Chatterjee 1:28:33 ... it's that simple, isn't it?

Speaker 1:28:34 Yeah.

Dr. Rangan Chatterjee 1:28:34 At its core.

Speaker 1:28:35 Yes. Yeah, yeah. It's, it's this decision-making that's ongoing and constant, and it's integrating all these different inputs to decide. And I think the thing with the, the sort of so-called Western diets that, that, y- you know, we talk about as being, having a negative impact on our health, um, it's just, it's just really tasty, and we just wanna eat it all the time. It's salty, it's sweet, it's delicious. It, it's everywhere. W- we can quickly override any lack of hunger cues just to, to, to eat. We kind of pathologize being hungry. It's like you're not ever allowed to be hungry. You have to have-

Dr. Rangan Chatterjee 1:29:12 Yeah

Speaker 1:29:12 ... 10 snacks in your bag in case you might not be able to reach some food. And, and then we have millions of incidences of eating across a huge portion of our a- waking time. And part of the research I was involved in several years ago was looking at postprandial inflammation. So when we eat, there's an inflammation, a subtle inflammation that happens in the body, and this is quite normal. We have plenty of checks and balances in place to keep that in check, and actually dietary fiber is one of the m- best ways to kind of seal that up again and prevent that from happening. As is having a period of, um, time without food in between meals. So eating enough and the right things at one meal that you do not need to eat then till the next meal, um, is actually quite good for o- overall-

Dr. Rangan Chatterjee 1:29:56 Yeah

Speaker 1:29:57 ... gut health, but the whole body health.

Dr. Rangan Chatterjee 1:29:59 I, I, I'm sort of super fascinated by this research as well and, you know, not only do many of us eat too much, we eat too often-

Speaker 1:30:07 Mm-hmm

Dr. Rangan Chatterjee 1:30:07 ... in the day. And as you just said there, you know, the, the act of eating is inflammatory.

Speaker 1:30:14 Yeah.

Dr. Rangan Chatterjee 1:30:14 So that's a response to eating, is that your body will become inflamed. But as you say, nothing to worry about. It's sort of that's part of-

Speaker 1:30:22 Yeah

Dr. Rangan Chatterjee 1:30:22 ... the process. But I guess, you know, and, you know, I know, uh, Satchin Panda's done a, a lot of look at this.

Speaker 1:30:31 Yes.

Dr. Rangan Chatterjee 1:30:31 Professor Panda. Um, and I think when, when he started his app in 2015, I think it's called My Circadian Clock.

Speaker 1:30:40 Mm-hmm.

Dr. Rangan Chatterjee 1:30:41 I, I, I can't remember the figures offhand, but it's something like 20, 30 years ago, most people were eating three times a day in the US.

Speaker 1:30:48 Mm-hmm. Yeah.

Dr. Rangan Chatterjee 1:30:48 I think we can probably infer in the UK as well. And then in 2015 when he was measuring-

Speaker 1:30:55 Mm-hmm

Dr. Rangan Chatterjee 1:30:55 ... and people were inputting into the app, I think the top 10% of people were eating 15 times a day, and it was a-

Speaker 1:31:02 Yeah

Dr. Rangan Chatterjee 1:31:03 ... you know, so that, if we think about that, let's say, let's say I'm eating 15 times a day, and let's say in theory it is all whole food, right? It's all nice, uh, health... W- what, what is considered-

Speaker 1:31:18 Yeah

Dr. Rangan Chatterjee 1:31:18 ... you've got to be careful with the language, but what is considered sort of helpful-

Speaker 1:31:22 Yeah

Dr. Rangan Chatterjee 1:31:22 ... foods for our health. You do have to ask the question, is eating them 15 times a day helpful? That's, that's like 15 bouts of inflammation, whereas if you had the same sort of food over, you know, it's, it's not a perfect analogy, but three times a day over five days, you're still getting 15 bouts of inflammation-

Speaker 1:31:42 Mm-hmm

Dr. Rangan Chatterjee 1:31:42 ... but that's over the whole week-

Speaker 1:31:44 Yeah

Dr. Rangan Chatterjee 1:31:44 ... as opposed to in just one day. And I, I really do think societally, culturally, there's a problem with how much we're being encouraged to eat. Even healthy foods-

Speaker 1:31:54 Mm-hmm

Dr. Rangan Chatterjee 1:31:54 ... like you can buy-

Speaker 1:31:55 Yeah

Dr. Rangan Chatterjee 1:31:55 ... healthy snacks here and healthy snacks there-

Speaker 1:31:58 Yeah

Dr. Rangan Chatterjee 1:31:58 ... but you're, you're sort of inflaming yourself- Each time and-

Speaker 1:32:02 Exactly

Dr. Rangan Chatterjee 1:32:02 ... I don't know. What, what, what would you make of that?

Speaker 1:32:04 Yeah, no, I think that's a real, uh, issue. I think it's not well enough understood in the scientific community to really translate into a kind of clear health message for people. But from the research I was involved in, and from work like what Satchin Panda has done, and others, I definitely think we need to look at the incidents of eating as well as, um, you know, the, the stretch of time that we're eating. I think some of the studies show that we're spending 18 hours a day eating.

Dr. Rangan Chatterjee 1:32:34 Yeah

Speaker 1:32:34 Which is, like, the whole time we're awake. Um, and I don't think that we're sort of designed to cope with that on a long-term consistent basis. You know, going back to the traditional diets, uh, you know, my grandparents weren't eating all day every day, um, because it, that just wasn't how it was constructed. And different cultures all eat in different ways, but, uh, certainly it's not common to eat all the time. And I, I wanna fuse the tradition with the modern life somehow, because I think that's the key that we need. We can't go back to times gone by-

Dr. Rangan Chatterjee 1:33:11 Yeah

Speaker 1:33:11 ... but we can bring bits that we've left behind and kind of integrate it into what we have to work with right now somehow.

Dr. Rangan Chatterjee 1:33:19 Yeah. I mean, I, I, I find a very effective and powerful recommendation I use on my patients-

Speaker 1:33:24 Mm-hmm

Dr. Rangan Chatterjee 1:33:24 ... is, uh, to try not to eat for 12 hours in every 24 hours. So, uh, you know, basically eating all your food within a 12-hour window.

Speaker 1:33:33 Mm-hmm.

Dr. Rangan Chatterjee 1:33:34 Uh, which, you know, really was the norm for pretty much-

Speaker 1:33:39 Yeah

Dr. Rangan Chatterjee 1:33:39 ... everyone maybe 30, 40 years ago. I mean-

Speaker 1:33:42 Yeah

Dr. Rangan Chatterjee 1:33:42 ... you know, we, we might stop eating at 8:00 PM.

Speaker 1:33:45 Mm-hmm.

Dr. Rangan Chatterjee 1:33:46 And maybe wouldn't have breakfast till 8:00.

Speaker 1:33:47 Yeah.

Dr. Rangan Chatterjee 1:33:47 I mean, I'm, I'm not talking about an extreme fast.

Speaker 1:33:50 No.

Dr. Rangan Chatterjee 1:33:50 I'm just saying as a... I think it's quite... I certainly know when I, uh, manage to stick to that consistently-

Speaker 1:33:55 Mm-hmm

Dr. Rangan Chatterjee 1:33:55 ... I sleep better, I feel more energetic.

Speaker 1:33:57 Yeah.

Dr. Rangan Chatterjee 1:33:58 And I think there really is this idea that, you know, you need time for the body to regenerate a little bit. Your-

Speaker 1:34:03 Mm-hmm

Dr. Rangan Chatterjee 1:34:03 ... if your gut is constantly having to use up energy to-

Speaker 1:34:07 Yes

Dr. Rangan Chatterjee 1:34:07 ... constantly digest food, that's gonna impact your immune system. It's gonna impact-

Speaker 1:34:11 Mm-hmm

Dr. Rangan Chatterjee 1:34:11 ... you know, the resource it has for something else, right?

Speaker 1:34:13 Yes, exactly. There's, um, you know, the, the gut lining as well, there is a kind of, um, uh, it's energetically costly because it's, there's a turnover of those cells quite regularly. And things like the short chain fatty acids we mentioned earlier that are produced when our gut bugs digest fiber, they are really nurturing to, uh, the growth of and repair of the, the cells that line the gut barrier.

Dr. Rangan Chatterjee 1:34:38 Yeah.

Speaker 1:34:38 And those are kind of the interface cells between what's going on in the gut and what's being put in the bloodstream that could exacerbate that inflammation. And we know that certain things like, um, saturated fats, um, high fructose diets, um, fiber poor diets, um, as well as other things like stress and extreme exercise can, uh, alter the integrity of that gut barrier-

Dr. Rangan Chatterjee 1:35:01 Yeah

Speaker 1:35:02 ... and exacerbate the sort of, uh, inflammation that you see postprandially. There's a really interesting study that looked at sort of these five major personality types. So they are kind of roughly divided into, like, openness to experience, conscientiousness, extrovertedness, agreeableness, and neuroticism. So in psychology terms, they're kind of ways that we can be categorized based on our personality. Um, and each of these personality types have specific immunological features, and one of the most interesting thing is that, um, some of them are more likely to be pro-inflammatory and have higher levels of C-reactive protein, which is a marker in the blood for, for inflammation. Um, and things like being neurotic and, um, being, uh, sort of less introverted, it can affect the inflammation in our bodies because I guess we're all very different, we're all on a sort of spectrum of different personalities, but that's evolved from maybe different roles you might play within a community, um, and then what your exposure to different infections might be, or your risk of getting injured. Um, things like anger is known to prime the body for, um, for becoming damaged, because maybe anger preceded violence. And throughout our evolution, we've, like, okay, if you're angry something might happen that might damage you, so we need to prime parts of our immune system to prepare for that.

Dr. Rangan Chatterjee 1:36:31 That's... You mentioned anger, and it's something I wrote about. I feel passion five is the importance of forgiveness.

Speaker 1:36:36 Mm-hmm.

Dr. Rangan Chatterjee 1:36:36 There is good research on forgiveness.

Speaker 1:36:38 Yeah.

Dr. Rangan Chatterjee 1:36:38 A guy called Fred Luskin's done the Stanford University, I think, forgiveness trial or research that I can't remember the exact name.

Speaker 1:36:46 Yeah.

Dr. Rangan Chatterjee 1:36:46 His research is incredible, and I, I shared in my last podcast story about one of my patients who had high blood pressure, and which again, you know, to, to, to make it relevant to our conversation, you know, high blood pressure is a chronic-

Speaker 1:37:02 Mm-hmm

Dr. Rangan Chatterjee 1:37:02 ... non-communicable illness that, you know, will have chronic inflammation-

Speaker 1:37:06 Yeah

Dr. Rangan Chatterjee 1:37:06 ... playing a role-

Speaker 1:37:08 Yeah

Dr. Rangan Chatterjee 1:37:08 ... in some way. And you know what? She had changed her lifestyle. And I was, you know, I was doing the stuff I try and, uh, talk about, food, and movement, and sleep. And you know what? It wasn't budging.

Speaker 1:37:19 Mm-hmm.

Dr. Rangan Chatterjee 1:37:20 And it was to do with, um, you know, basically her, um, her husband of many years had cheated on her-

Speaker 1:37:28 Yeah

Dr. Rangan Chatterjee 1:37:28 ... and they had split up. And it was only once she started practicing forgiveness-

Speaker 1:37:34 Mm-hmm

Dr. Rangan Chatterjee 1:37:35 ... right, that her blood pressure started going down. It-

Speaker 1:37:39 Oh

Dr. Rangan Chatterjee 1:37:39 ... it was incredible. And so, and that's a, like that's an anecdotal story from my clinic.

Speaker 1:37:45 Yeah.

Dr. Rangan Chatterjee 1:37:45 But, uh, it really, I think it does stand, uh, firm-

Speaker 1:37:50 Mm-hmm

Dr. Rangan Chatterjee 1:37:51 ... and consistent with the research that is out there in terms of if you're holding onto resentment-

Speaker 1:37:56 Yeah

Dr. Rangan Chatterjee 1:37:56 ... and anger, that will influence your biology-

Speaker 1:37:59 Yeah

Dr. Rangan Chatterjee 1:37:59 ... and your immune system.

Speaker 1:38:00 Exactly. And- It, maybe that is culturally what we see dividing different groups in how they deal with illness as well because they may feel, uh, uh, marginalized. I think social status is also really important. I know that i- in the animal kingdom, being lower down the pecking order can be quite stressful for an animal, and that can be seen in its, its blood chemistry, but also for us humans. Um, and I think that's-

Dr. Rangan Chatterjee 1:38:28 Yeah

Speaker 1:38:28 ... you know, something that w- we see playing out with the sort of lower socioeconomic, um, uh, demographics are worst hit by some of these lifestyle related diseases.

Dr. Rangan Chatterjee 1:38:38 Yeah, and-

Speaker 1:38:39 They may have more stressful lifestyles and...

Dr. Rangan Chatterjee 1:38:41 But we alw- we put it down, don't we, to, oh, less access to good food, more stress, and of course, I think those play a role.

Speaker 1:38:49 Mm-hmm.

Dr. Rangan Chatterjee 1:38:49 But what if it's also related to status as it is-

Speaker 1:38:53 Yeah

Dr. Rangan Chatterjee 1:38:53 ... in the animal kingdom? What-

Speaker 1:38:54 Yeah

Dr. Rangan Chatterjee 1:38:54 ... you know, that's something I hadn't probably given as much thought to and it's probably not as common a narrative. It's h- where do you... I guess it's, you know, in many ways it's do you feel your life [laughs] has purpose?

Speaker 1:39:07 Yes. Yeah.

Dr. Rangan Chatterjee 1:39:08 Do you know? How do you see your life? What's the meaning behind it? 'Cause that as well in itself has a huge amount of research suggesting it's a, you know, if you feel your life has meaning and value, you tend to have a happier and healthier life.

Speaker 1:39:20 Yeah. I mean, another piece of research I came across recently was comparing, um, Samoan individuals to European individuals with, um, Epstein-Barr virus, which is a virus that almost all of us harbor, but when we activate our stress chemistry, um, this can be actually a sign that the virus uses to allow itself to reactivate and, and cause problems. And we know in the Western culture that being of a lower socioeconomic status means that you're more likely to experience viral reactivation. But in the Samoan culture, um, being in a lower socioeconomic status has a totally different impact on the stress chemistry that actually meant it was the people in the higher socioeconomic bracket that were worse affected by latent viral reactivation. And this is just an, you know, they used the viral reactivation as a readout, an empirical way of, of measuring the immune system changes. But i- in different cultures, you know, you... And we never think about this-

Dr. Rangan Chatterjee 1:40:20 Yeah

Speaker 1:40:20 ... in medicine.

Dr. Rangan Chatterjee 1:40:21 I mean, what's that like for you as a scientist and as a lecturer? These are the kind of, you know, these would be, these would be perceived as the kind of softer-

Speaker 1:40:30 Yes. Yeah

Dr. Rangan Chatterjee 1:40:31 ... aspects of health and science. But it's, you know, that, that data-

Speaker 1:40:35 We need to-

Dr. Rangan Chatterjee 1:40:35 ... is data, right?

Speaker 1:40:36 Exactly. We need to bring it together. A lot of the data is actually quite old now, but I guess it's just been parked there, and we have this real kind of biomedical model where we focus in on one cell type, and what is that cell doing, and it's really reductionist, and then we try and piece the jigsaw together. And we kind of need to fuse it with the anthropology and be like, "Okay, now how do we bring these two fields together?" Because that's the only way we can tackle, I think, where we're at-

Dr. Rangan Chatterjee 1:41:01 Yeah

Speaker 1:41:02 ... with our health.

Dr. Rangan Chatterjee 1:41:02 And, and, you know, you, you sort of, you, you really beautifully bridge it throughout the book, all these different components.

Speaker 1:41:09 Mm-hmm.

Dr. Rangan Chatterjee 1:41:10 Emotions, food, movement, sleep, stress.

Speaker 1:41:13 Yeah.

Dr. Rangan Chatterjee 1:41:13 You know, you, there's got a nice section on supplements as well, which we probably won't be able to get into today. Um, but-

Speaker 1:41:20 And the, um, the joy of the table, so the gioia della tavola, which is an Italian phrase for enjoying being at the table, and linking what we were talking about earlier with food to emotions. You know, make your table a joyous place to be because endorphins from enjoying being at your table with your family, your friends, or even on your own and just enjoying the meal, endorphins can alter the function of our immune cells because they have receptors for those on them. So those feelgood hormones, that actually helps nurture things like the T regs, the regulatory T cells. So bringing the food together with the emotion and, and enjoying that, that's so, so important.

Dr. Rangan Chatterjee 1:42:04 Yeah.

Speaker 1:42:04 I mean, we haven't had a kitchen for the last four months, so we've had no table, [laughs] no joy, but we've still been trying to cobble together as a family, you know, little meals on the floor. And it's just-

Dr. Rangan Chatterjee 1:42:15 It's, i- you know what, I- I'm so delighted to hear you speak about these things because I think these are things we've missed-

Speaker 1:42:25 Mm-hmm

Dr. Rangan Chatterjee 1:42:25 ... in health advice.

Speaker 1:42:26 Yeah.

Dr. Rangan Chatterjee 1:42:27 It has been too reductionist. You know, eating at a table with, you know, your community, your-

Speaker 1:42:34 Yeah

Dr. Rangan Chatterjee 1:42:34 ... tribe has kind of always been a part of human culture.

Speaker 1:42:38 Yeah.

Dr. Rangan Chatterjee 1:42:38 And I, and I think i- and, and if you sort of extend the argument that you're making, it's kind of like, well, you could potentially eat the same foods-

Speaker 1:42:46 Mm-hmm

Dr. Rangan Chatterjee 1:42:47 ... feeling stressed out and lonely-

Speaker 1:42:49 Yeah

Dr. Rangan Chatterjee 1:42:49 ... and the same food might have a different response if you're eating it with good friends when you're feeling relaxed and calm.

Speaker 1:42:59 Yeah. Exactly.

Dr. Rangan Chatterjee 1:43:00 I, I'm, I'm convinced of it. You know, one thing I've really, I've, I've observed clinically maybe for two, three years now-

Speaker 1:43:06 Mm-hmm

Dr. Rangan Chatterjee 1:43:06 ... a lot of people these days are reacting or, or perceive themselves as reacting to foods.

Speaker 1:43:11 Yes.

Dr. Rangan Chatterjee 1:43:11 And I think what's really interesting for me is, and I think I really got this in the year preceding me writing The Stress Solution, because I thought, "Well, if stress changes your, uh, your gut and your GI tract and your, your-

Speaker 1:43:27 Mm-hmm

Dr. Rangan Chatterjee 1:43:27 ... digestion significantly, as it does, well, are they actually reacting to the foods, or are they reacting to the fact that they're eating in a stressed state?"

Speaker 1:43:36 Mm-hmm.

Dr. Rangan Chatterjee 1:43:36 And I've seen with some patients, the same food, if they do some sort of what I call the transition-

Speaker 1:43:42 Mm-hmm

Dr. Rangan Chatterjee 1:43:43 ... between, you know, action state and eating, so when they do that for one or two minutes before eating-

Speaker 1:43:48 Yeah

Dr. Rangan Chatterjee 1:43:48 ... they're no longer reacting to the same foods.

Speaker 1:43:52 Yeah.

Dr. Rangan Chatterjee 1:43:52 Which- You know, it's-

Speaker 1:43:54 I think this has even been shown with gluten as the nocebo effect.

Dr. Rangan Chatterjee 1:43:58 Yeah.

Speaker 1:43:58 Which, I, I, people say this all the time. I go on holiday, I can eat the bread. It doesn't make me feel bloated, but the bread at home must be somehow different. Maybe it's different, but also you're different. You're in a different frame of mind when you're on holiday and you're eating, and you're chewing your food as you look at the lovely vista-

Dr. Rangan Chatterjee 1:44:14 Yeah

Speaker 1:44:14 ... and you're just feeling more relaxed, and that's affecting your digestion and-

Dr. Rangan Chatterjee 1:44:19 But that, this stuff matters-

Speaker 1:44:20 Yeah

Dr. Rangan Chatterjee 1:44:20 ... more than people think. You know, when I, I really don't, I hardly, pretty much don't drink anymore. Um, but when I did, I used to remember that I'd go on holiday and like, you know, a glass of red wine would affect my sleep in the UK or-

Speaker 1:44:36 Mm-hmm

Dr. Rangan Chatterjee 1:44:36 ... you know, I'd feel a bit groggy the next day. But I found when I was on holiday I could have a glass or two with dinner-

Speaker 1:44:42 Yeah

Dr. Rangan Chatterjee 1:44:42 ... and I felt nothing.

Speaker 1:44:43 Yeah.

Dr. Rangan Chatterjee 1:44:44 I thought, this is stress.

Speaker 1:44:45 [laughs]

Dr. Rangan Chatterjee 1:44:45 This is like, there's no, like, stress load on my life.

Speaker 1:44:48 Yeah.

Dr. Rangan Chatterjee 1:44:48 I'm sort of chilling with my wife and my kids and there's a beach.

Speaker 1:44:51 Yeah.

Dr. Rangan Chatterjee 1:44:51 So it's not bothering me. But if your life is chronically overly busy, you're stressed out-

Speaker 1:44:56 Yeah

Dr. Rangan Chatterjee 1:44:57 ... the whole time, not only are you gonna get sick more-

Speaker 1:44:59 Yes

Dr. Rangan Chatterjee 1:44:59 ... or potentially, you know, you're gonna be able to not tolerate-

Speaker 1:45:04 Yeah

Dr. Rangan Chatterjee 1:45:04 ... various things. You're gonna, you're gonna, you're not gonna be able to manage those insults as well, right?

Speaker 1:45:08 Exactly. I call it the food prison, you know? I see so many people who are so stressed about eating the perfect diet that that's, that's just eroding their health. Never mind what they're eating-

Dr. Rangan Chatterjee 1:45:20 Yeah

Speaker 1:45:20 ... being, being helpful. Um, but I guess, you know, you asked me earlier about what I do [laughs] to manage my stress and I think it's my, still my learning curve, but it's just on my radar now that I'm, I'm, I'm always experimenting. I'm learning how to say no. I think having boundaries was one of the biggest things I, I learned as an adult. Like, why are we not teaching kids this in school? And saying no is okay, and there's a time and a place for projects.

Dr. Rangan Chatterjee 1:45:47 Yeah.

Speaker 1:45:47 If I wanna get involved and it, it can't be now because that compromises my time as a mother or my time spent with family, or my time just, you know, being on my own or doing the things that-

Dr. Rangan Chatterjee 1:45:59 Yeah

Speaker 1:46:00 ... nurture my day, then I have to say no and let go of that.

Dr. Rangan Chatterjee 1:46:05 Yeah.

Speaker 1:46:05 And I guess that's like, you know, the catharticism of writing or some ways of, you know, putting a narrative to what's stressing us out has a release to it.

Dr. Rangan Chatterjee 1:46:16 Yeah.

Speaker 1:46:16 And that you can feel that, you know, like a big physiological sigh that your body is making when you're like, "Okay." And once the decision's made, you move on from it.

Dr. Rangan Chatterjee 1:46:25 Yeah.

Speaker 1:46:25 I've said no to that. It's sad, and I wish I could say yes, but I don't think about it the next day when I've moved on and other things are, you know, in front of me.

Dr. Rangan Chatterjee 1:46:34 It's very freeing, actually.

Speaker 1:46:35 Mm-hmm.

Dr. Rangan Chatterjee 1:46:35 You know, something I struggled with for years and it's, I'm getting much better at it, but it's, it feels good.

Speaker 1:46:42 Yeah.

Dr. Rangan Chatterjee 1:46:43 You... Half the time I used to say yes to stuff and then I would just be stressed out. Well, why did I say yes? I've got to do this. I've committed now.

Speaker 1:46:49 Yeah.

Dr. Rangan Chatterjee 1:46:49 They've started advertising it. They're all... And I, I'm, I'm getting much better at nipping it in the bud-

Speaker 1:46:54 Yeah

Dr. Rangan Chatterjee 1:46:54 ... at source.

Speaker 1:46:55 Yes. [laughs]

Dr. Rangan Chatterjee 1:46:56 And, you know, and it's, but it's taken a lot of work.

Speaker 1:46:58 Oh, yeah. I had to learn the hard way.

Dr. Rangan Chatterjee 1:47:00 Yeah.

Speaker 1:47:00 Um, but the, I started feeling like I was doing everything badly. And when you start to feel like you're being a bad parent, probably I wasn't, but in my mind-

Dr. Rangan Chatterjee 1:47:09 Yeah

Speaker 1:47:09 ... I wasn't doing what I wanted to do, and that, I think, with my kids, I just, that had to be a firm line that-

Dr. Rangan Chatterjee 1:47:16 Yeah

Speaker 1:47:16 ... I couldn't ever cross again.

Dr. Rangan Chatterjee 1:47:17 Wow. Now, you mentioned eating, and you said, um, that, you know, there's some studies that our immune system operates differently if we're eating in company, feeling joy-

Speaker 1:47:28 Mm-hmm

Dr. Rangan Chatterjee 1:47:29 ... feeling happy. That reminds me of something else I read in your book about, it's something to do with, you were giving a, a list of strategies to people, but it was about, you know, like walking whilst listening to music. It was about putting two senses in together.

Speaker 1:47:44 Oh, yes.

Dr. Rangan Chatterjee 1:47:45 I, that I found-

Speaker 1:47:45 Yeah

Dr. Rangan Chatterjee 1:47:45 ... really interesting. Could you expand on that at all?

Speaker 1:47:47 Yeah. That, this is, it's really interesting actually. So this was, um, data that was generated in the 1980s. There's some scientists who were trying to disprove research that had come out of Russia around that time about conditioning. So the classical example of conditioning is Pavlov's dogs. Um, most people will be aware of that. But there, these experiments they had done where they, they had looked to try and condition the immune system. And so the scientists were like, "This, this can't be right." You know, "We, we're gonna redo the experiments much more stringently and, and see i- if it's is really what it makes out to be. Can you condition your immune system with various rituals and routines?" And what they did was they, they used an animal, uh, model experiment, and they gave the, the animals a s- a sweet solution to drink, and, uh, one group got the sweet solution that also had a particular chemical inside it that would modulate antibody responses. So they could measure the antibody responses in the blood and see, um, if, uh, there was an effect happen- happening. Some kind of readout, tangible piece of data that they could observe. Um, so the mice were given these, this sugar solution with this chemical for a period of time, and after a while when they just gave the sugar solution on its own, they got the same effect happening to the immune system. So it's kind of like a placebo effect.

Dr. Rangan Chatterjee 1:49:16 Wow.

Speaker 1:49:17 It's like you expect something. The mouse expected this effect to take place in its body on some kind of subconscious level because it was so used to that happening, that the, it, the effect happened anyway, even without the chemical presence to actually cause the modulation to the immune system. And people have been scratching around to try and understand the mechanism, and I think the best we've come up with is the placebo effect. Like, it's, it, there's some part of us that we don't quite understand that embodies things, and w- when there's a response expected, that the biology changes. And we can start to pair things together. So- What you were referring to in the book is, like, the kind of little stress-relieving rituals, like f- you know, playing your favorite music whilst you're doing something like taking a, a nice bath or, uh, having a s- particular scent being in the room-

Dr. Rangan Chatterjee 1:50:18 Yeah

Speaker 1:50:18 ... while you're doing something else. And eventually then you just can play that music, and you start to feel the same relaxed feeling that you do when you're in a nice warm bath, even without taking the bath.

Dr. Rangan Chatterjee 1:50:28 Yeah. You know, it makes me think about, you know, if your home is or has been a stressful place-

Speaker 1:50:36 Mm-hmm

Dr. Rangan Chatterjee 1:50:36 ... then, you know, that it kind of works that you may come into that, and y- your body may start to almost-

Speaker 1:50:44 Yeah

Dr. Rangan Chatterjee 1:50:44 ... the immune system might sense that and go-

Speaker 1:50:46 Yeah

Dr. Rangan Chatterjee 1:50:46 ... "Okay, this is a stressful place," and, and react even if nothing stressful happens.

Speaker 1:50:50 Yes.

Dr. Rangan Chatterjee 1:50:51 But then you could also flip it. And, you know, I'm a huge fan of ritual and sort of daily-

Speaker 1:50:55 Mm-hmm

Dr. Rangan Chatterjee 1:50:55 ... practices, that even if they only take five minutes-

Speaker 1:50:58 Yeah

Dr. Rangan Chatterjee 1:50:58 ... they can be very powerful. And I think when I hear that, I think of a morning routine, and I think what if someone, you know, can design their ideal morning routine. Let's say c- let's say it was five, 10 minutes.

Speaker 1:51:09 Yeah.

Dr. Rangan Chatterjee 1:51:09 You know? A bit of maybe a minute or two of breathing.

Speaker 1:51:12 Yeah.

Dr. Rangan Chatterjee 1:51:13 Um, you know, three or four minutes of some light movement practice.

Speaker 1:51:17 Yeah.

Dr. Rangan Chatterjee 1:51:17 And then let's say five minutes of reading a positive book.

Speaker 1:51:20 Yeah.

Dr. Rangan Chatterjee 1:51:20 For example, I mean, that's, you know, I, I, in The Stress Solution, I write about the three Ms of a morning routine; mindfulness, movement, and mindsets.

Speaker 1:51:26 Mm-hmm.

Dr. Rangan Chatterjee 1:51:27 I think you can create one that lasts an hour. You can create one that lasts five minutes. But the point I'm trying to make is if someone started doing that in the same room, let's say they lit a candle-

Speaker 1:51:39 Yeah

Dr. Rangan Chatterjee 1:51:39 ... in the room, did that, that even on a day when they're a little bit busy or they haven't quite, they can't quite-

Speaker 1:51:45 Yeah

Dr. Rangan Chatterjee 1:51:45 ... switch off, and they just, you know, sat there with their coffee with the candle on-

Speaker 1:51:49 Yes

Dr. Rangan Chatterjee 1:51:49 ... maybe that will also condition their immune system the other way and go, "Hey, things are okay-"

Speaker 1:51:55 Exactly

Dr. Rangan Chatterjee 1:51:55 ... "because he's got the candle on."

Speaker 1:51:57 Yeah.

Dr. Rangan Chatterjee 1:51:57 I don't know. It's quite, it's quite empowering.

Speaker 1:51:58 The smell, all the senses kind of integrating, so it might be a particular scent that you're burning. There might be a particular song or playlist that you always play when you're doing those, uh, activities for your morning routine. And then in the morning, you wake up, and you're just tired, and you don't wanna do your movement. You just wanna sit and enjoy a tea, but you're in that room with that space.

Dr. Rangan Chatterjee 1:52:19 Yeah.

Speaker 1:52:19 And you're still may be reaping the benefits of the, the meditation and the movement-

Dr. Rangan Chatterjee 1:52:22 Yeah

Speaker 1:52:22 ... that you would normally do. And I think routine, as a, as a human being, we just seem to be anchored by routines.

Dr. Rangan Chatterjee 1:52:29 Yeah.

Speaker 1:52:30 For me, uh, especially becoming a mother, it's been, it's been hugely important, so much so that now I can buffer the lack of routine more because I can circle back to a really strong routine-

Dr. Rangan Chatterjee 1:52:40 Yeah

Speaker 1:52:41 ... that I've built over time. And I think when we went into lockdown this year, everything kind of got off kilter, and we haven't, we, we're living in a building site, basically, at the moment. [laughs] So-

Dr. Rangan Chatterjee 1:52:52 Yeah. That's stressful, right?

Speaker 1:52:53 It's stressful. The routine is, is shot. You know, is shot. It's really done a number on us. But w- I think having been someone who needs routine, particularly as a bit of a stress head, it didn't take long for us to find a new rhythm-

Dr. Rangan Chatterjee 1:53:08 Yeah

Speaker 1:53:08 ... uh-

Dr. Rangan Chatterjee 1:53:08 It's, uh-

Speaker 1:53:09 ... being at home, and that's anchoring. I think that's-

Dr. Rangan Chatterjee 1:53:12 I, I, I love the way you, the way you say certain things. You said, you know, we can build a routine.

Speaker 1:53:18 Mm-hmm.

Dr. Rangan Chatterjee 1:53:18 Like, you can build your immune system.

Speaker 1:53:21 Yeah.

Dr. Rangan Chatterjee 1:53:21 This, it's a very empowering words.

Speaker 1:53:23 Yeah.

Dr. Rangan Chatterjee 1:53:23 You know, build means we can do that, right?

Speaker 1:53:25 Yes.

Dr. Rangan Chatterjee 1:53:25 It doesn't mean it's fixed.

Speaker 1:53:27 Exactly.

Dr. Rangan Chatterjee 1:53:28 We, we've got some agency over that.

Speaker 1:53:30 Yeah.

Dr. Rangan Chatterjee 1:53:30 Um, it's really interesting as, as, you know, as I, as I mentioned right at the start, this is, you know, day one in the new studio.

Speaker 1:53:36 Yeah.

Dr. Rangan Chatterjee 1:53:36 And Gareth, who's videoing, uh, and sitting there in the corner, um, we've been talking about, you know, how do we create a stress-free space-

Speaker 1:53:48 Mm-hmm

Dr. Rangan Chatterjee 1:53:48 ... that allows a really deep, authentic, vulnerable conversation to happen.

Speaker 1:53:53 Yeah.

Dr. Rangan Chatterjee 1:53:54 And, you know, it's not quite ready yet. You know, bringing plants in is one thing.

Speaker 1:53:58 Yeah.

Dr. Rangan Chatterjee 1:53:58 You know?

Speaker 1:53:58 Mm-hmm.

Dr. Rangan Chatterjee 1:53:59 Um, we're gonna probably have a candle on or some sort of-

Speaker 1:54:01 Yeah

Dr. Rangan Chatterjee 1:54:01 ... you know, a nice scent.

Speaker 1:54:03 Yeah.

Dr. Rangan Chatterjee 1:54:03 You know, my, my dream is, 'cause my, this podcast is all about authentic conversation.

Speaker 1:54:08 Mm-hmm.

Dr. Rangan Chatterjee 1:54:08 It's not interviews. It's conversation. I want, um, someone like you to walk in, and within, you know, I almost wanna program it so that people feel calm and go-

Speaker 1:54:21 Mm-hmm

Dr. Rangan Chatterjee 1:54:22 ... they wanna open up and actually-

Speaker 1:54:23 Yeah

Dr. Rangan Chatterjee 1:54:23 ... Do you know what I mean?

Speaker 1:54:24 Yeah.

Dr. Rangan Chatterjee 1:54:25 You know?

Speaker 1:54:25 I think you've done a really good job already.

Dr. Rangan Chatterjee 1:54:27 Oh. [laughs]

Speaker 1:54:27 But also, I think the, what you give off as a person really helps. So the way people's eyes feel relaxed. You know when we're angry, we, like, narrow our eyes-

Dr. Rangan Chatterjee 1:54:37 Yeah

Speaker 1:54:37 ... or if we're feeling quite negative or stressed. And then we pick that up when we're sort of reading the body language.

Dr. Rangan Chatterjee 1:54:44 Yeah.

Speaker 1:54:44 And so if somebody has a sort of relaxed disposition, that's gonna be interpreted-

Dr. Rangan Chatterjee 1:54:50 Yeah

Speaker 1:54:50 ... by the other person and make them feel at ease as well, so.

Dr. Rangan Chatterjee 1:54:53 And interpreted by our immune systems.

Speaker 1:54:56 Yes, exactly.

Dr. Rangan Chatterjee 1:54:57 You know?

Speaker 1:54:57 As this is a safe environment. It's all about all of those millions of inputs that are going in-

Dr. Rangan Chatterjee 1:55:02 Yeah

Speaker 1:55:03 ... every minute of every day, and our immune system's reading those, shaping, and responding.

Dr. Rangan Chatterjee 1:55:08 [Instrumental music] If you enjoyed that conversation, I think you are going to love the one that I had with Professor Tim Spector all about foods. It's right there, so give it a click, and let me know what you think.

Dr. Andrew Weil 1:55:19 If you snack a couple of hours before a meal, your metabolic response to that meal is poorer than if you didn't snack.

Dr. Rangan Chatterjee 1:55:27 Okay. Just say that again, because I think that's really important