Doctors Won't Tell You This - What Happens If You Don't Eat For 36 Hours | Dr. Pradip Jamnadas

1. 0:00 – 2:17

   Fasting benefits Dr. Jamnadas saw in cardiology patients

   1. PJDr. Pradip Jamnadas0:00

      Blood pressure comes down, joints seem to get better, bowel symptoms seem to get better. This is gonna keep your eyesight, this is gonna keep you from getting dementia, renal disease, peripheral vascular disease, and cancers. You are not your habits. You can do it.

   2. RCDr. Rangan Chatterjee0:14

      [upbeat music] I've been pretty excited about talking to you for a number of months now, ever since I saw some of your YouTube videos. So first of all, thank you for making time to come onto the show.

   3. PJDr. Pradip Jamnadas0:27

      It's a pleasure for me. I'm honored, actually. And I've been watching your shows, too. They're amazing.

   4. RCDr. Rangan Chatterjee0:32

      Well, I think there's a lot that we're gonna share a common view on, and, um, I wanna unpick a lot of that. To start off, though, you were a cardiologist. You're very proactive about promoting the benefits of fasting with your patients, and I guess across society as a whole. So right at the start of this conversation, I wonder if you could outline what are the key benefits of fasting that you have seen in your patients?

   5. PJDr. Pradip Jamnadas1:00

      Traumatic. You know, I've been a cardiologist for 30 years, and I've tried everything. But when I tried fasting, I started seeing changes. People began to lose weight. People's blood pressures came down. Diabetes got reversed. The progression of coronary artery disease went down. You see, I had the benefit of seeing patients from day one, so I saw that they were having a second angioplasty, another heart attack in two years, five years. I saw the numbers going down on those whom I was able to get them to lose weight through a di-, uh, fasting program. And I tried lots of fa- uh, diet programs. They didn't seem to work, but fasting did. So, decreased blood pressure, decreased diabetes, uh, rehospitalization, LV function seemed to stay good, which means that heart muscle function continued to do well. Patients mentally also seemed to be doing better. So, fasting gave me not just this benefit, but a lot more. Also, my patients didn't end up in the hospital with fractures or falls, and they had stronger muscles and, and mentally they were better. Um, so I started seeing that just generally patients were doing better. ER doctors telling me, "How come your dop- your patients don't end up in the ER with acute heart attacks?" Um, all these benefits I saw-

   6. RCDr. Rangan Chatterjee2:17

      Yeah

   7. PJDr. Pradip Jamnadas2:17

      ...

2. 2:17 – 8:04

   Why few doctors promote fasting and the role of empowerment

   1. PJDr. Pradip Jamnadas2:17

      with, uh, fasting.

   2. RCDr. Rangan Chatterjee2:19

      With, with all these, you know, quite different benefits that you've just outlined for us, why is it, do you think, that very few medical doctors are promoting fasting with their patients? Of course, as you've demonstrated, it has huge benefits. It's very effective. It's also kind of free of charge. So why is there such a resistance among, you know, like our profession, to recommend this as a treatment?

   3. PJDr. Pradip Jamnadas2:49

      It's a tough sell, and it takes time. You see, you're only as good as getting into your patient's brain. Can you get in there and make them make those changes? And that's a tough one-

   4. RCDr. Rangan Chatterjee3:02

      Yeah, yeah

   5. PJDr. Pradip Jamnadas3:02

      ... because all you're doing is you're giving them the advice. There's no tools for me to give them. There's no tablets to give to them. They gotta make that effort. And all I gotta do is get into their brain, change the way they think. And if they get convinced that, yes, Doc is telling me something that resonates inside me, and, and I'm gonna, I'm gonna make that change, um, then they'll do it. So the trouble is that most of us doctors are too busy. We're actually taking care of disease processes rather than prevention. Here, we're really talking about a lifestyle change, and that's the hard part about fasting and talking to someone about fasting. Physicians find it very difficult to talk to them about that, because you can't just tell them that, okay, these are the benefits. That's not good enough. Um, it takes much more than that. It's a deeper dive into the patient's lifestyle. How do you wake up in the morning? How do you feel in the morning? What are the main issues in your life? So it's, it's not just about fasting. It's about your relationships. Who are you? Um, what's your life all about? Um, all that affects your diet. 'Cause see, fasting is also about, it's much more, it's about your whole life. It's about who do you think you are, and can you empower yourself to do it?

   6. RCDr. Rangan Chatterjee4:20

      Yeah, yeah.

   7. PJDr. Pradip Jamnadas4:20

      Or are you just a slave to your day-to-day routines and advertising? So to get somebody to fast, you really need to change their, their whole outlook on who they are. You are not your habits. You are not even your body. You are something that can change everything. There's a separate part of you besides your body, even your mind. There's a separateness. There's an awareness inside you. And if I can get into that awareness, then I can empower you.

   8. RCDr. Rangan Chatterjee4:56

      Yeah, yeah.

   9. PJDr. Pradip Jamnadas4:56

      And if I can empower you, then I can make you fast. So doing this whole thing, it, it's not easy for most physicians, and, um, you know, e- even, even, even people who are dedicated to teaching people about diet, it's a hard sell.

   10. RCDr. Rangan Chatterjee5:10

       Yeah, yeah.

   11. PJDr. Pradip Jamnadas5:10

       And I think that our approach has to change. Our, our approach, I first look at patients and I have to empower them to say, "You know, you are more than what you think you are. You can do it."

   12. RCDr. Rangan Chatterjee5:23

       Your videos on YouTube have been going viral for a number of years now, and, you know, I've read a lot of the comments, and I've watched a lot of those videos. And I think what, one of the many things people deeply resonate with you and your message about is this real passion to help people and this real passion to empower people. And I, and I want to sort of dive in there a little bit, because you are, you know, a, a very well-respected cardiologist. You literally go into people's hearts, you put in stents, you do all this kind of stuff. In some ways, you know, a- as life-saving as putting a stent in someone's heart potentially can be- You know, it's slightly disempowering, isn't it? It's kind of like, well, I've got to rely on the skill and ability of my doctor to be good at what he does, to be sharp on the day, to have slept properly the night before, right? Those- all these things are out of my control as a patient. Whereas pretty much everything you're talking about, and we're gonna go through in detail today, is about putting the patient back in control of their health, and I guess I would argue their wider happiness as well.

   13. PJDr. Pradip Jamnadas6:37

       Absolutely. Absolutely. And, and, and that's the thing, that the patients have to take responsibility because the medical profession, the way it's set up right now, we, we, we just- we, we're not in a position to do that. We have to ... You know, we don't have enough resources. We don't have enough time. So what we can do is we can educate patients, and we can throw light on the issues that have brought them to where they are now and show them how they can get out of it. Show them, empower them, and educate them so that they make the decisions. And when they make the decisions, they will do it.

   14. RCDr. Rangan Chatterjee7:09

       Yeah, yeah.

   15. PJDr. Pradip Jamnadas7:09

       And then it's, it's, it's self-empowering. It feeds back on themselves and say, "Look, look, I was able to do this, and I didn't think I could do this." And, and so that brings us to that issue that there are so many layers of onions that we can peel off, and fasting is the one that really seems to me to open up aspects of their lifestyle which they would not have otherwise looked at because fasting does bring in lots of issues into their life. The, the, it opens up the introspection into their life. It's what's going on, what's driving these things in my life?

   16. RCDr. Rangan Chatterjee7:44

       Yeah, yeah.

   17. PJDr. Pradip Jamnadas7:44

       And that's what I like about fasting is it's, it's so different. Uh, I mean, imagine if I just give them a diet and say, "Okay, you're just gonna eat this. Um, okay, they're gonna eat that. That's it." But in fasting, it's self-control. It's int- it, it's deeper thinking about the habits and all the other things that we're, we're gonna talk about.

3. 8:04 – 12:17

   Fasting from other addictions: dopamine, sugar and digital habits

   1. RCDr. Rangan Chatterjee8:04

      Yeah. I- in many ways, fasting is, you know, really swimming against the tide of societal norms because we live in a society of abundance, yet fasting is self-imposed scarcity. And, you know, we're gonna talk about fasting from food and the benefits for various different disease processes, uh, but also for promoting health and wellbeing. But you could take it all a step further, couldn't you? If we're gonna sort of link mind and body and heart all together, well, it's not just about fasting from food, is it? It's, it's also we can take social media fasts. We can take alcohol fasts. We can take caffeine fasts. Even that term fasting, it goes far beyond just food really, doesn't it?

   2. PJDr. Pradip Jamnadas8:58

      Absolutely. Absolutely. You have so much insight into this. You, you've just hit, you know, into something very important. When we talk about our habits in fasting and our addiction really to eating and this pattern, you also talked about digital addiction. You almost just ... You didn't quite say it in that way, but it- there is digital addiction. There's alcohol addiction. There's gambling addiction. There's other forms of addictions, and sugar addiction. And all these things seem to go to that part of the brain that gives us that reward. So we're living in a society where it's all about the instant rewards. And when you prime yourself in one area, you can slip into other areas as well, and that brings up this whole addiction thing that perhaps this pattern of eating that we've developed and this addictive pattern of eating every few hours all the time, it's really an addiction. It is an addiction, and it, it seems to give us that instant reward. And doesn't really matter what you're eating, but it's the fact that you're eating all the time, and we need to get out of this.

   3. RCDr. Rangan Chatterjee10:03

      Yeah, yeah.

   4. PJDr. Pradip Jamnadas10:04

      So we need to really look at our whole life to say that, look, the dopamine centers are primed already from a young age, and, um, yes, we are addicted. We're an addicted society. You, you know, the, the, the book that I just finished reading a few months ago, um, Dopamine Nation I think it's called.

   5. RCDr. Rangan Chatterjee10:21

      Yeah.

   6. PJDr. Pradip Jamnadas10:21

      Yeah. Fascinating insights that, you know, you prime yourself in one area, and then you'll slip into another addiction very easy, and I think that food is one of them.

   7. RCDr. Rangan Chatterjee10:31

      Yeah, yeah.

   8. PJDr. Pradip Jamnadas10:31

      I, I'm convinced that food is one of them. Um, so yeah, no, you're absolutely right. It is, it's, it's a whole lifestyle, and, and I tell my patients that if you really want to come off your f- current eating habits, we need to look at your whole life as well. Are you addicted to alcohol? Are you addicted to, to caffeine? Are you addicted to sugar? Are you addicted to even digital, uh, uh, media? Um, because it's just the way we're priming ourselves.

   9. RCDr. Rangan Chatterjee10:59

      Yeah, yeah.

   10. PJDr. Pradip Jamnadas10:59

       And when they start looking to that, they do see insights. It's oh, my God, he was right. They, they ... You know, I am probably addicted to this pattern, and I can get out of it.

   11. RCDr. Rangan Chatterjee11:07

       I've read that book, Dopamine Nation. I actually spoke to Anna Lembke, who wrote that, just a few weeks ago on this show. A great conversation.

   12. PJDr. Pradip Jamnadas11:15

       Oh.

   13. RCDr. Rangan Chatterjee11:15

       I, I agree. It's a, it's an awesome book. Um, many of us have heard of fasting. We've heard that various religions have used fasting for years. Many of us, depending on what culture we have grown up in, may know that our parents or our grandparents would fast from time to time. Yet despite knowing that, certainly in our current society, many of us aren't taking that next leap. Many of us think ... You know, and I know you ... I, I've heard you say before that you were a bit skeptical of fasting when you were at medical school. Many of us probably have thought in the past that, oh yeah, you know, what do my grandparents know? You know, I'm not going to fast. And what I'd love to do, 'cause I think you do it so well, is really go through what happens in the body biochemically, physiologically when we start fasting. Because I think for many people, they're gonna need that knowledge and that science to convince them that actually, yeah, you know what? Maybe I should give this a go.

4. 12:17 – 20:05

   Insulin, insulin resistance and how Dr. Jamnadas found fasting

   1. PJDr. Pradip Jamnadas12:17

      Yeah, yeah, yeah. No, absolutely, absolutely. You know, what fasting does, it allows the body to do what it was made to do. You see, we eat, eat, eat. Insulin comes in, puts everything into storage, so you build up some fat. And then you're supposed to live. So when you live, you now start utilizing your calories a- and you start burning the sugar. When that goes out after maybe about four hours or five hours, then the, you know, glycogen stores in your liver and in your muscles start breaking down, start giving you the calories that you really need to burn so you can run, do your day-to-day activities and all that. And when you run out of that by, let's say, about 18 hours or 20 hours, and then the body says, "Hmm, I need to start burning fat now," that's what you're supposed to do. That's why you put on fat in the first place. That's why we have fat. It's a storage. And then you start burning that fat, and therefore, you start burning that fat, so the fat comes out, comes into your liver, gets converted to some ketones perhaps, and now you're making ketones, and the ketones are being utilized for energy, and then, uh, you go for your next meal again. So the body was made to do this. It was not made to just pile on, pile on, pile on all the time, because that, th- that results in increased fat stores, which you'll never break down. So your body was supposed to do this. From the, from the, from the design, you're supposed to do this. So the important thing is that when you eat and you're taking calories, your insulin level obviously goes up. Why? Because insulin has to get that sugar out of the bloodstream. S- blood sugar must always come down, because otherwise you get damage from that high glucose level in your bloodstream. That's why we treat diabetes, right? Because the blood sugar, or the glucose rather, attaches itself to proteins, get glycation end products, and therefore these proteins become m- they, they become dysfunctional. So insulin says, "I'm gonna take the glucose out, put it down into the bloo- uh, into the storage." First place it puts it into is the liver. When the liver stores are full, then it spills over into the pancreas. More calories come in, there's more glucose, then it goes into the muscles, and it stores everything, and from there into the skin. And that's the way it was supposed to be. But now when we continue to do that, we just keep piling it on, piling it on, and we never get a chance to burn it down, and we're supposed to burn it down. So the biochemistry of the body was made for feeding, fasting cycles, and this is the way the, the, uh, the, the b- bioengineering of our body was, but we became dysfunctional because as food became more available, we just kept piling it on and on and on and on, and that's the problem that we have today. It is exactly what you said, excessive calories too frequently. So our insulin levels stay high all the time. So that's the biggest problem I've found as a cardiologist. You're eating all the time, you're stimulating your insulin all the time, insulin stays high, stays high-

   2. RCDr. Rangan Chatterjee15:13

      Yeah

   3. PJDr. Pradip Jamnadas15:13

      ... never gets a chance to come down. And because your insulin doesn't come back down again, you're always in a storage mode.

   4. RCDr. Rangan Chatterjee15:20

      Yeah.

   5. PJDr. Pradip Jamnadas15:20

      This high insulin is the problem. We've hormonally changed because we're eating too frequently. We're not designed to ea- eat that frequently. Insulin's supposed to go up, then come back down again. Up and back down. We stay up all the time, so your body develops, in a simple terms, insulin resistance. Now, the next time you eat, you need even more insulin because just like wearing a jacket, you first feel it, then you don't feel it. The body, when it has high levels of insulin all the time, it becomes insensitive to it, and that's what's happening. We are a hormonally modified human being now. We're becoming insulin resistant, and this insulin resistance results in higher and higher insulin levels, and that's the problem I found. And I just wanna digress a little bit, and I'll tell you how I came to this. In my practice, what is happening is patients were coming in with heart attacks and hardening of the arteries and angina, and I said, "Okay, there must be a cause," and I looked for it. And the cholesterol m- most of the time was okay, blood pressure was okay, they were not diabetic, and then I see all this hardening of the arteries, and I'm wondering why. So about 12, 15 years ago, I, I started doing sugar tests on them, and I found that they actually had mild diabetes, what we call glucose intolerance or impaired gluco- fasting glucose. So the sugars were just slightly high, but not enough to make them a diabetic. So I said, "Okay, fine. So I should put these patients on something to sensitize them and make them better," and I put them on metformin, and I got a lot of resistance from a lot of physicians in the community, plus patients, uh, but the outcomes were better. They, they actually did better. Then I started doing insulin testing in my office, and I started doing this when I read, uh, some information from, um, uh, fr- from a, a physician, uh, who wrote a book on, on, on insulin, and he c- Dr. Kraft.

   6. RCDr. Rangan Chatterjee17:10

      Yeah.

   7. PJDr. Pradip Jamnadas17:10

      So it's called the Kraft test. So now what we do is we give them sugar water, patients, and we measure the, the sugar levels going up and back down again, and said, "Okay, it went up a little bit. Not too bad." But I looked at the insulin response, and it was massive in these patients. So I took 100 patients, and I saw that they were making so much insulin, and I says, "This is ridiculous. Why are you making so much insulin?" Well, they had insulin resistance. And then I linked the fact that it's the high insulin level that's actually causing the hardening of the arteries, because the sugar levels are okay. Of course, what happens is over time, it's taking a gallon of insulin to bring your sugar levels under control. Eventually, even that's not enough.

   8. RCDr. Rangan Chatterjee17:54

      Yeah, yeah.

   9. PJDr. Pradip Jamnadas17:55

      So then the sugar level goes up, and then they go to the doctor and say, "Oh, your sugar levels are high," or, "Your hemoglobin A1C level is high. Now you're a diabetic." Well, guess what? It's too late. You already have all the hardening of the arteries. You've done so much damage to your arteries. You probably did it for 15 to 20 years, and that's the discovery, and that's what really motivated me to make these changes in my patients, to say that, "Look, you know, I gotta get that insulin level down." And it is that high insulin level that really motivated me-

   10. RCDr. Rangan Chatterjee18:25

       Yeah, yeah

   11. PJDr. Pradip Jamnadas18:25

       ... to really do the fasting program. Because I said, "Okay, how am I gonna get insulin levels down?"

   12. RCDr. Rangan Chatterjee18:29

       Yeah, yeah.

   13. PJDr. Pradip Jamnadas18:30

       "How, how do I do that? I don't have a drug." So that's what-- Look, the whole thing comes down to insulin, for me it was. Now, as things happened, I discovered more and more fun things that-- in this fantastic journey. But the bottom line is, it was the high insulin level that really got me into this, because I found that when I brought the insulin levels down, my coronary artery disease, atherosclerosis just went down. Patients did so much better. And that high insulin level, the only thing I know that really helps to bring that insulin level down, besides metformin and a few other drugs, really is fasting.

   14. RCDr. Rangan Chatterjee19:06

       Yeah.

   15. PJDr. Pradip Jamnadas19:07

       Because when you don't eat, guess what? You don't make insulin. That's it.

   16. RCDr. Rangan Chatterjee19:11

       Yeah, yeah.

   17. PJDr. Pradip Jamnadas19:11

       Your insulin levels plummet. And then the next time you eat, you make insulin, but a much less amount-

   18. RCDr. Rangan Chatterjee19:18

       Yeah

   19. PJDr. Pradip Jamnadas19:18

       ... because you're now sensitive. So this fasting, I got into it through this way, not because I've-- I, I just wanted to make them reduce weight-

   20. RCDr. Rangan Chatterjee19:27

       Yeah, yeah

   21. PJDr. Pradip Jamnadas19:28

       ... not because I just wanted to reduce blood pressure. It was really the insulin that got me into fasting. Then, of course, I discovered, as time went on, that, my God, the blood pressures were coming down, and I realized that insulin is a vasoconstrictor. It reduces nitric oxide in your blood vessels, so therefore, your blood vessels can't dilate. Now, that brings me to hypertension, that I said, "Oh, my God." I was taught, and you were taught, that 95% of hypertension is essential. And this very word essential, there's nothing essential about hypertension. You don't need it. So I discovered-

5. 20:05 – 28:06

   Blood pressure, weight loss and mood: what patients experienced

   1. RCDr. Rangan Chatterjee20:05

      Sh-shall we, shall we, shall we explain to non-medical listeners what, what does that term essential mean? When we say essential hypertension, what do we mean by that?

   2. PJDr. Pradip Jamnadas20:14

      It means we don't know the cause of it. It's idiopathic. Idiopathic is another word we use, uh, which means we don't really know clearly what the cause is. It's just something that just happens. So this essential hypertension is not really essential. You don't really need it. And I found, through my own experiences here, that the fasting brought the blood pressures down. And I said, "Okay, so what's the correlation? It's insulin." I started reading more about insulin, and sure enough, when you give patients an insulin shot, the blood pressure goes up.

   3. RCDr. Rangan Chatterjee20:44

      Yeah, yeah.

   4. PJDr. Pradip Jamnadas20:45

      You take them off insulin, blood pressures come down. Insulin causes nitric oxide depletion in the blood vessels. Nitric oxide, by the way, is a vasodilator. Yeah. Nitric oxide is a natural endogenous product that makes your blood vessels dilate. And then when nitric oxide goes down, the vessels constrict. This is a dynamic state that you're supposed to have. You walk into a cold room, your vessels constr- uh, constrict. That means your blood vessels go down. When you go into a hot room, your vessels dilate. That's a normal response. This nitric oxide is most essential in our body. It is so important for blood vessels that, in fact, there was a Nobel Prize awarded for this nitric, as you know.

   5. RCDr. Rangan Chatterjee21:22

      Yeah.

   6. PJDr. Pradip Jamnadas21:22

      So for the audience to realize that insulin, when it comes down, your nitric oxide production goes up, and therefore, your vessels dilate appropriately. Your blood vessels are not imprisoned anymore, and blood pressure started coming down. I said, I said, "This, this is amazing"-

   7. RCDr. Rangan Chatterjee21:40

      Yeah

   8. PJDr. Pradip Jamnadas21:40

      ... because for the first time in my life, I felt that the patients were doing something that was actually bringing their blood pressures down. I mean, we always tell patients who have high blood pressure, "Okay, avoid excessive salt and go do some exercises," and those are fine, because they also can improve nitric oxide production. But this was a very powerful one. When I brought that insulin levels down on these patients through fasting, blood pressures just plummeted, and I had to actually take patients off blood pressure medications.

   9. RCDr. Rangan Chatterjee22:05

      Yeah, yeah.

   10. PJDr. Pradip Jamnadas22:06

       So that was a huge thing that I found with insulin. So fasting seemed to me the, the best way to, to, to really make the patients' blood pressures come down, and I found that their weights came down. Now, the question is, why did the weight come down? Well, insulin, you know, bottom line for all your listeners, insulin just is a storage molecule.

   11. RCDr. Rangan Chatterjee22:29

       Yeah, yeah.

   12. PJDr. Pradip Jamnadas22:29

       Puts everything in storage. So when the insulin levels come down, the storage padlocks are taken off, so your fat can now be mobilized.

   13. RCDr. Rangan Chatterjee22:39

       Yeah.

   14. PJDr. Pradip Jamnadas22:39

       Now, there's, of course, I can go into all the enzymes that are involved and, and the, and the hormone-dependent lipase, et cetera, et cetera, et cetera. But the bottom line is when insulin levels come down, now your fat pads are available-

   15. RCDr. Rangan Chatterjee22:52

       Yeah, yeah

   16. PJDr. Pradip Jamnadas22:52

       ... for metabolism. And I found that the fats just started coming off the patients. And when I would look at these patients who would do the fasting program, I'd look at them, and they, they look great. It's not like their faces are all, you know, the, the excessive skin hanging off or they have skin hanging off their arms. No. Fasting patients seemed to lose weight in a more beautiful way. That they were actually losing fat, but they were also losing the s- right amount of skin as well.

   17. RCDr. Rangan Chatterjee23:24

       Yeah.

   18. PJDr. Pradip Jamnadas23:24

       Because, you see, prior to this, prior to this, I used to tell patients, "Okay, you're gonna cut your calories to only 850 calories a day, and you're gonna have, uh, four meals a day. Each one is gonna be this much." And the patients would come back, sure, they lost some weight. They would lo- lose a lot actually sometimes, but they would look terrible. They would look absolutely terrible. Their faces, their skin, and, and, and plus they were miserable because th-they just never en- they didn't feel good-

   19. RCDr. Rangan Chatterjee23:54

       Yeah, yeah

   20. PJDr. Pradip Jamnadas23:55

       ... eating small amounts of food frequently. This advice that we gave patients previously, that, "Hey, cut your calories down by eating four small meals a day or nibble throughout the day," totally wrong in clinical experience. They lost temporary weight. They all would put it back on again. Did it for years. I did it for 15 years, and I was sick and tired of it. They would come back miserable saying, "Doc, my, my life's miserable. I only eat this much, and I just feel terrible. I'm hungry all the time." And I look at them, they sure they even look miserable, and their skin was just so... So when patients were fasting, they would come back and- They were laughing. They were, they were so happy

   21. RCDr. Rangan Chatterjee24:38

       Yeah, yeah

   22. PJDr. Pradip Jamnadas24:38

       The mood was better. And I said, "Well, why is this guy's mood so good? He hasn't eaten for two days now." And he says, "Doc, my mood is better than it ever was before. I'm sleeping better as well." Uh, and he empowered himself. And I said, "No, wait, wait, this is psychological. He's just, you know, he was able to do it, so he's feeling good about himself." He says, "No, doc, I, I do feel good that I was able to do it, and, and I, I'm self-empowered." But also they felt better. And then of course, as I do the research, I see that there are many substances that are produced during fasting, and one of them is BDNF, which is a big word for brain-derived neurotrophic factor. And what that really basically means is, look, when you are fasting, does nature want you to just crawl into your, into your cave and fall asleep a- a- and just, just, just, just die? No. Nature wants you to go out there, find your kill or your, or your prey, or your, or your find your berries or something. So it actually makes your brain more alert, inju- rejuvenates your brain. A- and you actually, now there's data to show that you can actually grow new cells as well in prolonged fasting. So what happens is that you actually become more wide-eyed and bushy-tailed.

   23. RCDr. Rangan Chatterjee25:56

       Yeah, yeah.

   24. PJDr. Pradip Jamnadas25:57

       And that's what I saw with the patients, too, that they were, they, they were so happy when they walked into my office. They're walking to a cardiologist office laughing and joking. I says, "This is fantastic." So and then, so that's something. And then I found that their, their, their energy levels, they just not only felt better mentally a- and, and, and their mood was better, but they said that they moved around better. So I said, "What does that mean?" They said, "Well, look, my aches and pains went away." I said, "Come on." They said, "Yes. I only lost 15 pounds so far, but my joint pains are all gone." Now wait a second. Why is that? Why did the joint pains go away? You don't take off that much weight to take it off your knee. Well, there's inflammation. And I found that inflammation went down in these patients.

   25. RCDr. Rangan Chatterjee26:41

       Yeah, yeah.

   26. PJDr. Pradip Jamnadas26:41

       So I said, "Okay, so how do I measure inflammation?" So I looked at the CRP levels on these patients, and I found that the CRP is a blood test, and the, and your audience would know that is a test that we do to look for inflammation, micro inflammation in your blood vessels, and I found that they were coming down. Now you know how hard it was for me to bring these inflammatory markers down. I mean, you know, we give patients statins and, and that does bring down CRP, but I found that these patients who are fasting, the CRPs levels came down. And perhaps a lot of the inflammation in their joints was getting better because the inflammation went down. So I said, "Okay, that's fine. What else are you feeling?" They said, "Well, you know what? My, my stomach feels good, too." I said, "Wait a second. Come on, guys. I mean, you're fasting and how can this be happening to you?" They said, "Yeah, less bloating. Uh, my bowel movements are better. Um, I'm not getting so gassy, and I don't get that fatigue after eating. You know, I just, ugh, I just feel so down." Of course, they're not eating, but when they do eat, after the meal they feel so much better. So they are eating after, when they break the fast, but they're feeling better, their guts are better, their joints are better, their minds are better. I just said, "Oh, God, th- this is crazy. This is crazy." So that's what really [laughs]

   27. RCDr. Rangan Chatterjee28:01

       Yeah, yeah

   28. PJDr. Pradip Jamnadas28:01

       ... I got so excited about fasting, as you can tell. Uh, it just, it is amazing journey.

6. 28:06 – 32:18

   Freedom from hunger and regaining control

   1. RCDr. Rangan Chatterjee28:06

      Yeah, it's ... You know, what's incredible is hearing you talk about this with this incredible passion. You know, you have seen really, really sick patients. You've been inside their body. You're, you're obviously ... You know, there was, there was clearly a frustration at some point that, you know, why am I keep doing this with all these patients? They keep coming in. What else can I do? But what you're talking about with fasting, it's not giving more things to someone. Oh, you've got to add this into your life. You've got to take more medications, take more supplements, go, uh, and go to the gym more, right? 'Cause most of the things we advise, we're asking them to do more, add more things in. Actually, this is very, very simple at its core. We're asking them to do less. We're saying actually, don't cook. Um, we'll get, we'll get into the specifics, but I'm just saying sort of 30,000-foot view is it's kind of like, well, I'm gonna save you some money. You can eat less. I'm gonna save you some time. You don't have to cook. Uh, this is gonna help improve your sleep, your cognitive function. It, it's kind of, it's very interesting. It's something so simple that pretty much every religion has as part of its kind of culture and tradition, yet it's so alien to us in the way that we currently live, or as doctors, the way we currently practice, isn't it?

   2. PJDr. Pradip Jamnadas29:28

      A- absolutely, absolutely. And you know, on this journey, they find out something about themselves.

   3. RCDr. Rangan Chatterjee29:34

      Yeah, yeah.

   4. PJDr. Pradip Jamnadas29:34

      And I'm talking about what they find out. They find out that they are not the hunger, they are not the craving, that they are something ... I mean, I'm just gonna say in first terms, I am something beyond my hunger. I'm beyond my body. I'm beyond my habits. I've suddenly realized that I am in charge, that I don't have to have breakfast. If I'm not hungry, I don't have to have breakfast. And now doc tells me that's good for me. Lunch comes around, are you hungry? Or have you been a victim of just it's 1:00, so I have to eat? So when the patient suddenly realize that, gosh, I don't have to eat 'cause I'm not hungry. Of course, if you're not hungry. And now they're empowering themselves.

   5. RCDr. Rangan Chatterjee30:20

      Yeah, yeah.

   6. PJDr. Pradip Jamnadas30:20

      They realize that there's another part of themselves, a real inner am-ness, my, my awareness, the, the real me which is beyond my body, beyond my feelings, beyond my sensations, and I have control over it. Now- I found that that seems to empower patients more because you start them out first doing this, this, this, this dietary stuff. Okay, learn how to just skip meals. Then all of a sudden, it roller coasters and they themselves become so empowered. They say, "Whoa, whoa, whoa, whoa, what have you done?" He says, "Well, you know, Doc, you told me to fast. I haven't eaten for 48 hours." I said, "Yeah, but I didn't tell you, tell you 48 hours." So what I'm saying is that it empowers them even more-

   7. RCDr. Rangan Chatterjee31:03

      Yeah, yeah

   8. PJDr. Pradip Jamnadas31:03

      ... because they realize, yes, I have control. I've regained my control over my eating habits. I don't have to eat because it's, uh, 1:00 in the afternoon, I have to go downstairs to the cafeteria to eat. I don't have to do that if I'm not hungry. And when I am hungry, my ghrelin levels have gone up. They'll stay up for about an hour, Doc told me, and then it'll come right back down, and my hunger will be gone. So now I'm empowering myself that, yep, I can do it. I'm gonna wait it out for one hour. I drink a glass of water. Doc told me to drink a glass of water. And yeah, sure enough, my hunger went away. I moved on.

   9. RCDr. Rangan Chatterjee31:40

      Yeah, yeah.

   10. PJDr. Pradip Jamnadas31:40

       Doc told me to keep my mind busy, go and do your chores at 1:00, or do your shopping at 1:00, or pay your bills at 1:00, and your time will pass, and before you know it, you'll be back to work at 2:00, and you'll have n- no problems till the evening.

   11. RCDr. Rangan Chatterjee31:54

       Yeah, yeah.

   12. PJDr. Pradip Jamnadas31:54

       So I think that self-empowering the patients this way, they're taking control, and they're looking back, and they're getting positive feedback. Oh, yeah, I have regained control.

   13. RCDr. Rangan Chatterjee32:03

       Yeah, yeah.

   14. PJDr. Pradip Jamnadas32:04

       So, you know, because compliance is such a big problem. So when I did that, the compliance with medications also improved.

   15. RCDr. Rangan Chatterjee32:12

       Yeah, yeah.

   16. PJDr. Pradip Jamnadas32:12

       Because the patients just-- They, they, they, they took control.

   17. RCDr. Rangan Chatterjee32:15

       Yeah, yeah.

   18. PJDr. Pradip Jamnadas32:16

       They took control-

   19. RCDr. Rangan Chatterjee32:16

       It, it-

   20. PJDr. Pradip Jamnadas32:16

       ... giving back that control to the patients

7. 32:18 – 44:18

   Ketones, autophagy, stem cells and growth hormone

   1. RCDr. Rangan Chatterjee32:18

      Yeah. I mean, there's so many things to kind of follow up on there. You mentioned that actually when people fast, they often get more energy and more mental clarity, and this is very alien to, as you say, how most of us have been brought up, and I think kids are still being brought up that you have to eat regularly. And I give an example from my own life, which is my son is 11 years old currently, and every Saturday morning, we try and do something called Parkrun, which is a five-kilometer run in the local town. Now, just to be clear, I am not giving anyone medical advice with their children at the moment, so this doesn't get misinterpreted. But I know my son, I know his health well, I know what he's capable of, and we run at 9:00. And my son loves food, right? He loves food. But actually he's realized that actually he runs better and feels better when he runs at 9:00 if he doesn't eat. So he said, "Daddy, I don't want to eat today." I said, "No, no, if you don't want to eat, that's fine." Right? Which is not what I would've been told at that age. I can tell you it would've been, "No, you're gonna need to eat, so you've got energy for your run." So on a Saturday morning, he gets up, let's say, at 7:00. He'll probably have, you know-- I'll probably keep reminding him/nudging him to have two glasses of water. Um, but then we'll go and do a run together at 9:00. Let's say 9:00 till 9:30. Then we nip to the supermarket, we come back. And what I've started doing with him is I say to him, "Gentleman, how do you feel now? You know, you missed breakfast." And he'll say often, "Daddy, I actually feel really good. Like, I could think really clearly." So first of all, kids get this stuff, right? And I'm delighted that my son is actually, uh, showcasing some of the stuff that you are talking about at the age of 11. I tell you, I certainly was not. I was very much eat from the minute you get up, go downstairs, have your bowl of cereal, and still be eating last thing at night. Well, I remember just going to my room with big bowls of muesli and milk and just I was eating all the time. So that was one thing I wanted to say. Um, but the second thing I wanted to talk about was what you said about, "I am not the hunger." And I thought that was so powerful, Dr. Jamnadas, because I think many people these days have forgotten what real hunger is. And then if they ever experience hunger, it's like, "I need to eat now because I'm hungry." It's like, well, you could just sit with your hunger and see what happens. So just a couple of points there and, uh, yeah, I'd, I'd love you to share your sort of view on that.

   2. PJDr. Pradip Jamnadas34:49

      Absolutely. Now, the experience with your son is so empowering. So he's-- he and all of us have realized there's a, the, you know, that we are a hybrid engine, so you have your, your metabolism that's based on glucose, and everyone needs to understand that sugar and glucose, that, that is the, the ultimate, uh, currency that we use to produce, uh, ATP. But there's another currency in the body, and that currency is ketones. So when everything's put into storage and you've depleted the glycogen in your liver because you've been exercising now, then you need your fat stores. That's another source of energy. So when the fats kick in and your ketones start going up, you will feel different when the ketones are in your body. So that feeling of euphoria, that feeling that the patients feel empowered, and your son feels so good after running on an empty stomach, of course, partly because of endorphins that are produced-

   3. RCDr. Rangan Chatterjee35:43

      Sure, sure

   4. PJDr. Pradip Jamnadas35:43

      ... from the exercise, which is very good. But the other product is these ketones. We all make ketones. We are supposed to make ketones. The trouble is when we eat so frequently, you turn ketones off. We must all experience some degree of ketogenesis in our life. In our day to day, maybe at least two to three times a week, you should become significantly ketotic. That does not really mean that you need to fast for three days or four days. No. Look, when we cut down on the amount of carbohydrates, simple sugars, and we, we will go into ketogenesis sooner and sooner in a fast. So that's adaptation. You're adapting your metabolism. If you're eating a lot of carbs and sugars all the time, then stop eating, you will start producing ketones maybe at 24, 36 hours. But if you're already on a diet that cuts out processed foods, sugars, simple starches, all the refined products, now your body Will start making ketones at a much earlier state. So maybe by about 15, 16 hours or so, some people start making substantial amounts of ketones. Now, those ketones, when they are being used in your metabolism, you will experience what your son experienced, "I feel great, my exercise turns better, my thinking's better." So it's a different chemistry you're using in your body, and I think all of us, all of us need to go into some degree of ketone production because it has multiple other benefits to be in ketone production. And in ketone production, there's a whole new biochemistry that's going on in the body, which we need. Because one is anabolic, what putting on, on, on all the time. When you're in the ketosis, now the body's cleaning up and becoming efficient, so it's another metabolism that we need to engage, and we just don't engage enough of it. And now, on the fasting program is when I'm seeing that the reparative processes all kick in. Now, I'm gonna say this again, the reparative process in your body is kicking in at a higher level when you are doing your fasting. How do I say that? Oh, I tell you, blood pressure comes down, joints seem to get better, bowel symptoms seem to get better, patients look better. But now there's data showing that these patients live longer, less cancer as well, and we know about the chemistry that is induced, which one of them is called autophagy, where the cells actually recycle all the inner parts to become more efficient.

   5. RCDr. Rangan Chatterjee38:17

      Yeah, yeah.

   6. PJDr. Pradip Jamnadas38:17

      And mitochondria recycle as well, what's called mitophagy. So these autophagy and mitophagy, which is recycling your, your biochemistry of your cells, does not occur in a fed state.

   7. RCDr. Rangan Chatterjee38:33

      Yeah.

   8. PJDr. Pradip Jamnadas38:33

      It occurs much more when you're in a fasting state.

   9. RCDr. Rangan Chatterjee38:37

      Yeah, yeah.

   10. PJDr. Pradip Jamnadas38:37

       So we're supposed to have that. We're supposed to do it. That's what our whole life-

   11. RCDr. Rangan Chatterjee38:41

       Yeah, yeah

   12. PJDr. Pradip Jamnadas38:41

       ... cycle was supposed to be. Yeah.

   13. RCDr. Rangan Chatterjee38:44

       Yeah, it's, it's, it's interesting. As you speak, you remind me very much of a conversation I had with Dr. William Li, uh, very, very recently on the podcast, who's done a lot of research into comparing food as medicine compared to drugs. And, uh, Dr. Li talks about these, uh, defense systems that we have inside our body. He's got these five-- He talks about these five defense systems, and he talks about using food as medicine to support these defense systems. And, you know, there are things like, you know, inflammation, the immune system, the gut microbiome, uh, stem cells, DNA. And it's interesting, he talked about what particular foods have been shown to support those various defense processes. But also what you're talking about is the withdrawal of foods, uh, at prescribed set intervals also activates these natural defense processes that the body have got. And, and I find that really, really fascinating, that actually what we're trying to do is support the body's natural defenses. We're trying to support that body's own natural resilience that's there if we and modern life kind of gets out of the way. We're getting in the way and actually stopping this stuff from working, but what you're talking about is let's get out the way and we're gonna naturally kick all of these kind of different systems into gear.

   14. PJDr. Pradip Jamnadas40:13

       Yeah, yeah, yeah, so right. Now, Dr. Li, amazing.

   15. RCDr. Rangan Chatterjee40:16

       Yeah.

   16. PJDr. Pradip Jamnadas40:16

       So he talks about the foods that you want to, to, to, to consume to, to, to bring about these beneficial changes, right? And the mechanisms are, uh, immunity, of course, and stem cells, as you mentioned, and, and, and, uh, your m- gut microbiome, which we know now plays a huge role in your-

   17. RCDr. Rangan Chatterjee40:32

       Yeah, yeah

   18. PJDr. Pradip Jamnadas40:32

       ... day-to-day health. Now, fasting impacts on all of them.

   19. RCDr. Rangan Chatterjee40:36

       Yeah, exactly.

   20. PJDr. Pradip Jamnadas40:38

       Uh, uh, after you finish your fast and then when you have your meal, you get, you get stem cell mobilization. So after a fast, you're getting, you're getting more stem cells mobilized from your bone marrow. Now, what are stem cells? Stem cells will go into the circulation, go to the parts of the body, and they already have messages on them tagging them where to go, what to do. The body has immense internal signals, so these stem cells go exactly and hone in exactly where they need to go and create the new cells and repair the body, because maybe those cells that were senescent died. Maybe certain, uh, organs', uh, dysfunctional cells died, and these stem cells move in. And we know that. We know this is stem cell mobilization. It occurs with fasting. You talk about growth hormone. Growth hormone. You want to increase your growth hormone? Growth hormone, as you know, goes down after the age of 30, plummets, really goes down. Growth hormone is responsible for muscle building, and growth hormone production skyrockets when you're fasting because your body makes much more growth hormone. You, you, you-- More than taking shots. So if you exercise in a fasting state, you'll actually put on more muscle mass, which is what your son is gonna come back and tell you that, "Dad, I'm, I'm putting on more muscle in my fasting state when I exercise it then than if I exercise," and it's because of growth hormone. So there's another one. Immunity. Your immunity gets better when you're fasting. During your fast, your body m- is developing mechanisms to, to strengthen itself, and, and immunity does go up, and we know that, that certain foods can go do the same thing. But, but, but there you go. Now, imagine the power if we joined all this together. So eat the right foods, eat the foods to im- improve your immunity as well, and do the fasting as well. Uh, uh, this, this is just-- I think that the future is so exciting in this area where, where people like you and Dr. Li and others could come together, and we're gonna, we're gonna change things and say, "Look, we need to change what we're eating- We need to change the sourcing of our foods, and we need to broaden our outreach. Look up at the microbiome. I didn't even talk about the microbiome just now. So fasting does affect the microbiome.

   21. RCDr. Rangan Chatterjee42:54

       Yeah, yeah.

   22. PJDr. Pradip Jamnadas42:55

       It, it does. Uh, a- and when we know that that's a whole new area that's so dynamic and the, the, the, the life, the, the half-life of, of bacteria in the gut changes. Uh, so we know that when we're fasting, certain bacteria are gone, a- and we know that the types of foods that we eat affect our microbiome. Uh, but fasting itself also affects the microbiome.

   23. RCDr. Rangan Chatterjee43:15

       Yeah, yeah.

   24. PJDr. Pradip Jamnadas43:15

       So I love fasting because it, it does, uh, have positive effects on the microbiome, and we know that that's huge. I never believed about the microbiome stuff until about five years ago, but the data-

   25. RCDr. Rangan Chatterjee43:27

       Yeah, yeah

   26. PJDr. Pradip Jamnadas43:27

       ... now coming out is so compelling for me-

   27. RCDr. Rangan Chatterjee43:29

       Yeah, yeah

   28. PJDr. Pradip Jamnadas43:30

       ... uh, as a cardiologist. Um, [laughs] in fact, I just saw a patient yesterday, and I advised him that he needs to be eating pro- probiotic foods and fermented foods and, and he, he's like, "But Doc, I, I'm here for my, uh, my coronary calcium score, which was so high," you know? [laughs] So it's, it's just fascinating stuff.

   29. RCDr. Rangan Chatterjee43:49

       Yeah, it, it really is, and it's, it's again, it's that one thing, fasting, that's hitting so many different things, isn't it? It's reducing your insulin. It's encouraging autophagy. You know, we've not mentioned really apoptosis yet. It's encouraging apoptosis, stem cell production, growth hormone. So many different things are being activated, and actually, if we could get a drug to do any one of those, we'd be sort of shouting about it. But, but this one thing does all of them, which is, which is incredibly fascinating.

8. 44:18 – 49:59

   A graded fasting protocol: diet first, then skipping meals

   1. RCDr. Rangan Chatterjee44:18

      Look, I, I really wanna understand because, um, I, I wanna talk more about the science a bit later on in this conversation. But in terms of getting really practical for people, like if we, if we compare fasting to, let's say, movement, right? So people, if they wanna move more, they know they could start off with a 15-minute walk around the block. You know, they wanna do a bit more, they make it 30, 40 minutes around the block. Uh, then they might start jogging. Some people might wanna do a 5K or a 5K walk or even a run, a 10K. Some people wanna do a marathon, right? So there's different grades of movement, and so what are the different grades of fasting? You know, where can people start, you know, r- super, super simple? What are the benefits of that level? And then how can people progress up, depending on their state of health, depending on their goals? You know, I, I think that would be quite a useful way at looking at fasting and making it really practical for people.

   2. PJDr. Pradip Jamnadas45:17

      Uh, good, great question. So my general advice in my office, and, and all my nurse practitioners do the same thing with our patients, is look, the first thing you need to do is cut out all the sugars. Because if you go into a fasting with your regular diet pattern, you're gonna have a very nasty experience. You're gonna feel very hungry. You're gonna go through withdrawal from sugar. You're gonna f- feel terribly hungry, sweaty. You may even actually have worse symptoms. So the first thing we gotta do is look, just we explain to the patients that your body is not supposed to consume so much sugar. You know, we consume about, about more than 10 tea- 20 teaspoons of sugar a day in one form or the other. So the first thing I tell my patients is, "Look, you need to get rid of all artificial foods." Sugar is manufactured. Sugar is artificial. Sugar is a poison for the body. You need to cut out all sugar, all processed foods. Processed foods, anything that is made in a factory, anything that has a barcode on it is suspect. Anything that's been pulverized, anything that has been made into a powder, get rid of everything. You need to eat foods in their natural, whole form, and that's the first thing you do. So forget fasting right now. The first thing you're gonna do is just change your diet. I want you to eat whole foods. So I have a chart in my office that's an anti-inflammatory diet, and it contains all the whole foods. I said, "When you look at the food in your plate, you need to be able to recognize it. Yes, this is what this is. This is what this" And they say, "What about meat and chicken and fish?" I said, "No problem, as long as it is grass-finished meat, organic chicken, organic eggs, and you can have some, uh, some turkey, but you must have vegetables in their normal, natural state." And first thing you need to do is do that. So get rid of all the bread, all the bagels, pastries, all the things that are coming in a box, spaghetti included, pasta included. I said, "Look, right now, just get rid of all those things. I want you to eat a natural diet. So eat as much as you want, but of the right food, and I want you to do that for approximately two to three weeks. No fasting right now. No, no fasting right now." So that way, they get used to that idea-

   3. RCDr. Rangan Chatterjee47:33

      Yeah

   4. PJDr. Pradip Jamnadas47:34

      ... that I'm going to first just change my diet. And then after two to three weeks, then I bring them back inside and I say, "Okay, so now that you've been doing this, how do you feel?" They say, "Doc, I really do feel much better." Now I say, "Now you're gonna learn to skip meals. So step number two is skip meals. Wake up in the morning, I'm not hungry for breakfast. Skip it. Come around to lunch, have your lunch, have your dinner. Next day, uh, have breakfast, but skip your lunch. Um, the next day, skip your dinner. So learn to just skip meals. And look, you felt fine. Nothing bad happened. You were perhaps a little hungry. You got over it by drinking a glass of water. Drink lots of water during the daytime." So I do that for another two weeks or so. See? I'm doing it gradually, just like your athlete. You can't go do your 5K right now. You first need to build into it. So for a couple of weeks, I make them just skip meals randomly. Then I sit down with them and say, "Now, this week, five days a week, I want you to have only two meals, and these two meals are gonna be within six hours of each other so that you're gonna have 18 hours that you're not gonna eat at all and only drink water. No calories in those 18 hours whatsoever. You can have water, black tea, black coffee." But no calories whatsoever. And they say, "Oh, gosh, that's great." And they do that for about two weeks. So for two weeks, Monday to Friday, two meals within a six-hour window period. So they're 18 hours, they are fasting. They do that for two weeks. Weekends, I let them have fun because they're with their family, so I say, "You can have breakfast, you can have lunch, dinner, but no snacks in between." So most you're gonna have on weekends is three meals on the weekends. Then they do that for another two weeks, then I say, "Okay, now is when you're really gonna start your fasting. Monday, Wednesday, and Friday I want you to skip that second meal also. Now you're only gonna eat one meal on Monday, Wednesday, and Friday. That's it. The rest of the days during the week, you're gonna have your two meals. Weekends, you can still have your three meals." So I gradually get them into that, and most of the time patients are able to do it this way.

   5. RCDr. Rangan Chatterjee49:39

      Yeah, yeah.

   6. PJDr. Pradip Jamnadas49:39

      When I go then-- When I try to make them go to once-a-day eating or time-restricted feeding within a six-hour window from the get-go, um, my failure rate is much higher. So I make them do it gradually.

   7. RCDr. Rangan Chatterjee49:50

      Yeah, yeah.

   8. PJDr. Pradip Jamnadas49:51

      And then, then they self-empower themselves, and then eventually I come to a three-day water fast, which we can talk about-

   9. RCDr. Rangan Chatterjee49:57

      Yeah, yeah

   10. PJDr. Pradip Jamnadas49:57

       ... and the biochemistry of that.

   11. RCDr. Rangan Chatterjee49:59

       I mean,

9. 49:59 – 1:02:22

   Who it's for: coronary calcium scores and metabolic syndrome

   1. RCDr. Rangan Chatterjee49:59

      I love that. You know, I, I love chatting to fellow clinicians. Uh, I, I love chatting to researchers as well, I must be honest. But clinicians like yourself, you know, you've got the real-life experience, not just what does the laboratory study say, what happens in the lab. No, that you're dealing with real patients who are probably quite scared and, you know, that, that, that sort of protocol you just took us through, just to make it really clear for people, you know, what types of patients are you recommending this in? You're a cardiologist. Of course, you know, you practice in America. I don't know the exact differences on who gets referred to a cardiologist in America compared to here in the UK. So my guess would be that people are, you know, sick on some level. You know, they've, they've either got angina already, uh, maybe they've already got ischemic heart disease, maybe they have already had a heart attack. You know, you're obviously seeing those kinds of patients. But then we could take it one step further, which is that we know in America there was a recent study, wasn't there? Well, not that recent, a few years ago now, that showing that maybe over 80% of Americans are not in good metabolic health, which is really quite incredible. So I'm imagining pretty much all of your patients who come to see a cardiologist are already metabolically unhealthy, are already having a degree of insulin resistance, and therefore problems with their health and wellbeing. So, you know, maybe help us through that a little bit, because what I, what I wanna be really clear on, someone who feels that they're in good health, they're of, you know, a decent weight, they don't have any health problems, is that the approach that they should be doing as well? Or are you specifically talking about patients who are already a little bit sick?

   2. PJDr. Pradip Jamnadas51:44

      No, no, no, no. You're, you're sort of right. No. What I'm talking about here applies to just about everybody. In fact, it's more than 80%. I think it applies to more than 90% of the people. Now, of course, the cohort that I see in my office are patients who already have coronary artery disease-

   3. RCDr. Rangan Chatterjee52:01

      Yeah

   4. PJDr. Pradip Jamnadas52:01

      ... or they already have had a heart attack. So those patients are kind of easy for me, uh, to, to, to convince that, "Hey, listen, you already had a heart attack. Now, you want another one? Well, you already have had two stents, and when you're gonna get the third one. So you need to do this, and I'm gonna put you on this program." Okay, that's fine. But then there's another cohort of patients who come to me, and I do a coronary calcium score, and it's high. But they're asymptomatic, and they've passed their stress test. So let me just tell everybody who, who doesn't know about coronary calcium score, because this is so important, and I'll tell you why it really it's important. So it's a CT scan, low-level radiation of the heart, and it looks at the amount of calcium buildup in your coronary arteries. So it tells you you already have atherosclerosis. So there's no guessing that, oh yeah, you know, your cholesterol, your blood pressure, your weight, and therefore your risk of having a heart attack in the next 10 years is such and such, except I've gotta plug you into a formula. No. This is, do you have the disease? Yes or no? Do the scan. Yes, you have disease. Do the stress test. Pass my stress test. Why? Why did I pass my stress test when I've got calcium in my arteries? Well, you pass the stress test because your blockage in your artery caused by the calcium is less than 70%, 'cause it takes a blockage more than 70% to reduce the blood flow in it, and then you may have symptoms or you may pass-- I mean, fail your stress test.

   5. RCDr. Rangan Chatterjee53:26

      C- can we just back-- Can, can we just back it up a second for people? Like, what is ischemic heart disease? What is atherosclerosis? What is a stress test? Because I think there'll be some people listening who probably may not be familiar with those terms, and I think it would be quite useful to sort of set that foundation, if you don't mind.

   6. PJDr. Pradip Jamnadas53:43

      Yeah, yeah. They're very important. So atherosclerosis is the buildup of plaque in the walls of the arteries, and they occur everywhere, in your neck, in your brain, in your legs, but most importantly in your heart. So when the artery, the walls of the arteries develop calcium in them, it's atherosclerosis. You cannot get atherosclerosis without calcium. Actually, you can, but very little. Most of the time, there's a lot of calcium with it. So the calcium is a surrogate for the plaque buildup in the walls of the arteries, and that calcium buildup, the atherosclerosis, can cause two problems. It can narrow your artery down on the inside, so the pipe becomes narrowed, and therefore that causes ischemic heart disease. Ischemic heart disease, lack of circulation, lack of blood flow going down that artery. Therefore, the muscle is deprived of blood, and the patient may experience pressure, tightness, heaviness in the chest, particularly on exertion. That's called angina. So angina, chest pain, is because of lack of circulation due to the plaque- Which is picked up by the calcium and a positive stress test. Now, a positive stress test, stress test is where you exercise you or we use chemicals to simulate an exercise, and it can tell us the consequences, the consequences of the blockage. Is my blockage more than 70% or less than 70%? If it is more than 70, it may reduce the blood flow in the muscle, and we'll pick that up on the stress test. The stress test can be a nuclear stress test or an EKG stress test. But now, if your blockage is more than 70, you are more likely to experience chest pain and the effects of the lack of circulation in the heart muscle. And depending on the location of that blockage and how much muscle is getting the effects of the lack of circulation, your cardiologist may opt to either put you on medicines or, if you're having very bad symptoms, maybe even put a stent inside, which we can talk about. But what I really want to stress here is that you can have a blockage, atherosclerotic, calcium-laden blockage, that is less than 70%. You pass your stress test. You have no chest pain. And those are the patients that I'm seeing in my office now, because they're coming in, they're getting the coronary calcium score, which they would not have otherwise.

   7. RCDr. Rangan Chatterjee56:06

      Yeah. Yeah.

   8. PJDr. Pradip Jamnadas56:06

      'Cause you go to your primary care physician's office, and they say, "Oh, yeah, your stress test is good. Your cholesterol's fine. Your blood pressure's okay. Yeah, keep going." And the guy gets a heart attack within a year or two years, and say, "What happened to me?" Well, because you already had the plaque, you just didn't know it. So the coronary CT scan that we do, low level, looking for the calcium, picks up the calcium in the walls of the arteries and quantitates it on a score that goes from, like, zero to 4,000. Over 100 is significant. Between 100 and 400 is, is v- very significant. But over 400 is critical. That means you really have a lot of calcium in the walls of the arteries. So these are the patients who, coming in, they do the scan, and I see that they have all this calcium in the walls of it. Now, I turn around to them and say, "Did you know that you already have atherosclerosis? You already got it."

   9. RCDr. Rangan Chatterjee57:01

      Yeah.

   10. PJDr. Pradip Jamnadas57:01

       And we have studies that show that that coronary calcium is gonna predict whether you're gonna have a heart attack or a coronary event or a stroke or even total mortality more accurately than all the other blood tests put together. So now I say, "Now, do I have your attention? You already have..." You see, you've got to motivate the patient. And this is my, uh, this is my carrot. And I'm, "Look, you have atherosclerosis. Now I want you to do my program. Now I'm gonna look for some parameters on your blood test. I'm gonna see what's causing this calcium buildup." And the patient will say, "But I'm fine." I said, "Yeah, but you didn't just build this up. Something is making your coronary calcium build up, so let's find out what it is." So I do a CRAFT test. I do a full physical examination. I'll do tests, uh, advanced lipid panel. These are tests that I do in the office to see. And then I might even inquire into their gastrointestinal health. I'll do a whole evaluation to see why this patient's building up this atherosclerosis. And part of the treatment program is gonna be my fasting program, which I think is the number one program for this. So those patients, um, are very happily motivated because I show them the coronary calcium score. I say, "Look, look at your picture. This is it."

   11. RCDr. Rangan Chatterjee58:16

       Yeah. Yeah.

   12. PJDr. Pradip Jamnadas58:16

       "Check it out. You got this calcium." Another group of patients, they come in, the 80% that you're referring to have metabolic syndrome. So for the, for the sake of the audience, I'm just gonna tell everyone what metabolic syndrome is.

   13. RCDr. Rangan Chatterjee58:28

       Yeah, yeah. Thank you. Thank you.

   14. PJDr. Pradip Jamnadas58:29

       This is a, a derangement of your metabolism. And basically, it means that you're, you're overweight, your body mass index is greater than 25, um, and you have, uh, an increased abdominal girth. All the weight is around the belly. And there's actually a ratio that you can do between the waist and the belly. The belly is increased. And then the HDL, the cholesterol, is low, and the triglycerides are high. And, um, they have borderline high blood pressure. Now, when you look at all these numbers, what's the common theme that comes to mind from everything I've already said? It's insulin. It's all about in- insulin lowers your HDL, increases your triglycerides, increases your abdominal girth, because all the fat is down there. Remember what insulin does? Insulin puts all your calories, excess calories and frequent calories and, because of the high insulin levels, puts it where? Into the liver, pancreas, and visceral gut. And that fat is totally different from the fat that you put on all over your body when you overeat. When I overeat, just eating a lot of fats and, you know, okay, that's different. But the fats that are produced under the influence of insulin by the liver, de novo lipogenesis, the new fats that are created, the glucose has to be converted into a storage product. The storage product is that fat. That fat in the liver gets de- deposited in the liver, pancreas, visceral gut. It's very inflammatory. Its composition's totally different. You do a biopsy of it, you'll find inflammatory cells in it that are producing tons and tons of interleukin-6 and tumor necrosis. Bad stuff. So metabolic syndrome, although you have these basic features, when you do additional biochemistry on them, you will find that they have increased CRP level, which is a blood test for inflammation. And if you can do even further testing, you will find that they have very high interleukin-6 or tumor necrosis factors, and they have small, dense LDL particles, indicative of inflammation. So these patients come into the office for prevention, or they're sent to me because they have a low HDL. And, a- and these are the patients that also I'll do the, the p- uh, the, the fasting program. So some patients are motivated to go into my fasting program and lose the weight that way. 'Cause, see, the weight, by the way- I gotta tell everybody, the weight is a side effect of the metabolism that's gone wrong.

   15. RCDr. Rangan Chatterjee1:00:55

       Yeah, yeah.

   16. PJDr. Pradip Jamnadas1:00:56

       You fix the metabolism, the weight comes down as a side effect.

   17. RCDr. Rangan Chatterjee1:01:00

       Yeah, yeah.

   18. PJDr. Pradip Jamnadas1:01:01

       It's not really a weight loss program, [laughs] it's a metabolic program in which one of the side effects is that your weight comes back down to the way it's supposed to be.

   19. RCDr. Rangan Chatterjee1:01:09

       Yeah, yeah.

   20. PJDr. Pradip Jamnadas1:01:09

       It comes back to the way it was supposed to be. So, um, so these patients come in a- a- and, and they get referred to me, so I almost invariably do a coronary calcium score on them. But even if their coronary calcium score is not very high, the metabolic derangements are going to make coronary calcium in the future, and I motivate these patients to start making the lifestyle changes by showing them that their metabolism's off. Now, these metabolic tests are not being offered by every doctor's office and, and nobody, 'cause it takes a lot of effort.

   21. RCDr. Rangan Chatterjee1:01:38

       Yeah, yeah.

   22. PJDr. Pradip Jamnadas1:01:38

       And the insurance companies sometimes don't want to pay for it, like the advanced lipid panel. Um, sometimes they pay for it, sometimes they don't. So what I did in my office is I developed a program where it's a cash paying. If the insurance doesn't pay for it, okay, this is how much it's gonna cost you, but get the test done. It's a good investment, and I have to show them that it's-

   23. RCDr. Rangan Chatterjee1:01:57

       Yeah, yeah

   24. PJDr. Pradip Jamnadas1:01:57

       ... that it's gonna change their life.

   25. RCDr. Rangan Chatterjee1:01:59

       Yeah.

   26. PJDr. Pradip Jamnadas1:01:59

       So, but you're absolutely right, that this metabolic derangement is, is not 80%. It, it's probably more than that.

   27. RCDr. Rangan Chatterjee1:02:05

       Yeah, yeah.

   28. PJDr. Pradip Jamnadas1:02:06

       Uh, uh, and it's very... Because I'm seeing it in children. I mean, [laughs] I just the other day I saw a mother bring in her 16-year-old, and I'm like, you know. And I said, "You, I'm not a pediatric cardiologist, but there you go." Um, she had all the derangements already at the age of 16.

   29. RCDr. Rangan Chatterjee1:02:21

       Yeah. Th- this is-

   30. PJDr. Pradip Jamnadas1:02:22

       And it's, it's-
10. 1:02:22 – 1:08:30

    Motivating patients, compromises on diet and coming off medications

    1. RCDr. Rangan Chatterjee1:02:22

       this is so, it, it's so fascinating, and I think, you know, I, I think I've read a study where they're saying nowadays atherosclerosis starts in some children even under the age of 10, I believe you can see in some kids, which is, you know, you know, clearly no one wants to be hearing that. No parent wants that for their child. We don't really want that across society. What, what I find really interesting is the, the different groups of patients who come in to see you. You know, the proper ones who've already got established heart disease, and obviously, hopefully, a lot of them will be motivated to go, "Okay, Doc, tell me what to do, and I'll do it." But then you've also got some who are probably coming in for prevention. You know, what's the state of my heart? What's the state of my bloods? You know, is there anything I need to do? And the approach I can see is, is very similar. But you also, you know, you're, you're, you're sort of encouraging them to go all out and cut out all of the, uh, highly processed foods. You know, you're saying all breads, all pastas. Which for m-

    2. PJDr. Pradip Jamnadas1:03:27

       Absolutely

    3. RCDr. Rangan Chatterjee1:03:27

       ... which for many people is very difficult. Now, some people, in the UK at least, would call that quite extreme, okay? Um, now, I also have used that approach successfully with my patients, so I can, I've absolutely seen the value of that. But I think it's worth talking about that. Does everyone need to go to that extreme? And I know a lot of breads these days are highly processed. They've got about 10, 15 different ingredients in. They have a high glycemic index, they spike our blood sugar. Whereas I know some of the kind of German breads, uh, like the rye bread sometimes, and some of the, uh, like the, in the UK at least, the square-shaped German breads often can have a much lower, uh, sugar response. So I guess what I'm trying to get at is all patients presumably say, "Look, I'm gonna try it," but they can't do the whole thing the way you would ideally want them to. Um, you know, are there some common obstacles? Are there some sort of common compromises you have to make with people when they can't go the whole way?

    4. PJDr. Pradip Jamnadas1:04:28

       No, no, you're, you're absolutely right. I mean, if you gr- you grew up on toast and, and white bread, and it's gonna be very hard to do. So it just depends on, on their stats. Now, if they come in purely for prevention, they're not overweight, but they do have some family history, it might be difficult for me to convince them that-

    5. RCDr. Rangan Chatterjee1:04:44

       Yeah

    6. PJDr. Pradip Jamnadas1:04:44

       ... "Hey, listen, you need to cut out all the, all, all the bread." But clearly, if they're overweight, you know, it's, it's basically convincing the patient that, "Look, you're overweight. You, you have metabolic disease. Uh, I can see some parameters here on the blood tests, uh, or you already have coronary calcium in your arteries." And then explain to them the consequences of that. That it's not just that you're gonna get a heart attack. You're also at risk of getting dementia when you grow older. You're gonna get peripheral vascular disease. You're gonna get renal failure. Such a big link between kidney disease and heart disease. I said, "So take your pick. What, what, what do you want? What do you want?" And cancers. Obesity is also related to cancer. So sitting down in between my, myself and my staff, explaining to the patients that, hey, listen, this is not just about, about your heart, this is also about your whole life. This, this is a-

    7. RCDr. Rangan Chatterjee1:05:31

       Yeah, yeah

    8. PJDr. Pradip Jamnadas1:05:32

       ... a, a really a holistic approach. This is, this is gonna affect everything. This is gonna affect the way you're gonna retire, and what your retirement gonna be like, and are you gonna be aware of your own retirement, and are you gonna be able to think? Um, because Alzheimer's is going off the roof, too. I mean, we have a huge increase in the amount of dementia that's going on, and, and I'm one of those who believes that much of that is also vascular. It's all vascular. I think everything you do has all is your arteries, you know?

    9. RCDr. Rangan Chatterjee1:05:56

       Yeah, yeah.

    10. PJDr. Pradip Jamnadas1:05:56

        Um, uh, so, so what's your arterial age? Let, let, let's look at that. And so I think that making these dietary changes and cutting out the bread, uh, yes, you're absolutely right, is a difficult one to sell. Uh, but at least even if they cut down or move to pumpernickel bread or, or, or, or even sourdough bread is better, because at least it has, uh, some benefit on the microbiome. But at least make some compromises.

    11. RCDr. Rangan Chatterjee1:06:19

        Yeah, yeah.

    12. PJDr. Pradip Jamnadas1:06:19

        And start, start. At least do something. Um-

    13. RCDr. Rangan Chatterjee1:06:23

        Yeah, yeah

    14. PJDr. Pradip Jamnadas1:06:24

        ... and, and I think that that's, that, that, that's the key thing, is motivating the patient to think more long-term also, and not just think coronary artery disease. Everything that I tell the patients to do for their heart, I tell them straight up front, this is gonna keep your eyesight. This is gonna keep you from getting dementia, you know, renal disease. This is gonna help you from hopefully also decrease your risk of cancer, joint disease, back problems. I mean, name it. It, it, it, it really has so many ramifications. So yeah, so again, it comes down to what we said in, right in the beginning of this talk, that we have to motivate the patient.

    15. RCDr. Rangan Chatterjee1:06:55

        Yeah, yeah.

    16. PJDr. Pradip Jamnadas1:06:55

        I need to get into your brain- Make a change in you so that you know that this is the right thing to do, and then it resonates with you. Yes, this is right, and then see the practical results of it. And it's a slow process, gradual process, but, you know, we've, we've done this.

    17. RCDr. Rangan Chatterjee1:07:12

        Yeah. Yeah.

    18. PJDr. Pradip Jamnadas1:07:13

        We've gotten patients off blood pressure medication. We've got them off insulin. You, you know, the biggest achievements I've had in the last, uh, few years now is getting patients off insulin, and it makes me feel so good when I do that. And all through this program. They come in, and they're already taking 25 units of insulin twice a day-

    19. RCDr. Rangan Chatterjee1:07:29

        Yeah, yeah

    20. PJDr. Pradip Jamnadas1:07:29

        ... and now they're on nothing. And, and their A1Cs are so good.

    21. RCDr. Rangan Chatterjee1:07:33

        Yeah. You-

    22. PJDr. Pradip Jamnadas1:07:33

        And-

    23. RCDr. Rangan Chatterjee1:07:33

        You, you love it, and I bet the patients love it as well, don't they?

    24. PJDr. Pradip Jamnadas1:07:37

        Oh, gosh, c- coming off insulin, coming off blood pressure medications-

    25. RCDr. Rangan Chatterjee1:07:41

        Yeah, yeah

    26. PJDr. Pradip Jamnadas1:07:41

        ... um, coming off cholesterol medica- Do you know how many patients walk into my office and, and, and they're on tons of statins and, and I do a coronary study on them, and the score is zero. Score is zero. They have no coronary calcium, and they're taking all these statins and they're, and they're hobbling around with all these muscle aches and pains, and I'll just stop the statin. So that's another thing, you know, empowering patients to know that, you know, there's no one treatment for all. That, yes, your cholesterol level is a little high, and therefore you have to be on a statin. I try to individualize-

    27. RCDr. Rangan Chatterjee1:08:13

        Yeah, yeah

    28. PJDr. Pradip Jamnadas1:08:13

        ... the treatment for the patients based on, on, on what, what's doing to your body. You know, you have, you, you have a decent advanced lipid panel, and, uh, we can make some dietary changes here so that you don't get any f- more coronary calcium, but you don't have to be on a statin. Empowering the patients-

    29. RCDr. Rangan Chatterjee1:08:28

        Yeah, yeah

    30. PJDr. Pradip Jamnadas1:08:28

        ... to do that as well. Yeah.

11. 1:08:30 – 1:18:16

    Withdrawal, women, South Asian risk and individual obstacles

    1. RCDr. Rangan Chatterjee1:08:30

       What, what, what, uh, you know, thinking about your approach, uh, um, because I've been using similar approaches with my patients for a number of years now, and I think we see a different subset because I'm a general practitioner and you're a cardiologist. Of course, there's a huge crossover given how common type 2 diabetes is, how common metabolic syndrome is, and... But it's interesting. So you go, before you approach any form of fasting, you have a three-week period where you, you know, in inverted commas, try and clean up the diet. You try and reduce the processed foods that they're gonna consume, increase the whole natural foods, which is just gonna put them in a much better state for when you then bring in your 18-hour fast.

    2. PJDr. Pradip Jamnadas1:09:18

       Right.

    3. RCDr. Rangan Chatterjee1:09:18

       So, uh, which I, which is really interesting, I, I take quite a softly, softly approach, I guess. I always start with a 12-hour fast, which some people-

    4. PJDr. Pradip Jamnadas1:09:27

       Right

    5. RCDr. Rangan Chatterjee1:09:27

       ... wouldn't even call a fast. Um, but I think pretty much every human being should be able to go for 12 hours in every 24 hours without eating food. And if you can't currently, that's okay, but it would indicate that you are, you know, you have some sort of dysfunction, some metabolic dysfunction somewhere. Otherwise, you would be able to, 'cause some people, you know, say, "I really struggle with that." And I say, "Okay, it doesn't mean that that's not a good thing for you. It just means at the moment, your biochemistry and physiology is not able to support that, so let, let's, let's work on that and get you to a point where you can." And then, yeah, for the right patient, I also increase it up gradually. Um, so I find that super interesting as, as kind of just to notice a difference because there's no right or wrong, is there? There's just we're all trying to empower our patients, and we- we're all kind of biased, I guess, by our own experiences as to what we have found, uh, working with patients. So I found that really interesting. Also, are most of your patients men? And the reason I ask that is because, of course, heart disease, we hear a lot about killing men. Of course, it affects women as well. Um, but also there is this question mark that many people have over fasting as, okay, it kind of works for men, but maybe it's not so good for women. Um, I have my own view on that, but I, I wonder if you could share some of your thoughts on that.

    6. PJDr. Pradip Jamnadas1:10:51

       Yeah. So the first part was, uh, 12 hours versus 18 hours. Um, you know, there's two things that I'm concerned about when patients start, uh, fasting. One is the withdrawal, um, and I think that withdrawal is i- it comes in two shapes. Uh, there's mental withdrawal, that it's, uh, um, a Pavlovian reflex. I have to eat at 8:00 in the morning. I've done that for so many years. The other one is a true biochemical, um, addiction at the level of the brain. So that really concerns me. That, that's why I do this period to come in-

    7. RCDr. Rangan Chatterjee1:11:28

       Yeah, yeah

    8. PJDr. Pradip Jamnadas1:11:28

       ... because that gets them rid of the addiction, 'cause I think addiction is a real issue.

    9. RCDr. Rangan Chatterjee1:11:32

       Yeah, yeah.

    10. PJDr. Pradip Jamnadas1:11:33

        They're addicted Pavlovian-wise, but they're also biochemically in the brain, and some of them really do go through withdrawal symptoms. And they say, "You know, I felt terrible. I, I started sweating, and I had these intense cravings and, um..." And I said, "God, this sounds like heroin withdrawal." A- a- and I think it's real. Um, so that's why I do this, just skipping meals and gradually getting into it. But once-- How long does that take? That's the question. How long does that take? And in my experience, I've been doing this, it takes three weeks. At the end of three weeks, I can pretty confidently say that the patients have gone through their withdrawals-

    11. RCDr. Rangan Chatterjee1:12:10

        Yeah, yeah

    12. PJDr. Pradip Jamnadas1:12:10

        ... and they're gonna be now okay to take on the 18 hours, and that's why I do it that way. And the withdrawals are very real because the foods have addictive properties. Sugar is definitely addictive. We know that. We know dairy products have, um, casomorphin, um, which actually are addictive. So you crave those things that you, that, that, that doc has told you to, to, to skip the meals on and all that. But I think that after three weeks, they're done. And I tell patients, "It's not gonna be easy. For the first three weeks, you're gonna get a lot of cravings. You need social support. You need to structure your life. You need to do your shopping during the times that you're gonna be eating that meal otherwise, so you keep your mind busy, and, and you gotta get your seven hours of sleep, and so yeah." So w- the, the withdrawal issue is very important. That's why I do this gradual stuff. Uh, and then the answer to the second part, that women, uh, definitely, w- women are not exempt from CAD and heart disease. And, and, and something that, uh, applies to you and me is, uh, Asian women too. Did you know, did you know that the instance of coronary artery disease in Indian women is actually higher than Indian men? But it's just that they, they don't get diagnosed and, and they don't seem to complain that much, so they don't come to, to, to the doctor's office. But actually, I've seen worse coronary artery disease in Indian women in my office than in Indian men. And in Indians in general-

    13. RCDr. Rangan Chatterjee1:13:34

        Yeah

    14. PJDr. Pradip Jamnadas1:13:34

        ... they have far more coronary artery disease than Caucasians, so it's a huge problem. So I think that women are, are, are certainly a, a, a, a, a, a population that is not exempt from coronary artery disease. Now, the fasting programs in women, uh, there are some data to suggest that they may not benefit as much as, as men, but overall, I think that what I've seen is that th- they also seem to benefit just as much. Um, so I, I-

    15. RCDr. Rangan Chatterjee1:14:03

        Yeah. Yeah

    16. PJDr. Pradip Jamnadas1:14:03

        ... I don't make much distinction between men and women. They come in here, I work them up the same way. Um, I'm very aggressive with the women as well.

    17. RCDr. Rangan Chatterjee1:14:10

        Yeah, yeah.

    18. PJDr. Pradip Jamnadas1:14:11

        Especially, especially, uh, women from South Asia. Uh, the, the, when they walk in, they've got my antennas up. In fact, any South Asian that walks into my office, my antennas are up because-

    19. RCDr. Rangan Chatterjee1:14:21

        Yeah, yeah

    20. PJDr. Pradip Jamnadas1:14:22

        ... um, they are what I call TOFI's. You know, they're thin on the outside, they're fat on the inside and, and they're metabolically very deranged. And, uh, there are specific things that I-

    21. RCDr. Rangan Chatterjee1:14:32

        Yeah

    22. PJDr. Pradip Jamnadas1:14:32

        ... tell them about fasting and dietary recommendations for their diet. And, and the reasons, uh, have to do with, uh, vitamin K2 as well, which I'm finding absolutely fascinating these days.

    23. RCDr. Rangan Chatterjee1:14:44

        Yeah, yeah.

    24. PJDr. Pradip Jamnadas1:14:45

        So-

    25. RCDr. Rangan Chatterjee1:14:45

        Now, I pr- now, I, I very much appreciate that perspective. Thank you, first of all, for sharing that you're seeing lots of coronary artery disease, potentially worse in South Asian women than South Asian men. I don't think that is commonly known. I did not know that, and actually I'm now thinking of people and women in my family. I'm thinking, right, okay, maybe instead of thinking about the, the men, we need to start thinking about the women as well in terms of, you know, prevention, in terms of getting early screening done, blood tests, maybe, you know, coronary calcium score or, you know, whatever might be available to people. Um, my experience of fasting, in inverted commas, because fasting can mean so many different things to so many different people, is, yeah, I have seen some women with hormonal, uh, problems. Uh, I'm not talking about necessarily insulin hormonal problems. I'm talking more about kind of around the menopause, let's say, or estrogen, progesterone sort of imbalance issues. I found with some women, uh, it can be a bit challenging for fasting, and some women don't do so well, but I've also found many women who thrive on it. So I think a lot of the time people-- I've noticed this on social media a lot, people trying to, "Oh, it doesn't work for women." It's like, well, d- what do you mean 100% of women all the time? It's like, you know, and this is why I love talking to real-life clinicians. It's like, well, we see that not everything works for everyone all of the time, and we have to tweak our view depending on what we see. And, you know, when we make these kind of gross generalizations that, oh, fasting doesn't work for women, it's like, well, we put-- Like, let's say there's that subsection of women who, who, who thrive on fasting, well, they get put off. They think, "Oh, it's not for me." And it's kind of like, well, there's no one size fits all in anything. And as you see enough patients, you kind of realize that, that there's very few, although fasting might be one of them, I guess you might argue. But do you know what I mean? I kind of feel these days w- we get too polarized on these things and, and it, and it-- we, we just miss the kind of nuance, uh, that, that's actually there.

    26. PJDr. Pradip Jamnadas1:16:44

        No, no, you're absolutely right, and this is the new medicine. We're gonna become more individual. Okay, why is this lady not able to enter into my fasting program? She really needs to. Her BMI is 42-

    27. RCDr. Rangan Chatterjee1:16:55

        Mm-hmm

    28. PJDr. Pradip Jamnadas1:16:56

        ... and she has all this stuff going on. There may be other reasons. She may have so much stress in her life, you know? She may have financial problems that she can't buy the right kinds of foods that I want her to buy. She may be in a very dysfunctional relationships, and that may be causing so many problems for her. She may not be sleeping at night. A simple thing, she may have undiagnosed obstructive sleep apnea, which is why during the daytime she has so much fatigue, tiredness, and she's never gonna develop enough, uh, willpower to enter into my program until I get her a good night's sleep. So maybe put a CPAP on her for the time being and then see that, oh, yeah, now she can abide by the, the principles of the fasting. So, you know, it just means looking deeper into the p- why weren't you able to do this? There, there are, there are obvious factors why you cannot.

    29. RCDr. Rangan Chatterjee1:17:41

        Yeah, yeah.

    30. PJDr. Pradip Jamnadas1:17:41

        Where's your willpower? Why aren- don't you have the willpower? Let's look into this. And, you know, we don't always find the answers to everything-
12. 1:18:16 – 1:26:08

    Longer fasts: 24, 36 hours and the three-day water fast

    1. RCDr. Rangan Chatterjee1:18:16

       So back to, back to the kind of therapeutic use of fasting. So you do this kind of three-week program where they unprocess their diet. Then you put them on this kind of 18-hour fast, so they're having two meals a day over six hours, and then for 18 hours, they're not consuming anything. Sorry to interrupt. If you are enjoying this content, there's loads more just like it on my channel, so please do take a moment to press Subscribe, hit the notification bell, and now back to the conversation. Uh, we must talk about any contraindications like insulin or blood sugar medications at some point, just to make sure that, you know, people who are listening who want to try stuff, that we've, we've covered that. But also, I want to go a bit further because I know you have used 24-hour fasting with patients. I know you have used three-day fasts, and you have also shared in previous conversations some very powerful statistics. One in particular, I remember, on a seven-day fast, you shared a statistic, a bit of research from Boston, in terms of what that does to your lifetime cancer risk. So maybe you could talk about some of these longer fasts, and then practically, how do people start going about that?

    2. PJDr. Pradip Jamnadas1:19:27

       Yes, yes. So absolutely. So at all times, they are supposed to take their blood pressures twice a day, make sure that, uh, the blood pressure not going down too, because I do not stop the blood pressure medications-

    3. RCDr. Rangan Chatterjee1:19:37

       Okay, okay

    4. PJDr. Pradip Jamnadas1:19:38

       ... right off the bat. So on- the blood pressure medication reduction will be done, uh, depending on your blood pressure readings. As far as blood sugar is concerned, if they are on oral agents, I'll continue those oral agents while they're doing the 18-hour fast periods. Even the 24-hour fast, I'll keep them on it, and I will ask them to monitor their blood sugars. Now, continuous glucose monitoring, the, the, the, the little, uh, devices, I only advise those on, on patients who are on insulin-

    5. RCDr. Rangan Chatterjee1:20:07

       Right, right

    6. PJDr. Pradip Jamnadas1:20:07

       ... when I'm fasting them, because I wanna make sure that their insulins don't drop off. But when a patient is taking insulin and he does the 24-hour fasts, I drop the insulin levels by half first, I mean, insulin dosage by half, and I monitor their blood sugars, and then when they go beyond 24-hour fasts, I stop insulin completely.

    7. RCDr. Rangan Chatterjee1:20:29

       Yeah, yeah.

    8. PJDr. Pradip Jamnadas1:20:29

       Completely, completely. I stop it completely, because I don't want them to become hypoglycemic. So oral agents, I will continue. Insulin, I will discontinue if I'm doing more than 24 hours, but I monitor their blood sugars very closely. And then that brings me to a little longer fast. Before I go to, uh, longer fasts, I make them do a 36-hour fast. So I'll make them do that once a week. Once a week means that evening rolls around, skip that meal also, and then have yourself a breakfast. Treat yourself with a breakfast the next day. And that brings it to 36 hours. So I make them do at least one 36-hour fast for maybe, you know, two consecutive weeks, and then I'll take them to higher levels.

    9. RCDr. Rangan Chatterjee1:21:14

       Can I just clar-

    10. PJDr. Pradip Jamnadas1:21:15

        I-

    11. RCDr. Rangan Chatterjee1:21:15

        C- can I just clarify that? So the 36-hour fast, the way you have found it most beneficial for most of your patients is what, you skip one evening meal to the next evening meal? What, how, when, when does that fasting time-- I know you can do it any way you want, but what have you found to work? Can we just clarify that?

    12. PJDr. Pradip Jamnadas1:21:33

        Yeah. So the patients already are used to having only one meal a day.

    13. RCDr. Rangan Chatterjee1:21:36

        Okay, okay.

    14. PJDr. Pradip Jamnadas1:21:37

        So then I'll say, "Skip that one meal, and then have the next meal when you're supposed to have, then that'll bring you to 36 hours." So for most patients these days, they're having their evening meals because it's more social, they're having it with families.

    15. RCDr. Rangan Chatterjee1:21:48

        Okay, okay.

    16. PJDr. Pradip Jamnadas1:21:49

        So they'll skip breakfast, they'll skip lunch. Evening comes around, they're supposed to eat, and I tell them, "Skip it and go and have breakfast the next day." That brings them to 36 hours.

    17. RCDr. Rangan Chatterjee1:21:58

        I guess if they're already used to having one meal a day, then actually skipping that evening meal is kind of, I don't know, just go to-

    18. PJDr. Pradip Jamnadas1:22:08

        Yeah

    19. RCDr. Rangan Chatterjee1:22:08

        ... go to bed early as well, you know. [chuckles] But sort of, you know, uh, it's... Yeah, I like that. So what stage do you take them from this two meal a day, which is this, uh, you know, this six-hour eating window. You know, you, you do that initially for the 18-hour fast, then you take them to 24 hours, do you, with just one meal a day? Is that how you do it?

    20. PJDr. Pradip Jamnadas1:22:26

        That's exactly how I do it. And then they're doing one meal a day, five days a week.

    21. RCDr. Rangan Chatterjee1:22:31

        Mm.

    22. PJDr. Pradip Jamnadas1:22:31

        Weekends, they're gonna have two meals. They do that for two weeks. And then I say, "Okay, you've been doing this for two weeks now. You've been having only one meal a day. Next few weeks, one day a week, you're gonna go to 36. And the way you're gonna do it is you're gonna skip that one meal also and then have a breakfast the next day. So that'll bring you to th- and I wanna see how you feel." And most of them come back saying, "I just missed the meal in the evening, I watched a movie and went to bed." So why am I going from 24 to 36? Because I want to get them ready for longer fasts, especially if they're tremendously overweight and they're metabolically deranged. What's the biochemical advantage between 24 and 36? At, by 36 hours, almost all of them will be in some degree of ketogenesis. So it's hard to know who's gonna start spilling ketones at 18 hours, 24 hours, 30 or 32 hours. It's hard to know that. So when I prime them, [clears throat] then I'm finding that there's longer and longer periods of ketogenesis. That means they go into ketone production at 16 hours. So long as they made their dietary changes, gradually got into this, the ketogenesis phase starts a little bit sooner, at about 16 hours. And the most motivated patients say that, "Oh, I wanna know." I said, "Okay, if you wanna know, then go to the pharmacy and pick up some keto sticks and just test your urine and tell me when you started spilling the ketones." So after 24-hour fast, almost all of them are spilling ketones. And when they're spilling ketones, I know what's going on with their physiology at that point. I know that they're getting the benefits of some degree of autophagy, growth hormone, um, uh, BDNF production and mitophagy. I know that's happening because they- they're spilling ketones. So spilling ketones, so that's another motivating thing. In the patient who's showing me the interest and the ones I really want them to be, yes, give them the tool. Take this home. Check your ketones. That's what I find so fascinating. So by 36 hours, they're making the ketones. So they'll do that for a couple of weeks, where they now went to 36-hour fasts once a week for two weeks. Now, at that point, depending on how motivated they feel and how well they are doing, now I'll go to more prolonged fasts. And my favorite fast is the three-day water fast. And, uh, most of the-- I'm telling you, greater than 95% of them, when they've graduated to this point, where they've gradually gone and done all this, they're able to do the three-day water fast with no difficulty whatsoever. And if they get cramps, then I tell them, "Okay, take a glass of water and put a pinch of salt in it and just, just down it and you'll feel better." But most of them don't because they've adapted themselves. If you go into a three-day water fast too quickly, you're gonna get more cramps, but more importantly, you're gonna go through what is known as keto flu, and you just feel terrible and achy, and you just feel- Really bad. So I do it gradually. But I must make them go to a three-day water fast. I use it in that case. I also use it in patients who are able to lose weight, but then they reach a plateau. So now they're weighing 230 pounds, and I want them to have more weight loss, so they've been doing this now for a month, and they said, "Look, Doc, I just can't shed any more weight now. I've done everything you're saying," and I'll put them on a three-day water fast, and lo and behold, they'll start losing weight again. So I use that in patients who have reached a plateau, going to the three-day water fast.

13. 1:26:08 – 1:30:25

    Eating disorders and overdoing fasting

    1. RCDr. Rangan Chatterjee1:26:08

       Thank you for sharing that. I think something I did want to bring up today, um, because I know a lot of people, and again, we're, we're all influenced by the online world or the patients that we've seen or the online world that we inhabit, and, you know, I spoke to David Sinclair, uh, this Harvard professor who talks about aging in a very, very profound and novel way, and, you know, when I put out that episode with David, a lot of people were saying, look, asking people to skip meals, uh, is very triggering for people with eating disorders. And I know eating disorders are on the rise, uh, massively all over the world, certainly here in the UK and in, and in America. So I think we need to be careful about that. Uh, I think it's worth me, uh, just flagging that here, that potentially this advice is not for people with eating disorders. That's a sort of separate issue. Well, I'd welcome your perspective on that. Um, but also, you know, is it possible that we take these things to extremes? I guess there would be some people, we mentioned Anna Lembke's book before, Dopamine Nation, and, um, that we're all, we're living in a world of addicts now, and that, you know, she mentions that the smartphone is the modern-day hypodermic needle, which I thought was a very provocative way, but, but I, I actually completely agree with her of talking about it. There's health, there's physical biochemical health, but there's also this kind of emotional health and our mental wellbeing. Do you think, as much as you love fasting, do you think some people, they can sort of overdo it and get so addicted to kind of that feeling of fasting and actually go to an extreme which potentially could become problematic?

    2. PJDr. Pradip Jamnadas1:28:00

       I think you're right. It can happen. Fortunately, I haven't seen it here with somebody. I tell them, "Stop now. Stop, stop. This is enough."

    3. RCDr. Rangan Chatterjee1:28:06

       Yeah, yeah.

    4. PJDr. Pradip Jamnadas1:28:06

       "Now you should be eating two meals a day, and, you know, I think that the pattern you need to settle down in is, for you, I think that two meals a day in a six or eight-hour window period may be a nice thing for you to do chronically to maintain what you've gain- uh, the benefits that you've already gained." Um, then I haven't seen any patients who ignored that and continued to do the-

    5. RCDr. Rangan Chatterjee1:28:30

       Right, right

    6. PJDr. Pradip Jamnadas1:28:30

       ... three-day water fast on a, on a weekly basis or whatever, or two weekly basis. I haven't seen that. But, but, but you are absolutely right that there are some patients who clearly have an eating disorder, and they clearly have a type of addiction, a- and they're going up at night, and they, and they, they creep downstairs, and they're eating away five bars of chocolates and all this kinds of stuff, and those patients clearly do need help, and I will not-

    7. RCDr. Rangan Chatterjee1:28:51

       Yeah, yeah

    8. PJDr. Pradip Jamnadas1:28:51

       ... deal with those on my own.

    9. RCDr. Rangan Chatterjee1:28:53

       Yeah, yeah.

    10. PJDr. Pradip Jamnadas1:28:53

        I will supervise it, but I'll send them to a psychologist that actually specializes in addictions, because they have to really spend time with that patient about addiction behavior, and it's not just behavior about the food. There may be other issues that are actually triggering, um, 'cause see, you, you slide from one addiction to the other-

    11. RCDr. Rangan Chatterjee1:29:10

        Yeah, yeah

    12. PJDr. Pradip Jamnadas1:29:10

        ... to the other, to the other. So, so you can't take up this alone on its own until you also take care, take care of the sugar and maybe the, the cell phone and, and other digital gadgets that gives you-

    13. RCDr. Rangan Chatterjee1:29:19

        Yeah, yeah

    14. PJDr. Pradip Jamnadas1:29:19

        ... the instant gratifications and, and there may be even be other issues. He may be a gambler for, you know, or have-

    15. RCDr. Rangan Chatterjee1:29:25

        Yeah, yeah

    16. PJDr. Pradip Jamnadas1:29:25

        ... other type of s- uh, deviant behavior addictions. So no, you're absolutely right. So recognizing those with the biggest problems, and addiction is a huge problem.

    17. RCDr. Rangan Chatterjee1:29:36

        Yeah.

    18. PJDr. Pradip Jamnadas1:29:36

        And it's becoming more, more known now that, uh, the addiction is to not only sugar, but it's also addicted, uh, to, to, to processed food content.

    19. RCDr. Rangan Chatterjee1:29:46

        Yeah, yeah.

    20. PJDr. Pradip Jamnadas1:29:46

        Processed foods and the content of processed foods, um, are very addictive.

    21. RCDr. Rangan Chatterjee1:29:52

        Yeah, for sure, for sure.

    22. PJDr. Pradip Jamnadas1:29:52

        And I think that that's why you wanna change the, the type of food that you... So you're getting rid of all the addictive substances in the food, the addictive sugar in the food, and then addictive behaviors in other aspects of your life as well.

    23. RCDr. Rangan Chatterjee1:30:05

        Yeah, yeah.

    24. PJDr. Pradip Jamnadas1:30:05

        So, so it's, it's really looking at the whole thing. Uh, it's, it's a, it's a huge problem. It's a huge problem. And yes, we, we are an addicted nation. Um-

    25. RCDr. Rangan Chatterjee1:30:12

        Yeah, yeah

    26. PJDr. Pradip Jamnadas1:30:13

        ... we, we, we... And that's why it's making it so easier for us to become addicted to food later on in life, 'cause it starts at a very young age.

    27. RCDr. Rangan Chatterjee1:30:20

        Yeah, yeah. No, no.

    28. PJDr. Pradip Jamnadas1:30:20

        When you're already getting addicted to gadgets, um, and instant gratification.

14. 1:30:25 – 1:36:11

    Fasting as a unifier across diets

    1. RCDr. Rangan Chatterjee1:30:25

       I wanna move on to the mental benefits shortly of fasting, 'cause I think there's a real, uh, important piece there that we touched on a couple of times in the conversation already. Before I do, w- I sort of feel that, that there's so much, um, divisiveness and, um, you know, frankly, fighting about different diets that I think sometimes gets so unhelpful for the general public. Um, they see doctors who they admire saying, "This diet has got this evidence. This is really good," and they see another doctor who they admire say, "This diet's really good, and it has all this evidence." And I think, and I know this from talking to patients and talking to the public, that many people find this incredibly confusing. I, I really like fasting for the right person and the right state of health. I kind of see it as the great unifier in many ways, because as long as you are metabolically able to do that fast, you know, whether you choose to eat meat and fish or whether you choose to be vegan, if you are whole food primarily and not having, uh, much processed food at all in your diet- Then you're still gonna get benefits from fasting, right? Whether you're low carb [laughs] or whether you're vegan. And, you know, it's interesting, that video that you did on fasting, Fasting for Survival, on YouTube, which has, you know, had millions of views, I was reading through the comments just before this conversation, Dr. Jamnadas, and the top comment was, really, I think encompasses everything that you stand for. He, I think, said he was mostly plant-based, and he started off following your advice with a whole food, mostly plant-based diet. I think he started off with 18-hour fasts. He moved up to 24-hour ones. I can't quite remember. Then he moved to maybe one three-day one every six months, and he's documented his health journey over two years, and it is utterly remarkable that you put out a video on YouTube, and you have completely empowered that guy to transform his life. So first of all, just I want to acknowledge you for that. That's just one of millions of people who've seen that video and changed their lives, so that's just incredible work that you're doing. [lip smack] But what do you think about this concept that fasting could be the great unifier? No matter what tribe you belong to, you can still get involved with fasting, and yield, and, and, and reap many of those benefits.

    2. PJDr. Pradip Jamnadas1:32:58

       Yeah. You're absolutely right. Um, the various dietary programs that have come out have confused the public. It's confused the physicians as well.

    3. RCDr. Rangan Chatterjee1:33:06

       Yeah, yeah.

    4. PJDr. Pradip Jamnadas1:33:06

       I mean, my patients come in and say that, "I'm following this diet, that diet, and nothing happened, and this one's too hard for me, and, a- and this one's too restrictive for me, and it doesn't fit with my lifestyle." I understand that. I understand that. Fasting forgives you. Fasting, in a sense, forgives you for certain foods that, that you may then consume. And actually, think about it this way also. You eat that slice of bread after a fast, your insulin response is totally different in the fasting state than in a fed state.

    5. RCDr. Rangan Chatterjee1:33:38

       Mm-hmm. Mm-hmm.

    6. PJDr. Pradip Jamnadas1:33:38

       You're gonna make less insulin for the same slice of bread in a fasting state. So it's l- And the c- the, the, the type of food that they consume. So when I first started out, I was, years and years and years ago, I would, I would say, "Oh, you gotta be a vegetarian. You got, you gotta drop all meats." And being in United States, how many patients are gonna become vegetarian, right? So, and then as the data came out and I started studying more and more, I changed.

    7. RCDr. Rangan Chatterjee1:34:06

       Yeah. Yeah.

    8. PJDr. Pradip Jamnadas1:34:06

       I decided that, hey, th- there's something wrong with this. You know? People should be able to eat ancestral foods and what they grew up with. Uh, uh, uh, but the problem was processed foods. Then we take the foods and we process them, we change them, and all the additives that we put into, and the way we grow our food or way we, we, we, we get our meats has changed. So I said, "No, no, no, no, this is not right." When I studied non-vegetarian diets, um, around the world, how come they had this low instance of heart disease? There are populations that eat only meat and only drink milk and, and blood, or, or, or the populations that only eat starches and a lot of it, and they also live long.

    9. RCDr. Rangan Chatterjee1:34:54

       Yeah, yeah, yeah.

    10. PJDr. Pradip Jamnadas1:34:54

        What's the commonality? What was the commonality in all of them? The commonality was no processed foods, no additives, right? No- no sugar. So they, they, they all had simple diets. So then I came up with my own plan, and I said, "Listen, you, you, what do you like to eat? What do you like to eat? So you want to only eat red meat? Okay, then eat grass-finished meat, because that'll have-

    11. RCDr. Rangan Chatterjee1:35:16

        Yeah, yeah

    12. PJDr. Pradip Jamnadas1:35:16

        ... more nutrients in it. The fats will be the right kind of fats. You will not have all those omega-6s in there. You, you, you'll have more natural fats in there."

    13. RCDr. Rangan Chatterjee1:35:23

        Yeah, yeah.

    14. PJDr. Pradip Jamnadas1:35:23

        "And if you want to eat eggs, chicken, pi-" So I let them do that, and I said, "But you got to also introduce plants in your diet because you need the plants, not for you. Yeah, and you're gonna get some, some water-soluble, uh, vitamins, et cetera, et cetera, into your system when you eat plants and all, but it's really for your gut bacteria." So again, I had to read a lot about the microbiome to understand that the fiber is hugely important, very important.

    15. RCDr. Rangan Chatterjee1:35:49

        Yeah, yeah.

    16. PJDr. Pradip Jamnadas1:35:49

        And, and, so I tell them, "Eat your vegetables as well." So this is my diet plan.

    17. RCDr. Rangan Chatterjee1:35:53

        Yeah, yeah.

    18. PJDr. Pradip Jamnadas1:35:54

        It's not so restrictive. Just stay away from anything that your great-great-grandfather wouldn't eat, and no processed foods. Anything in a packet, box, barcode. Stay away from anything made into a flour, and that's been a hard one, the flour one.

    19. RCDr. Rangan Chatterjee1:36:07

        Yeah.

    20. PJDr. Pradip Jamnadas1:36:07

        Um, also in South Asia-

    21. RCDr. Rangan Chatterjee1:36:08

        It's everywhere

    22. PJDr. Pradip Jamnadas1:36:09

        ... it's a huge, huge, huge problem.

15. 1:36:11 – 1:47:28

    Freedom, identity, meditation and top tips

    1. RCDr. Rangan Chatterjee1:36:11

       I, I, I love this, um, [lip smack] you know, I'm, I'm so enjoying speaking to you. There's a real kind of, there's, there's just a beautiful energy, but there's also this kind of real-life practicalness that you know what it's like when these patients come in, and you've got in your head the ideal thing, but y- you gotta work with people and their tastes and their preferences and their culture and what they want. And I really do strongly feel that too many people these days on social media commentate. They look at the science and go, "Oh, this is what everyone needs to do." It's like, that's just not how it works in real life, in my experience. You know, people are different. They've got different desires. They've got different cultures, different preferences. So I really like that. You've mentioned all the kind of physical benefits, the biochemical benefits when we have a period of not taking in food, a period of fasting. But there's also something really powerful, isn't there? Like you have touched on several times, about what it does for you when you know, oh, I can go 12 hours without food. I can go 18 hours. Wow, oh, actually, I can go 24 hours, and I don't actually need to put something in my mouth. I think we shouldn't undervalue just what that does for someone. You know, I think it's freedom. It's freedom from a dependency on foods, addictive foods, processed foods, sugar. It means that you can go about, you're out on the train station or the airport, and there's no good food to have. Cool, just don't eat. Take the flight, don't eat. It- there's a real freedom which many people feel that they are ch- they're in chains, I guess, to the food industry and to their, their hunger and their stomach. So, you know, can you speak a little bit about that and why you feel that's so important?

    2. PJDr. Pradip Jamnadas1:38:00

       Yeah. I, I love the w- the fact that you used that word freedom because, you know, I said, okay, it empowers the patient, but it is a real freedom. It's a freedom that, that they know that what their behavior resulted in no adverse effect, and that they were able to overcome this which they never thought they could overcome. So these little hurdles that they're overcoming in their diet actually has r- huge repercussions in other aspects of their life. And really, honestly, it, it percolates into their, into their workplace, into their family life, um, in, in their social interactions, uh, with their friends. Um, and I've seen that these people, they just, they just become more, more, uh, self-confident. Um, and, and I think it's because w- we introduce terms to them like, "That's who you are, the real you." So it opens up a new aspect of their existence, that there is a part of me that's separate and apart from my body and from my mind and my cravings and my stomach and my feelings and, and all these things, and that's the real me. And of course, you know, th- this gets into some of that part that I have a huge interest in, which is, who are you?

    3. RCDr. Rangan Chatterjee1:39:20

       Yeah, yeah.

    4. PJDr. Pradip Jamnadas1:39:21

       What w- you know, who are you really? Um, where is the you? Uh, and why can't you, that, that you change, uh, your behavior? Of course you can't, because you need to change your identification. So this is an identification change that I see the patients doing.

    5. RCDr. Rangan Chatterjee1:39:40

       Yeah, yeah.

    6. PJDr. Pradip Jamnadas1:39:40

       They realize that they are in charge, that, that, that them, inside them, not the body, not the mind, there's actually an awareness, an am-ness, an I am, and that is huge, huge. And I've found that people who have done this program over the last few years, they actually get work promotions. They actually become better supervisors. They become, uh, just better family, uh, members a- a- and caregivers. Um, and it's miraculous-

    7. RCDr. Rangan Chatterjee1:40:08

       Yeah, yeah

    8. PJDr. Pradip Jamnadas1:40:08

       ... how one thing ... Because it's, it's showing them that, yes, you are in charge. Look, you can do it. You can do it. And they just self-empower themselves. It feels so good. Self-confidence just goes off the roof. And I think that, that, that, that there's a ... You know, I'm learning more about this. Um, but, but, but I think it does boil down to, to ... Because that also brings me to stress management because one of the things we do tell our patients is that y- you, if you start getting stressed out during all this, these periods where you're getting into the fasting period, you need to go out and do some, some meditation, we tell them, and we show them how to meditate. And I have a very simple meditation technique where I just basically ask the patients to, okay, just, uh, close your eyes and just concentrate on your breathing only. And when a thought comes, let the thought go. Don't follow up on it, because then another thought will come in a few minutes. Don't follow up on it. Wait. Just come back to your breathing. Concentrate on your breathing as the breath goes in and out, and you will find that there'll be gaps in between your thoughts that get longer and longer and longer. And my patients have all said, "Yes, you're absolutely right. There's blankness." I said, "Well, that blankness when you don't have a thought or when you're not, you know, thinking of something, that's you. That's the real you."

    9. RCDr. Rangan Chatterjee1:41:28

       Yeah, yeah.

    10. PJDr. Pradip Jamnadas1:41:28

        And when you come out of this for 15, 20 minutes, you will realize that there is that you in you, and you can make up your mind about anything. You can, you can do anything. It'll empower you-

    11. RCDr. Rangan Chatterjee1:41:39

        Yeah, yeah

    12. PJDr. Pradip Jamnadas1:41:39

        ... and you'll feel less stressed out. You'll feel less compelled. You're less automatic. You will be ... Y- you, you will become, as you said, that word that you used, you'll have freedom. You'll have freedom.

    13. RCDr. Rangan Chatterjee1:41:50

        Yeah, yeah.

    14. PJDr. Pradip Jamnadas1:41:50

        And I find that fascinating.

    15. RCDr. Rangan Chatterjee1:41:52

        Yeah.

    16. PJDr. Pradip Jamnadas1:41:52

        So you see, th- this whole thing, I, th- th- I said this in the beginning that, you know, fasting seems to open up those, that onion into all different-

    17. RCDr. Rangan Chatterjee1:42:00

        Yeah, yeah

    18. PJDr. Pradip Jamnadas1:42:00

        ... parts of your life. You know?

    19. RCDr. Rangan Chatterjee1:42:01

        Yeah, yeah.

    20. PJDr. Pradip Jamnadas1:42:01

        It's just amazing stuff.

    21. RCDr. Rangan Chatterjee1:42:03

        I mean, I love it. I, I just love it, and, um, if and when we have our second conversation, I c- I could see us going deep into who we are, spirituality, and I, I, I really do feel that's a missing piece in medicine. Like, it's not just about telling someone what they should do for their health. I mean, people don't really do what other people say in the long term, in my experience. They, they, well, might do initially to get them going, but at some point it has to change from being the doctor's plan to being my plan. At some point it needs to be, like they go on your three-week unprocess your diet, uh, sort of regime. They start fasting. At some point, maybe after a month, two months, three months, you want that self-empowerment piece where it's like, yeah, okay, the doctor's guided me, but I know what I'm doing now, right? I want to eat this way. I wanna fast like this because I feel good when I do it. So I'm now doing it, not because he told me to, but because I want to. And I think that, you know, I, you know, I, like you, I teach doctors. I, I, I always talk to them about this. This is a really important piece of the puzzle. Another thought I had is fasting is, you know, initially at least, a difficult thing for many people to do, and we kinda know that when humans do difficult things, whether it's fasting for 24 hours when you find it hard, or whether it's completing a half-marathon when, you know, six months ago you couldn't walk round the block, what it does for us in terms of who we are and our self-esteem and our confidence, it's very, very powerful, isn't it? So I, I really love that you are bringing that up also in the context of fasting.

    22. PJDr. Pradip Jamnadas1:43:47

        We, we have to. You, you know that there's a huge, in health, there's a huge component of your, of your, your, your, your mental being and, and your understanding of who you are and your role in, in, in, in, in your life and, and the people around you. Um, so I, one of my interests, and maybe we can talk about this on other occasions, is, is, you know, what are your relationships like, especially with your mother, 'cause that's gonna tell you how long you're gonna really live. It's amazing. Or h- you know, when my patients are in the hospital, how many people come visit them after open heart surgery determines how quickly they're gonna recover from open heart surgery. Same surgery. Well, what's going on here? So we can, you know, there's huge repercussions-

    23. RCDr. Rangan Chatterjee1:44:27

        Yeah, yeah

    24. PJDr. Pradip Jamnadas1:44:27

        ... on how patients' health is, uh, de- depending on their social, and then how do they view themselves in society and their role and, and, and, and their hierarchy in society, and that seems to also dictate, uh, outcomes in health-

    25. RCDr. Rangan Chatterjee1:44:40

        Yeah, yeah

    26. PJDr. Pradip Jamnadas1:44:40

        ... irrespective of how much healthcare, uh, provide, uh, uh, facilities are available to them.

    27. RCDr. Rangan Chatterjee1:44:46

        Yeah, yeah.

    28. PJDr. Pradip Jamnadas1:44:46

        So there's all these other social determinants of health that are extremely important, and I think that we don't talk about that enough.

    29. RCDr. Rangan Chatterjee1:44:54

        Yeah, yeah.

    30. PJDr. Pradip Jamnadas1:44:55

        And I think that that's something that we need to talk about because in cardiology, besides my fasting, my other aspect is, is, is I do want to get into all of that with my patients to see that, you know, um, health is defined by, you, you basically metabolize your psychosocial being. You, you metabolize it into your body. So be careful about your thoughts about who you are and how you're interacting with the world and everything that's going around you, because in an instantaneous moment, you're actually metabolizing it into physiology in your body.

Episode duration: 1:47:29