How To Eat For Type 2 Diabetes, Weight Gain & Inflammation | Jessie Inchauspé

1. 0:00 – 1:20

   Making breakfast practical: why oats can spike glucose and how to “dress” them

   1. RCDr. Rangan Chatterjee0:00

      I wanna make this so practical for people.

   2. JIJessie Inchauspé0:02

      Yes.

   3. RCDr. Rangan Chatterjee0:02

      I want people to get your books for sure to get all the science and all the tips, but I really want some kind of... Maybe we could go through some common foods-

   4. JIJessie Inchauspé0:10

      Hmm

   5. RCDr. Rangan Chatterjee0:10

      ... for example, or common things that people do-

   6. JIJessie Inchauspé0:12

      Hmm

   7. RCDr. Rangan Chatterjee0:12

      ... just to explain blood sugar and maybe what people might be able to do, like, about it to limit the spike.

   8. JIJessie Inchauspé0:20

      Yeah.

   9. RCDr. Rangan Chatterjee0:20

      Oats, right?

   10. JIJessie Inchauspé0:21

       Ah, I was gonna say oats.

   11. RCDr. Rangan Chatterjee0:22

       Oats, right? A, a common breakfast food all over the world-

   12. JIJessie Inchauspé0:26

       Yes

   13. RCDr. Rangan Chatterjee0:26

       ... which may not be the best thing in all situations. Talk to us about oats.

   14. JIJessie Inchauspé0:32

       So oats are a grain, and grains are full of starch. And as I explained, there's two types of food that create glucose spikes in the body, starches and sugars. So oats are a starch. And actually, if you look at starch, it's just one long chain of glucose molecules attached hand to hand.

   15. RCDr. Rangan Chatterjee0:50

       Hmm.

   16. JIJessie Inchauspé0:50

       And when you eat starch, those glucose molecules get freed, and then it creates a glucose spike. So oats in the morning, if you're just having oats, you're just having starch, which means glucose spike. So if you have oats and you feel hungry two hours after eating them, or if you feel tired at any moment during the day, or if you have other symptoms that you wanna take care of, you might wanna look at your oats situation. You have two options. One, you can learn to put some clothes on those oats. So maybe some nut butter. Maybe you can put some

2. 1:20 – 2:45

   Savory breakfast rules: protein-centered mornings and avoiding sweet add-ons

   1. JIJessie Inchauspé1:20

      protein powder in there. Maybe you have a little egg, you know, a little soft-boiled egg in the oats, make it like savory oats. Uh, you can find lots of nice little combinations to put protein, fat, and fiber in the oats. Other option, you just change your breakfast completely, and [laughs] and you go for what I call the savory breakfast. And in The Glucose Goddess Method, lots of recipe ideas, beautiful, but the principle is the following: A savory breakfast that keeps your glucose levels steady and helps you feel amazing is built around protein.

   2. RCDr. Rangan Chatterjee1:53

      Hmm.

   3. JIJessie Inchauspé1:53

      So eggs, fish, nuts, tofu, protein powder, leftover from dinner, leftovers from dinner, one of my favorite ways to get protein in.

   4. RCDr. Rangan Chatterjee2:01

      Me too.

   5. JIJessie Inchauspé2:02

      I had leftover, um, butter chicken for breakfast this morning. I had Indian food last night, butter chicken for breakfast, perfect. And then you can add some fiber or some fat to that, so, you know, olive oil, butter, avocados, maybe a bit of spinach if you want. And then the most important thing to remember is that in a savory breakfast you should not eat anything sweet except if you want some whole fruit for taste. No fruit juices, no jam, no sweet cereal, no sweet yogurts, et cetera. You can still have sweet foods later in the day, but for breakfast if you wanna set yourself up for success, it's very important to not have sweet food. And then starch you can as well before taste. So you can have some oats before taste, you know, if your body really feels like them.

3. 2:45 – 4:15

   On-the-go breakfast decisions: coffee shops, pastries, and simple swaps

   1. RCDr. Rangan Chatterjee2:45

      See, a lot of people will feel that they don't have time in the morning to make a breakfast, and they will get on the road to work-

   2. JIJessie Inchauspé2:54

      Mm-hmm

   3. RCDr. Rangan Chatterjee2:54

      ... and they'll stop off at a coffee shop, and they'll pick up a coffee, and they may get tempted with pain au chocolats or croissants or pastries.

   4. JIJessie Inchauspé3:05

      Get a ham croissant instead of a chocolate croissant, right? 'Cause at least it has some protein in it. Or maybe on Sundays you can make a big batch of soft-boiled eggs, and you can take a couple with you every day. Or in my book I have a, a recipe for egg cups, which are really delicious. But at the coffee shop, maybe they have nuts, maybe they have a toast with something savory on it.

   5. RCDr. Rangan Chatterjee3:27

      Yeah.

   6. JIJessie Inchauspé3:27

      But I agree, it's a difficult food landscape to navigate.

   7. RCDr. Rangan Chatterjee3:29

      It, it, it really is, and I think, you know, having a savory breakfast is game-changing-

   8. JIJessie Inchauspé3:35

      Yeah

   9. RCDr. Rangan Chatterjee3:35

      ... when you've never done it. Um, you know, for, for years, like you, I've been talking to patients about eat your dinner for breakfast.

   10. JIJessie Inchauspé3:42

       Yes.

   11. RCDr. Rangan Chatterjee3:43

       You know? Cook too much, and in the morning heat it up.

   12. JIJessie Inchauspé3:46

       Absolutely.

   13. RCDr. Rangan Chatterjee3:47

       And there's a couple of people to mind who, I won't share their story now, I think I've spoken about them on the podcast before, and I wrote about one of them in, in, uh, in one of my books. Completely different experience of life.

   14. JIJessie Inchauspé4:01

       Yes, I say that sentence.

   15. RCDr. Rangan Chatterjee4:03

       They-

   16. JIJessie Inchauspé4:03

       Absolutely

   17. RCDr. Rangan Chatterjee4:04

       ... c- it's just-

   18. JIJessie Inchauspé4:05

       Absolutely

   19. RCDr. Rangan Chatterjee4:05

       ... they're, they're going into the world, but the, their cognition-

   20. JIJessie Inchauspé4:08

       Yeah

   21. RCDr. Rangan Chatterjee4:08

       ... their work performance, their hunger, completely different.

   22. JIJessie Inchauspé4:13

       It's like stepping through the mirror, you know, in the movie.

   23. RCDr. Rangan Chatterjee4:15

       Yeah.

   24. JIJessie Inchauspé4:15

       [laughs] Completely.

4. 4:15 – 7:03

   How cereal became “normal”: marketing, cultural shifts, and kids’ breakfasts

   1. RCDr. Rangan Chatterjee4:15

      And if you think about what is the common breakfast now in the West, and not only just the West, um, in India, where I used to go every other summer and spend six weeks in India, 'cause that's where all my family used to live, and, and many of them still do, and I can still remember so clearly that, you know, I'd play with my cousins, but they were still at school in the summer, you know? Different timetables and different, you know, year, um, and term times. In India, they would have a full-on meal before they went to school for the day. They'd have, um, you know, they'd have vegetable curries.

   2. JIJessie Inchauspé4:51

      Mm-hmm.

   3. RCDr. Rangan Chatterjee4:51

      They'd have, you know, a, a whole plate full of foods. And I remember, this is a little while ago now, but it all started to change when companies like Kellogg's got on-

   4. JIJessie Inchauspé5:02

      Yes

   5. RCDr. Rangan Chatterjee5:02

      ... and started marketing aggressively.

   6. JIJessie Inchauspé5:04

      Yeah.

   7. RCDr. Rangan Chatterjee5:05

      And it changed to being all these quick and easy, you know, we can... This is, this is advancement, right? This is e- this is us making progress. We can make a quick and easy breakfast with cereal, milk on top, and off we go. But actually, through the lens of blood sugar-

   8. JIJessie Inchauspé5:19

      But this wa-

   9. RCDr. Rangan Chatterjee5:19

      ... huge difference, right?

   10. JIJessie Inchauspé5:20

       This was invented. We all used to eat breakfast that was just like any other meal.

   11. RCDr. Rangan Chatterjee5:24

       Yeah.

   12. JIJessie Inchauspé5:24

       And then food companies were like, "Hmm, cereal for breakfast. Let me think about that. It's really cheap to make. It's addictive. People will get pleasure from it. Let's tell them that they should have cereal and orange juice in the morning." That was invented. It's a marketing thing going on. The best thing for breakfast is dinner, I completely agree with you. Or even upgrade, dinner in a pan, plus you crack two, two eggs, so you make like a-

   13. RCDr. Rangan Chatterjee5:47

       [laughs]

   14. JIJessie Inchauspé5:48

       ... a little, like [laughs] a breakfast version of the dinner, right?

   15. RCDr. Rangan Chatterjee5:52

       Yeah.

   16. JIJessie Inchauspé5:52

       But completely, like, if you have something sweet and starchy for breakfast, massive glucose spike, glucose rollercoaster, sugar addiction-

   17. RCDr. Rangan Chatterjee5:58

       Yeah

   18. JIJessie Inchauspé5:58

       ... inflammation, poor energy. So breakfast is really the worst time to eat just sugars and starches, but it's the time where most of us eat just sugar and starches

   19. RCDr. Rangan Chatterjee6:07

       And it's, it's the common breakfast for children.

   20. JIJessie Inchauspé6:10

       I know.

   21. RCDr. Rangan Chatterjee6:11

       Which, and I understand the pressure on parents, you know, maybe two parents working, maybe not enough time, you know, m- financial concerns. I, I understand all of that.

   22. JIJessie Inchauspé6:21

       Or not knowing.

   23. RCDr. Rangan Chatterjee6:22

       And not knowing, but it really isn't the best breakfast to give your kids, even from a school performance perspective.

   24. JIJessie Inchauspé6:28

       Yeah.

   25. RCDr. Rangan Chatterjee6:28

       And I wonder how many behavioral issues at school mid-morning, right, which get detentions and get sanctions for in the school, how many of those are actually blood sugar issues? It'd be very interesting to do a study on that someday.

   26. JIJessie Inchauspé6:43

       It would. You know, I grew up eating a Nutella crepe every morning for breakfast from the ages of, I don't know, 5 to, like, 16. Nutella crepe.

   27. RCDr. Rangan Chatterjee6:50

       Now, that does sound delicious.

   28. JIJessie Inchauspé6:51

       [laughs]

   29. RCDr. Rangan Chatterjee6:52

       [laughs] But, but, but-

   30. JIJessie Inchauspé6:53

       And then I was exhausted at 11. I was f- I felt so hungry that my stomach would hurt, you know? And it would, definitely affected my day on a daily basis. I just thought it was normal, but no, it was not normal.

5. 7:03 – 8:56

   Plant milks and blood sugar: why oat and rice milks behave like “liquid starch”

   1. RCDr. Rangan Chatterjee7:03

      Well, what has your research shown about plant milks?

   2. JIJessie Inchauspé7:08

      Mm.

   3. RCDr. Rangan Chatterjee7:08

      Right? A lot of people these days are having almond milk-

   4. JIJessie Inchauspé7:11

      Yeah

   5. RCDr. Rangan Chatterjee7:11

      ... uh, rice milk, oats milk. Um, what is that doing to blood sugar? And presumably it matters what they're having it with.

   6. JIJessie Inchauspé7:20

      It matters what they're having it with, but also matters what it's from. So if you look at milks that come from starches, so rice and oats are starches, when you make a milk out of them, you're essentially making, making liquid starch, and that's just pure glucose. When you look on a glucose monitor at what happens when you drink an oat milk coffee versus a whole- cow's milk coffee, I mean, it's night and day. The oat milk or the rice milk will create a big glucose spike in the body, and it makes sense because you're just drinking liquid starch. So it's pretty obvious if you think about the source of it. If you have something like almond milk, at least almonds don't have that much starch in them-

   7. RCDr. Rangan Chatterjee7:59

      Mm

   8. JIJessie Inchauspé7:59

      ... so it's a much better situation. Coconut milk is also better. Cow's milk if you're into dairy. But oat milk, unfortunately, massive, massive spikes in most people. Now, I know people really love oat milk, so here's, here's my recommendation. If you don't have many symptoms and you feel pretty great and you have good energy, no cravings, whatever, no problem, and you love the oat milk, go ahead. I have nothing to teach you. But if you could feel better than you currently do, and if you wanna help some of the symptoms you might be feeling, you might wanna consider switching to another type of milk. Or you can also do another hack I have, which is [laughs] if you wanna eat something sweet, have it at the end of a meal instead of on an empty stomach. So to me, oat milk is, like, essentially sweet. So you can have it after your breakfast instead of on an empty stomach-

   9. RCDr. Rangan Chatterjee8:44

      Mm

   10. JIJessie Inchauspé8:44

       ... before breakfast. You can also go for a little walk afterwards. You can use some of the hacks to reduce its impact on your glucose. But really it's not, it's not the vibe.

   11. RCDr. Rangan Chatterjee8:54

       Yeah. It's not the best.

   12. JIJessie Inchauspé8:55

       No.

6. 8:56 – 13:06

   Movement after meals: using muscles to soak up glucose (including calf raises)

   1. RCDr. Rangan Chatterjee8:56

      Movement and blood sugar.

   2. JIJessie Inchauspé8:58

      Mm-hmm.

   3. RCDr. Rangan Chatterjee8:59

      This is quite an easy hack for people. It's been in many cultures for years, but, but as you've already explained, we've lost a lot of this kind of cultural wisdom.

   4. JIJessie Inchauspé9:10

      Yeah.

   5. RCDr. Rangan Chatterjee9:11

      What is the relationship between movement and blood sugar, and how can we utilize movement to mitigate the effects of what we've eaten?

   6. JIJessie Inchauspé9:19

      So you know the mitochondria I was telling you about earlier, so the little factories that make energy? In our muscles we have a lot of mitochondria, and they turn glucose into energy so that your muscles can contract.

   7. RCDr. Rangan Chatterjee9:30

      Mm.

   8. JIJessie Inchauspé9:30

      So when you're walking, when you're dancing, when you're lifting weights, you know, playing a whatever, team sports, your muscles are using glucose to power themselves, and so we can use that to our advantage. And here's the hack: After a meal, use your muscles for 10 minutes. Now, this can be just walking. It can be cleaning your kitchen. It can be doing my new favorite thing, which is calf raises. So you just sit at your desk, and you just, like, put your feet planted on the floor, and you just raise your feet up on your toes so only your toes are touching, and you do these calf raises or calf pushups for, like, five minutes. And any way you wanna use your muscles [laughs] is gonna be helpful because as you're contracting your muscles, the glucose from the meal as it arrives in your bloodstream is gonna be soaked up by your muscles-

   9. RCDr. Rangan Chatterjee10:16

      Mm-hmm

   10. JIJessie Inchauspé10:16

       ... and used for energy. So you're gonna reduce the glucose spike of that meal without needing to change what's in the meal at all.

   11. RCDr. Rangan Chatterjee10:24

       So, yes, we can try and eat better quality meals to stabilize our blood sugar. We can change the food order.

   12. JIJessie Inchauspé10:32

       Mm-hmm.

   13. RCDr. Rangan Chatterjee10:33

       But let's say we don't wanna make any changes, and we've had a meal that we know possibly isn't the best for us in terms of blood sugar spikes.

   14. JIJessie Inchauspé10:41

       Yeah.

   15. RCDr. Rangan Chatterjee10:42

       You're saying if we do 10 minutes of movement after that meal, we can mitigate the effects.

   16. JIJessie Inchauspé10:48

       Exactly. So within 90 minutes after the end of the meal, use your muscles a little bit. And really it can be super simple. You can be sitting on the couch watching a movie after dinner. Grab a bottle of water and do, like, some bicep curls with the bottle of water.

   17. RCDr. Rangan Chatterjee11:01

       Anything, basically.

   18. JIJessie Inchauspé11:02

       Anything, anything, anything. And really the calf raises are a really easy place to start. Your calf actually has a muscle called the soleus muscle, which is specifically excellent at soaking up glucose from the bloodstream. So the calf raises are a good option.

   19. RCDr. Rangan Chatterjee11:15

       I saw this on your Instagram grid recently.

   20. JIJessie Inchauspé11:17

       Mm-hmm.

   21. RCDr. Rangan Chatterjee11:18

       Profound.

   22. JIJessie Inchauspé11:18

       Cool, right?

   23. RCDr. Rangan Chatterjee11:19

       And, and, like, I always look at things through an evolutionary lens and think, "Well, what is so unique about the calf muscle?"

   24. JIJessie Inchauspé11:26

       We use it for walking.

   25. RCDr. Rangan Chatterjee11:27

       We use it for walking.

   26. JIJessie Inchauspé11:28

       Yes.

   27. RCDr. Rangan Chatterjee11:28

       Exactly.

   28. JIJessie Inchauspé11:29

       Yeah.

   29. RCDr. Rangan Chatterjee11:29

       And then, yes, of course, bicep curls, um, I get it. Simple, easy hack.

   30. JIJessie Inchauspé11:34

       Mm-hmm.
7. 13:06 – 16:16

   Fruit vs dried fruit: breeding, fiber protection, and why juicing changes the impact

   1. RCDr. Rangan Chatterjee13:06

      Yeah. Fruit versus dried fruit.

   2. JIJessie Inchauspé13:08

      Oh my God, I think this is one of my favorite topics.

   3. RCDr. Rangan Chatterjee13:10

      Okay, let's go.

   4. JIJessie Inchauspé13:11

      Okay. So you know how people say, um, well, it's fruit, so it's natural. Yeah, okay. So I have a scoop for you. The fruit that we have today in our supermarkets is not natural. Just like humans bred gray wolves into Chihuahuas for their entertainment, humans have been crossing and breeding fruit for millennia to make them more appetizing for humans-

   5. RCDr. Rangan Chatterjee13:39

      Mm

   6. JIJessie Inchauspé13:39

      ... to make them sweeter, to make them have fewer seeds, less fiber. If you look at an ancestral banana, it's tiny. It's full of seeds. It's quite dense, and it's not very sweet. If you look at a banana today, it's very sweet, very little fiber, very little seeds, super easy to eat. Humans have been creating these fruits-

   7. RCDr. Rangan Chatterjee14:00

      Mm

   8. JIJessie Inchauspé14:00

      ... to be extra juicy and extra sweet and extra full of sugar. So that's one thing to note. The fruit you see today in the supermarket is not natural. However, a piece of fruit still has fiber in it, and fiber is protective, as I explained at the beginning. Fiber helps reduce the glucose spike of a meal-

   9. RCDr. Rangan Chatterjee14:18

      Mm

   10. JIJessie Inchauspé14:19

       ... because it creates that mesh in the intestine. So if you wanna eat something sweet, eating fiber is still the best... Sorry, eating a piece of whole fruit is still the best thing to do because of that fiber blunting the spike from the sugar.

   11. RCDr. Rangan Chatterjee14:31

       Mm.

   12. JIJessie Inchauspé14:31

       The problem arises when we denature that piece of fruit. So maybe we're gonna juice an apple.

   13. RCDr. Rangan Chatterjee14:38

       Mm.

   14. JIJessie Inchauspé14:38

       As a result, we're removing all the fiber from the apple, and we're concentrating the sugar that was already being concentrated for centuries by humans in that whole apple. When we dry fruit, we take away all of the water, so we concentrate the sugar, and we eat way more pieces of dried fruit than we would of regular fruit.

   15. RCDr. Rangan Chatterjee14:55

       Yeah, and what's, I think, particularly concerning about that is there's quite a few companies now which are targeting children with dried fruits, and I think many parents are... Again, um, I, I, I always say this, and I wanna reiterate this point. I genuinely believe that all parents are doing the best that they can in the context of their life situation, the context of their knowledge.

   16. JIJessie Inchauspé15:21

       Mm-hmm.

   17. RCDr. Rangan Chatterjee15:22

       But I'm not sure that [laughs] those dried fruit packets are the best thing to be giving our kids, particularly on an empty stomach.

   18. JIJessie Inchauspé15:30

       Yes, although you could argue that dried fruit is better than, like, candy because at least it has some fiber in it. Though what would be even better, if you really wanna give dried fruit, would be to pair it with some nuts, for example.

   19. RCDr. Rangan Chatterjee15:40

       Yeah.

   20. JIJessie Inchauspé15:40

       So you make a little snack with, like, a few, like, dried apricots and then some pecans or whatever. That's better 'cause you're putting some clothes on the [laughs] on the-

   21. RCDr. Rangan Chatterjee15:47

       Yeah

   22. JIJessie Inchauspé15:47

       ... carbs, right?

   23. RCDr. Rangan Chatterjee15:48

       I get it, and that, that's what I love about all your suggestions. They can be applied by anyone in any situation, no matter what diet they're following.

   24. JIJessie Inchauspé15:56

       Yes.

   25. RCDr. Rangan Chatterjee15:56

       Little hacks, little tweaks just to make things a little bit better than they would've otherwise been, right?

   26. JIJessie Inchauspé16:02

       Exactly. We're not talking, like, big overhaul-

   27. RCDr. Rangan Chatterjee16:04

       Yeah

   28. JIJessie Inchauspé16:04

       ... of your life, of your food habits. No, no, no. Small tweaks, big impact.

   29. RCDr. Rangan Chatterjee16:08

       Yeah. Adding those nuts into the dried fruit-

   30. JIJessie Inchauspé16:11

       Yeah
8. 16:16 – 19:27

   When to eat fruit: ancient claims, “rotting” myths, and a pragmatic approach

   1. RCDr. Rangan Chatterjee16:16

      Now, just, I had a thought there, Jessie. A lot of the time, the cultural wisdom that's there, we're now learning the modern science going, that's why that works. Now, the only place where I think your recommendations don't match up with certainly the ancient wisdom that I'm aware of is with fruits on empty stomachs.

   2. JIJessie Inchauspé16:39

      Mm.

   3. RCDr. Rangan Chatterjee16:40

      Because I know in Ayurvedic medicine, for many years they have been talking about if you're having a piece of fruit, have it before your meal-

   4. JIJessie Inchauspé16:48

      Yeah

   5. RCDr. Rangan Chatterjee16:48

      ... because then it's digested, uh, really easily-

   6. JIJessie Inchauspé16:51

      Yeah

   7. RCDr. Rangan Chatterjee16:51

      ... and it doesn't then sort of fester on top of your meal afterwards. Now, first of all, I, I welcome your thoughts on that. But just a, a little a- addition there, based on what you've just said about the fact that the way fruit is bred now compared to how fruit is bred in the past, maybe 2,000 or 3,000 years ago-

   8. JIJessie Inchauspé17:13

      Maybe

   9. RCDr. Rangan Chatterjee17:14

      ... the fruit that we were getting, lower in sugar, not quite as sweet, maybe that worked then.

   10. JIJessie Inchauspé17:20

       Mm-hmm.

   11. RCDr. Rangan Chatterjee17:21

       Maybe it doesn't work so well now. I don't know, but what, what's your sort of perspective on that?

   12. JIJessie Inchauspé17:25

       Well, this is a very common question.

   13. RCDr. Rangan Chatterjee17:27

       Is it?

   14. JIJessie Inchauspé17:27

       And I was fascinated by it. I was like, okay, where does this come from? Like, why do we think that fruit rots in the stomach if it's eaten last? And through my research, I found that there was a doctor in the Renaissance who said that fruit, and this is a separate branch from the Ayurveda stuff, but this doctor said that if you eat fruit after a meal, it's gonna rot and putrefy in your stomach and create all these vapors and stuff. Um, that doctor just said that. I mean, I don't know where he pulled that out of, but it just is not true. Like, nothing actually rots or-

   15. RCDr. Rangan Chatterjee17:57

       Mm

   16. JIJessie Inchauspé17:57

       ... putrefies in the stomach. So that particular thing about the rotting is just not true. Nothing can rot in the stomach, actually.

   17. RCDr. Rangan Chatterjee18:03

       Mm.

   18. JIJessie Inchauspé18:04

       So there is this ancient wisdom about having the fruits on an empty stomach or at the beginning of a meal, and to that I say, well, we have two opposing views, right? We have the glucose science which says if you wanna eat something sweet, the best time for your glucose is at the end of a meal, and we have ancient wisdom that could also, you know, have some really good sources. So maybe where we land is- If you don't feel any discomfort-

   19. RCDr. Rangan Chatterjee18:29

       Mm

   20. JIJessie Inchauspé18:29

       ... by eating fruit after a meal, maybe you do that. And if you're somebody and your body's like, "No, it's not working," maybe it gives you bloating or whatever, then you switch it up, you know? It's up to you to sort of tailor these recommendations to other things going on in your life.

   21. RCDr. Rangan Chatterjee18:43

       So what you're recommending is we take a pragmatic, nuanced approach to our health.

   22. JIJessie Inchauspé18:48

       [laughs]

   23. RCDr. Rangan Chatterjee18:49

       Mind-blowing.

   24. JIJessie Inchauspé18:49

       [laughs]

   25. RCDr. Rangan Chatterjee18:50

       You know, it's 2023. That's not the way it goes.

   26. JIJessie Inchauspé18:52

       Yeah. I know. I know. And I think this is also why, um, you know, my work has been so well-received, is that it feels fresh and nice, and it's no longer an-

   27. RCDr. Rangan Chatterjee19:01

       Yeah

   28. JIJessie Inchauspé19:01

       ... extreme diet. It's not like, cut out entire food groups. It's like, okay, guys, I think we're over diets. Like, personally, I would rather we never, ever have any diets ever again. So what about we use all this recent science, and we find these principles that are easy, that have a big impact on our physical and our mental health, that are not very hard, don't cost any money-

   29. RCDr. Rangan Chatterjee19:21

       Yeah

   30. JIJessie Inchauspé19:21

       ... and, uh, how about we do that? And people seem to, to be quite happy with that approach.
9. 19:27 – 26:51

   Handling criticism at scale: CGMs, Type 1 diabetes concerns, and eating-disorder sensitivity

   1. RCDr. Rangan Chatterjee19:27

      Now, Jessie, it's almost impossible now to have the audience size which you have and not get pushback.

   2. JIJessie Inchauspé19:35

      Mm-hmm.

   3. RCDr. Rangan Chatterjee19:35

      Okay? I'm sure it's technically possible, but I would say it's almost impossible.

   4. JIJessie Inchauspé19:39

      Yeah.

   5. RCDr. Rangan Chatterjee19:41

      If and when people push back against your work, what is the common thing they say, and how do you respond?

   6. JIJessie Inchauspé19:48

      Hmm. So I've, I've experienced, like, multiple waves of this.

   7. RCDr. Rangan Chatterjee19:52

      Okay.

   8. JIJessie Inchauspé19:52

      Um, and I sort of categorize pushback or criticism in two camps. So there's, like, the stuff that really I can't do anything about. For example, um, people who don't wanna hear any information about food.

   9. RCDr. Rangan Chatterjee20:03

      [laughs]

   10. JIJessie Inchauspé20:04

       Because it... No, but, you know, because maybe they had an eating disorder in the past.

   11. RCDr. Rangan Chatterjee20:07

       Yeah.

   12. JIJessie Inchauspé20:07

       Maybe they're just like, "No." So for those people, my work is like, they just, they just hate it because I'm talking about food. Those things I don't really pay attention to because, you know.

   13. RCDr. Rangan Chatterjee20:18

       It's not for them.

   14. JIJessie Inchauspé20:19

       Exactly. And then you have the useful criticism, and from the beginning of the Glucose Goddess project, I've always really listened to feedback, whether it's in comments or in DMs or in real life. Like, because my purpose here is to make science accessible, to make it inclusive, to make sure that I'm serving the people that I wanna give this information to. So I would say the biggest criticisms have been from people with Type 1 diabetes. Maybe this was a year ago that it started happening, that they didn't like that I was using a glucose monitor as a not, as a person without diabetes. And I really listened very carefully to this because, um, a lot of people were sharing with me how, um, saddened it made them that I was, like, showing my glucose monitor, like, "Hey, I'm wearing a glucose monitor," and for them it was a device that they need to survive. And so I really took that to heart, and I started thinking a lot about my glucose monitor approach and, you know, whether I think it's for everybody. I stopped also posting photos of myself with the device-

   15. RCDr. Rangan Chatterjee21:18

       Mm

   16. JIJessie Inchauspé21:18

       ... being like, "Hey, glucose monitor." Now I really am just like, I'm using it to make the illustrative graphs, but I no longer, um, use it as, like, a fashion statement.

   17. RCDr. Rangan Chatterjee21:28

       Yeah.

   18. JIJessie Inchauspé21:28

       You know? So that was really, really helpful. I think another thing that people, uh, push back on is the close on carbs thing. They say, yes, but if you take it to an extreme, it could be harmful. Like, as I explained at the beginning, you could put two pounds of butter on a piece of bread-

   19. RCDr. Rangan Chatterjee21:45

       Mm

   20. JIJessie Inchauspé21:45

       ... and that would reduce the spike, but you need to have more nuance. And that I think I really address it in the book quite well. So...

   21. RCDr. Rangan Chatterjee21:54

       I think you do address it really well.

   22. JIJessie Inchauspé21:55

       Yeah.

   23. RCDr. Rangan Chatterjee21:55

       I think, you know, I've read both books, and I think you're really clear that this is not to stress you out, right?

   24. JIJessie Inchauspé22:04

       Mm-hmm.

   25. RCDr. Rangan Chatterjee22:04

       This is not necessarily to be applied in every situation.

   26. JIJessie Inchauspé22:06

       Yeah.

   27. RCDr. Rangan Chatterjee22:06

       This is to try and help you.

   28. JIJessie Inchauspé22:08

       Yeah.

   29. RCDr. Rangan Chatterjee22:09

       Right? Yeah, sure, in an ideal world, we'd all eat an exclusively whole food diet-

   30. JIJessie Inchauspé22:14

       Mm-hmm
10. 26:51 – 35:58

    Lifestyle-driven chronic disease: shifting beyond the “one pill for every ill” model

    1. RCDr. Rangan Chatterjee26:51

       Jessie, it's been such a pleasure talking to you. It really has. I mean, we've not even scratched the surface over what's in your two books.

    2. JIJessie Inchauspé26:59

       Yeah.

    3. RCDr. Rangan Chatterjee26:59

       Uh, and I can see why so many people follow you online. So many people have been moved by your work. It's making a real material difference in their lives, and therefore the lives of the people around them.

    4. JIJessie Inchauspé27:14

       Mm.

    5. RCDr. Rangan Chatterjee27:14

       Right? That's something I'm so passionate about. If you can change one person, you don't just change them. They've got more energy. They're less moody. They're less cranky. That impacts how they parent. That impacts how they are with their partners, how they are with their work colleagues, right? So I think the work you're doing is so, so important. This podcast is called Feel Better, Live More. When we feel better in ourselves, we get more out of our lives.

    6. JIJessie Inchauspé27:39

       Mm.

    7. RCDr. Rangan Chatterjee27:39

       I think you would probably add when we have stable blood sugars-

    8. JIJessie Inchauspé27:42

       [laughs]

    9. RCDr. Rangan Chatterjee27:43

       ... levels, we get more out of our lives.

    10. JIJessie Inchauspé27:44

        Absolutely.

    11. RCDr. Rangan Chatterjee27:45

        How Can You Make Disease Disappear, right? Um, but I think it really goes to what is our definition of disease.

    12. JIJessie Inchauspé27:52

        Mm.

    13. RCDr. Rangan Chatterjee27:52

        So I've been a medical doctor now for, you know, almost 20 years, and I can tell you that the bulk of what I see, I'd say probably 80% of what I see, is in some way driven by our collective modern lifestyles. And when we change our lifestyles in the, in the right way, I have seen so many of these so-called diseases disappear. That's what I managed to demonstrate on my BBC show that's being shown now in 70 countries around the world. I've shown things like Type 2 Diabetes, um, you know, vanished within 30 days, a change that has proved sustainable two or three years later.

    14. JIJessie Inchauspé28:26

        Mm.

    15. RCDr. Rangan Chatterjee28:27

        Uh, panic attacks, anxiety gone down by 70, 80% in just 6 weeks by making these changes. Chronic back pain for 30 years, right? Once we started addressing the cause, completely gone. Okay, and, and, and the list goes on. I realized that no matter who they were, no matter what the name of their disease was, you know what? When you make simple changes in four key areas to your lifestyle, it is amazing how many of those symptoms just start to vanish.

    16. SPSpeaker28:56

        You've said that this is the first generation being born now that has a shorter life expectancy than the generation before them, which is pretty terrifying.

    17. RCDr. Rangan Chatterjee29:04

        Yeah. You know, in the United States, and I think in the UK now as well, the current generation that are being born, you know, have got a lower life expectancy than any previous generation before them, or certainly in the, in, in our recent history.

    18. SPSpeaker29:18

        Mm.

    19. RCDr. Rangan Chatterjee29:19

        And that's pretty worrying, actually. You know, I've got two young kids at home myself, and, and that makes me worry is what sort of world are they being born into? You know, are, are there now issues with health that are gonna mean they're gonna be less well off than the generation before them? And I think this, this really sort of plays into why there's such disillusionments at the moment with the way medicine is practiced. In the 20th century, right, even 30, 40 years ago, the bulk of what we were seeing as doctors, the bulk of what was coming in and people, what people were complaining of, were what we call acute problems. They responded very well to the sort of pharmaceutical model, the, the one pill for every ill model.

    20. SPSpeaker30:03

        Mm.

    21. RCDr. Rangan Chatterjee30:03

        So let's say you have a pneumonia, for example, okay? That's when modern medicine is brilliant. So a pneumonia, the overgrowth of a bug in your lung, right? You come in to see the doctor. The doctor says, "Yeah, this is the issue," right? "I'm gonna give you a pill to get rid of that bug," and then within a week, within two weeks, you know, your, your problem's gone, right? The model of medicine we have now responds, you know, w- was set up in that era. What we're seeing today in the 21st century ... is chronic disease.

    22. SPSpeaker30:36

        Mm.

    23. RCDr. Rangan Chatterjee30:36

        Whether it's Type 2 Diabetes, okay? Which i- it's like a modern epidemic. Whether it's mental health problems, right? In, in the UK, right, one in four people in any given year are gonna have a mental health problem. Um, whether it's Alzheimer's disease, which, you know, as we're living longer, people are now worrying, you know, as I get older, you know, how am I gonna be? Am I gonna be able to function? Am I gonna be able to talk to my family or I'm gonna start losing my brain health and my-

    24. SPSpeaker31:03

        Mm

    25. RCDr. Rangan Chatterjee31:03

        ... and my memory. We'll be back to the conversation in just a moment. Now, many of us struggle to find time to eat all of these incredible whole foods. That's why I'm a big fan of good quality whole food supplements like this one that's been in my own life for over three years now. It contains over 75 whole food source ingredients, vitamins, minerals, pre and probiotics, and can help us support our energy, focus, digestion, and our immune system. AG1 are giving my audience a fantastic offer, one year supply of vitamin D and five free travel packs with your first order. You can see all details at drinkag1.com/livemore or just click on the link below. And now back to the conversation. So these sort of conditions require a different approach, and that's why life expectancy is going down because w- we're, we're, we're not really well-equipped to tackle these problems. 'Cause these problems don't respond to a one pill for every ill model. You've gotta change multiple things, right? You've gotta understand, and a lot of people still don't understand, including a lot of the profession, that these are conditions. There may be a genetic tendency, right? You may have a genetic predisposition.

    26. SPSpeaker32:25

        Mm.

    27. RCDr. Rangan Chatterjee32:26

        That is not your destiny though. It doesn't mean you're gonna get that condition, right? We know there's a f- um, the, the field is called epigenetics, uh, which is basically this whole idea that, you know, you're born with some genes, but your environment, how you live your life, that shapes and that determines whether those genes are switched on, if they're switched off-

    28. SPSpeaker32:46

        Mm

    29. RCDr. Rangan Chatterjee32:46

        ... how those genes are expressed. And that's a big shift actually, and that's exciting because that means that we've in, in a huge part, we've got control over what happens to us. I think that's incredibly exciting. So we need to start teaching our children, we need to teach our doctors, we need to educate the public, we need to change the ethos in schools, in institutions to, to sort of helping us foster a community where health is absolutely valued at the top. Because if it isn't, right, we're gonna struggle in our lives. So, you know, I've, I've watched many of your, your, your videos, Tom, and, um, you know, when we talk about trying to make a difference, trying to live a meaningful and purposeful life, right? Health is an ingredient of that.

    30. SPSpeaker33:37

        Mm.
11. 35:58 – 58:34

    Four pillars and the “threshold effect”: how sleep and stress can stall progress despite diet changes

    1. SPSpeaker35:58

       was that there are so many other lifestyle factors. Talk about this notion of the threshold effect, which I think is so important for people to understand.

    2. RCDr. Rangan Chatterjee36:06

       Yeah. It's this idea that we've all got our personal threshold, okay? So the, the way I explain it, if you were in my clinic with me right now, and I pretty much go through this with every patient. I say, "Look, let's say you were born in perfect health here."

    3. SPSpeaker36:20

       Mm.

    4. RCDr. Rangan Chatterjee36:21

       Right? We've got this sort of personal... We've got a threshold, right? So we can deal with multiple insults up to a point. So that could be, you know, poor diet, the fact that we don't move very much. We might have had a relationship breakup, which is a stress on our body. We may have a job we don't like, right? It's all building us- building up, building up-

    5. SPSpeaker36:40

       Mm

    6. RCDr. Rangan Chatterjee36:40

       ... getting closer to our threshold. That's when they get sick. Right? What I mean by that is often a patient will come in to see me and they'll say, "You know, Doc, I was fine. Everything was going fine. And then, you know, I changed my job. I don't like my new boss." And then, you know, they've, they come down with an autoimmune illness.

    7. SPSpeaker36:59

       Mm.

    8. RCDr. Rangan Chatterjee36:59

       Right? But when you go into their history, you see things were not fine at all. They... You know, we're very resilient as humans. We can deal with lots of stresses, right? But something is like the straw that breaks the camel's back.

    9. SPSpeaker37:12

       Mm.

    10. RCDr. Rangan Chatterjee37:12

        And, and you can sort of... You can find the last stressor that tips you up, that pushes you over, right? But when you've gone over your threshold, often it's not a case anymore of taking off that last stressor, right? Often you have to go back to basics-

    11. SPSpeaker37:28

        Mm

    12. RCDr. Rangan Chatterjee37:28

        ... and build from scratch again. It's like, you know, if we were juggling balls, I often say, you know, in your life when things get busy, you can juggle one ball, two balls, three balls, four balls, and then someone chucks a fifth one in-

    13. SPSpeaker37:39

        Mm

    14. RCDr. Rangan Chatterjee37:39

        ... and what happens? Everything falls down. And, you know, we, we, we, we always look for what's that one thing that it is. Can I give you a case story?

    15. SPSpeaker37:48

        Yeah, please.

    16. RCDr. Rangan Chatterjee37:48

        Right. Right. This is, um, a very typical patient o- of mine, but this is a... It was a, it was a guy in his 50s. I think it's a 52-year-old guy, right? He's got type 2 diabetes. Now, he's a successful businessman. He's go, go, go all the time, right? He's, you know, working hard, working weekends. He's always on his email, right? And he got diagnosed with type 2 diabetes. So he saw on TV, uh, in, in the UK, like he saw my BBC show, the first series, and he saw what I did with that type 2 diabetic patient. So he, uh, drastically reduced the refined and processed carbs in his diet.

    17. SPSpeaker38:24

        Mm.

    18. RCDr. Rangan Chatterjee38:24

        Okay? And then he'd read some other blogs, and he really got obsessed with low carb. And he was getting some changes, right? His blood sugar was coming down, but then it plateaued, and he was getting frustrated 'cause he kept reading more and more blogs. He kept lowering his carb intake, and, and he, he just wasn't getting anywhere. So he, he, you know, he ends up on my waiting list. He comes in to see me, and I remember going through everything with him, and I thought to myself, "This is not a dietary issue anymore," right? Because he didn't realize, like many people don't, that your stress levels contribute to your blood sugar levels.

    19. SPSpeaker38:59

        Mm.

    20. RCDr. Rangan Chatterjee38:59

        Your sleep quality contributes to your blood sugar levels. It's not just your diet. Even a diet is something we can... We get it. You know, we, we eat a bit of sugar. That's gonna put the sugar up in our blood. We get that. But we don't get, right, and there's some really good studies on this, that if you only sleep four to five hours a night for six nights, okay, you are 40% less good at managing your blood sugar, right?

    21. SPSpeaker39:23

        Wow.

    22. RCDr. Rangan Chatterjee39:23

        You become pre-diabetic after five to six days.

    23. SPSpeaker39:26

        Just from the lack of sleep.

    24. RCDr. Rangan Chatterjee39:27

        Just from a lack of sleep. It's, it's incredible.

    25. SPSpeaker39:30

        Mm.

    26. RCDr. Rangan Chatterjee39:30

        When you start understanding that, you think, "Well, of course we need a more balanced, holistic approach to helping these people." So this, this chap, so what I did with him, I said, "Look, your diet is brill, okay?

    27. SPSpeaker39:41

        [laughs]

    28. RCDr. Rangan Chatterjee39:41

        It... Arguably, it's too good. Arguably, you're, you're, you're almost... You're trying too hard now, and it's stressing you out."

    29. SPSpeaker39:47

        Right.

    30. RCDr. Rangan Chatterjee39:47

        I said, "It's sleep and stress for you." So I, I talk about these four pillars, right? It's about food, movement, sleep, and relaxation, that it's not about perfection in any one pillar-
12. 58:34 – 1:04:42

    Simple, scalable changes: time-restricted eating, strength, sleep rhythms, and daily stillness

    1. RCDr. Rangan Chatterjee58:34

       Okay. I tell you what, man, let's start with food. We've just been talking about food. I would say for people who are struggling with their diets and they're struggling with what to eat, I would say why don't you focus on when you eat?

    2. SPSpeaker58:47

       Interesting.

    3. RCDr. Rangan Chatterjee58:48

       There's very powerful research now, a lot of it's coming out of California, the Salk Institutes-

    4. SPSpeaker58:52

       Mm

    5. RCDr. Rangan Chatterjee58:52

       ... where they're showing that when you eat is arguably as important, or certainly of critical importance, as well as what you eat. So a lot of research has been done, particularly in animals initially, that's showing that if you restrict your food intake to about 10 to 12 hours, okay?

    6. SPSpeaker59:10

       Okay.

    7. RCDr. Rangan Chatterjee59:10

       Right? You can eat whatever you want, 10 to 12 hours, [laughs] right? You get improvements in your weight, improvements in your blood sugar, improvements in your immune system function, just from changing the hours that you eat. Because what happens, when you, when you go through a period of time where you're not eating, so once you've not put food in your body for about 12 hours, we think that a process called autophagy has kicked in. Autophagy is like housecleaning for your body.

    8. SPSpeaker59:35

       Mm.

    9. RCDr. Rangan Chatterjee59:35

       So just as if in your kitchen, if you didn't clean up every day, if the dishes, the plates were starting to stack up, by the end of the week, it wouldn't be a very pleasant kitchen-

    10. SPSpeaker59:44

        Right

    11. RCDr. Rangan Chatterjee59:44

        ... to walk into. When we don't eat for 12 hours, that, that process autophagy starts to clean up the mess that's built up. Right?

    12. SPSpeaker59:52

        And is that the magic number, roughly 12 hours?

    13. RCDr. Rangan Chatterjee59:54

        Look, for different people it'll be different things, but you know, 12 hours a day where you don't eat, for most of us, autophagy will have kicked in.

    14. SPSpeaker1:00:03

        Okay.

    15. RCDr. Rangan Chatterjee1:00:03

        So a- and the reason I stick to 12 hours is it's achievable. My approach is not about perfection in any one area.

    16. SPSpeaker1:00:10

        Mm.

    17. RCDr. Rangan Chatterjee1:00:11

        It's about doing a whole array of different things, and that's what... It's the synergy. That's where the magic happens. That's where you start to get all these different pathways in the body kicking in. Information is not enough to make change in your life. You have to take action. So to help you take action after watching this video, I've created a free nutrition guide for you. This contains the five most important practices I've seen in over two decades of seeing patients. They work for you, no matter what your dietary preference. There's a step-by-step action plan to help you implement those changes in your life. If you wanna receive that free guide right now, just click on the link in the description box below. Sure, if you think you're gonna get more benefit from 10 hours or 8 hours, fine, go for it. But I'd much rather people go, "Yeah, I've got a tick there."

    18. SPSpeaker1:00:58

        Right.

    19. RCDr. Rangan Chatterjee1:00:58

        I'm gonna move on to another one.

    20. SPSpeaker1:00:59

        Okay, so we have our tick there, and that was cool 'cause it was not what I expected you to say. So that's food done. What are we gonna do next?

    21. RCDr. Rangan Chatterjee1:01:06

        Okay. Um, I think if we go with movement, I would say do not neglect strength training. Okay? And I would say do a strength-training workout, whether it's body weight, whether it's my five-minute kitchen workout or your own favorite one, at least twice a week. But my approach, whether it's the food recommendation I just made, whether it's the movement recommendation I, I just made, or the sleep or relaxation ones, it's about simplicity.

    22. SPSpeaker1:01:32

        Mm.

    23. RCDr. Rangan Chatterjee1:01:33

        Okay? So that's what I'd say in move.

    24. SPSpeaker1:01:34

        Okay, so that's food and movement.

    25. RCDr. Rangan Chatterjee1:01:36

        Okay. Sleep. Okay. I think this is arguably the most undervalued pillar of health, okay, because in 2018, if you're not prioritizing sleep, you're probably not getting enough. There's just infinite distractions, right? We all know that feeling where we're still [laughs] sat up late watching more and more content. And again, load of great content out there, but it could be having a consequence.

    26. SPSpeaker1:02:01

        Mm.

    27. RCDr. Rangan Chatterjee1:02:01

        So I can tell you that the majority of people who are having sleep problems are doing something in their everyday lifestyle that they do not realize is impacting their ability to sleep at night.

    28. SPSpeaker1:02:14

        Mm.

    29. RCDr. Rangan Chatterjee1:02:14

        Okay? So my top two tips there would be a no-tech 90, try and have 90 minutes before bed with no tech, right? But the counterintuitive one is get outside in the morning.

    30. SPSpeaker1:02:25

        Mm.
13. 1:04:42 – 1:49:26

    Group-based care and community: why peers and coaches can outperform expert-only models

    1. SPSpeaker1:04:42

       The locus of control has to shift from the doctor to the patient. That's the key thing of the transformation of healthcare. Is the doctor in charge or is the patient in charge? And the group is the structure by which that locus can be transferred and tran- and the, the patient can actually participate.

    2. RCDr. Rangan Chatterjee1:05:00

       So let's get into that. People currently think medicine is, "I have a problem with my health." Whatever country you live in, then it could well be, "I phone to make an appointment with a healthcare professional," maybe a doctor, maybe someone else, but, "Because then I can tell that person about my problems-

    3. SPSpeaker1:05:18

       Yep

    4. RCDr. Rangan Chatterjee1:05:19

       ... and they with their training and expertise can actually tell me what's wrong and what I need to do."

    5. SPSpeaker1:05:25

       Yep.

    6. RCDr. Rangan Chatterjee1:05:28

       And the benefits of that for me are... or the, the, the sold benefits are, "I'm gonna get expert advice-

    7. SPSpeaker1:05:36

       Yep

    8. RCDr. Rangan Chatterjee1:05:36

       ... from a professional. My healthcare is private. I don't have to share it with anyone. This is a private thing. I've got a one-on-one consultation." Yet what you're doing with groups is showing that this model that we're used to, that all healthcare systems that I'm aware of are currently set up around-

    9. SPSpeaker1:05:55

       Yep

    10. RCDr. Rangan Chatterjee1:05:55

        ... are fundamentally problematic for many of the conditions that we see.

    11. SPSpeaker1:06:01

        Yeah. Let me give you my favorite example.

    12. RCDr. Rangan Chatterjee1:06:03

        Yeah, thanks.

    13. SPSpeaker1:06:03

        And it's actually here in the UK. So Dr. David Unwin, 2016 NHS Innovator of the Year, what is he doing in his practice? So the first thing he works out is that Type 2 Diabetes is reversible with diet, and you know this better than anyone 'cause you did it on a TV show like four times, right? [laughs]

    14. RCDr. Rangan Chatterjee1:06:20

        Yeah.

    15. SPSpeaker1:06:20

        So he, he realizes that. But it's quite, like, labor-intensive to do that in a one-on-one GP visit when you've got a million other things to do. So Dr. David Unwin starts these Type 2 Diabetes groups, which is essentially community support plus a low-carb diet. That's pretty much what it is. So he implements it into his GP clinic, and over the next five years, reverses Type 2 Diabetes in the majority of the patients who have Type 2 Diabetes in his clinic. The savings on medication alone from doing that is 70- almost 70,000 pounds in that clinic, and they've shown that, and this was in the BMJ, that if you extrapolated that out to the whole NHS- That would save 270 million pounds, a quarter of a billion pounds. One chronic condition, right, just being done a little bit differently in a group, supported in that way. So, you know, if we're here- if we wanna talk about the transformation of the NHS and you're looking at, you know, what sort of examples do we need to lead out of the pandemic to the future, look at that and say, "Look, is there, is there an example? Is that a good example of what we look?" Lower cost, more access, more love, more accountability, more support, more professional satisfaction from what they run with.

    16. RCDr. Rangan Chatterjee1:07:32

        Patients getting better as well.

    17. SPSpeaker1:07:33

        Patients getting better, and not reliant on the healthcare system.

    18. RCDr. Rangan Chatterjee1:07:36

        I mean, that's incredible, and you think those savings should have anyone in any healthcare system, their ears should be pricking up going-

    19. SPSpeaker1:07:46

        Yeah

    20. RCDr. Rangan Chatterjee1:07:46

        ... "Okay, how do we do that?"

    21. SPSpeaker1:07:48

        Mm-hmm.

    22. RCDr. Rangan Chatterjee1:07:48

        And, and you obviously know how to do it 'cause you're doing it, right?

    23. SPSpeaker1:07:51

        Mm-hmm.

    24. RCDr. Rangan Chatterjee1:07:52

        And I'm very hopeful that what you're doing in America, you're gonna be able to bring to the UK very, very soon. 'Cause you- you- you're figuring out what the obstacles are, what the problems are. We'll come to that, right? But what is it about a group, then, right? What is it... You said it earlier, the most powerful thing for someone who struggles with their alcohol intake and, you know, wants to reduce it and ultimately get off it-

    25. SPSpeaker1:08:19

        Yeah

    26. RCDr. Rangan Chatterjee1:08:20

        ... is to know another alcoholic who no longer drinks.

    27. SPSpeaker1:08:24

        Absolutely.

    28. RCDr. Rangan Chatterjee1:08:25

        What is the magic in the group that they're not getting from the experts?

    29. SPSpeaker1:08:29

        Yeah. There's a, there's a key person that I would sort of... The term that I would use is a health coach, right? And that's the term that we use in America. And essentially, the health coach, it's not a health professional. It's not a dietician. It's not a nutritionist. It's really sort of this... It's the equivalent, in my estimation, it's the equivalent of the mentor in Alcoholics Anonymous, the sponsor. It's someone who's overcome a chronic illness, has learnt a ridiculous amount through that process. They have the lived experience of the disease. They have the lived experience of the reversal. And now they can be this sort of peer leader where you now know someone. You know, you- you're able to essentially hold space for someone else to come to their own conclusion, right? To support people in, in coming to that. So in the groups that we run, we have this health coach. In Dr. Dun- uh, Dr. Unwin's model, what he realized is the first couple people that he helped reverse their Type 2 Diabetes in the clinic, put them in the group, right? So it's not just Unwin saying, "Hey, the science says this. This is the most optimal thing. Look at the science." It's like, "Here's Jane, and Jane did it. Jane, tell us about your experience." You know, when we run these groups... I'll tell you something else. So now we're doing it virtually. I... You'll love this. Think about when you come on the first Zoom with a bunch of people you've never met. Most people have their camera off on the Zoom-

    30. RCDr. Rangan Chatterjee1:09:55

        Mm
14. 1:49:26 – 2:22:28

    Metabolism and the “constrained” model: why more exercise doesn’t always mean more calories burned

    1. RCDr. Rangan Chatterjee1:49:26

       That's why these men's groups, I think, are, are being so effective for so many people. Moving more doesn't necessarily mean that we are going to burn off more. I wonder if you could expand upon that, please.

    2. SPSpeaker1:49:40

       Yeah. Yeah, that's right. So, um, even if you're more physically active, you're getting more exercise every day, or getting more physical activity every day, that doesn't necessarily mean that you're burning more calories every day than someone who's m- more sedentary than you. Uh, and the surprising... That, that kind of goes against, you know, what we're taught and what we're told, you know, uh, both in nutrition classes if you take them or, you know, whatever sort of basic biology you might have had, or for that matter, you know, every website that talks about, you know, exercise as a way to lose weight or every glossy magazine, you know, th- sort of self-help idea about exercise and weight loss. Um- And so it was a real surprise to us, and, and we came to this in a, in a kind of a funny way. We were doing work with really physically active, uh, communities in, in northern, uh, Tanzania and, uh, measuring energy expenditures. And even though they're more physically active than us, uh, they don't burn any, any different, you know, the, the energy expended per day is no different than you and me.

    3. RCDr. Rangan Chatterjee1:50:35

       Yeah. I mean, that's incredible to hear. I remember, I think it was two or three years ago when I first came across one of your research papers, and for me, it really helped me understand what I see a lot in clinical practice. And I thought, "Oh, it's so good to see some research there," because you're right, there is this, there's this narrative within the public health community, within the scientific community, but it's gone beyond that. Even within just common everyday conversation with people, it's an assumption that we all have made that m- moving more will lead to burning off more. And that was what's so striking about those early research papers I read of yours, which is it's, it's literally turning that on its heads. So what you're proposing, you know, is, is pretty game changing for, for, for a lot of people.

    4. SPSpeaker1:51:27

       Yeah, I think so. I mean, it was game changing for us, I can tell you that. It's, it was a total sea change in the way that I think about metabolism and in the way that I think a lot of, uh, us on the sort of basic research side of things. You know, I'm an evolutionary biologist, an anthropologist. I want to understand human evolution and how our deep past, you know, shapes the way our bodies work today. Um, so I don't, I didn't come into this from a clinical kind of public health, uh, training. You know, that, that's not my background. Um, so it's been fun sort of seeing that work, uh, you know, be relevant and be in the discussion in public health. But we just wanted to understand how the body works, right, from a fundamental level, and to discover that, that sort of there's this, this really basic assumption that we're all making that had never really been tested very well. And then to go and test it, this c- uh, this rela- you know, relationship between activity and expenditure, to go out and finally do that work and go, "Wait a second, this is not actually what we all assumed coming in, w- but what we were trained in coming in," um, that was really exciting. So I think it is a game changer. I think you're right.

    5. RCDr. Rangan Chatterjee1:52:24

       Yeah. I think many people will have heard that and go, "W- what does he mean that, you know, if I move more, I, you know, I know, like I can, I can-

    6. SPSpeaker1:52:33

       Yeah

    7. RCDr. Rangan Chatterjee1:52:33

       ... I can eat a Mars bar. I can see the calorie content," and therefore we- you have it in gyms that, "Oh, therefore I can go and, you know, run for 45 minutes now," or whatever the metric may be. So why don't we start at the, you know, right at the very beginning, you know, what is metabolism? How would you explain it to people? What are calories? And there, and then from there, can you then take that next step and show us why moving more doesn't always lead to burning off more?

    8. SPSpeaker1:53:04

       Yeah. Yeah, that's a great place to start. So, um, so metabolism is just the s- the sort of umbrella term for all the work that your cells do all day, right? So you've got 37 trillion cells, and, uh, they all are doing work all day to sort of bring nutrients in, break them down, make other, other, uh, you know, other molecules, get waste out, you know, so this sort of housekeeping work that all of our cells are doing all day. Um, all of that work requires energy, right? And so y- you could measure all the products that your cells make, and some people do that. They study metabolomics, it's called, and they're studying the proteins and enzymes that your cells are making. So you could measure the output, or you could do what a lot of us do, which is measure the energy expended for all that work, and it's, it's basically two different ways of measuring the same process, which is all the work that those 37 trillion cells are doing. Now, um, you know, most of that work we're only dimly aware of or maybe even not aware of at all. So things like your liver digesting your food and, you know, doing all the work that your liver does. Um, your brain. Your brain burns 300 kilocalories a day, right? We're, we're dimly aware of that, if we're aware of that at all. Um, you know, your, your immune system, uh, reproductive system, all these things that, that your s- your body's doing all day, most of it that you're not even, you know, conscious of, that's metabolism. Um, now the parts of it that we're aware of i- are, are the exercise parts, right? When we get moving, we get sweaty, we get our heart rate up. We're aware of that part, and so we tend to sort of equate energy expenditure per day with the activity part that we're, that we can see or we can feel. But in fact, even for somebody who exercises regularly, um, that activity portion of your expenditure is only, it's l- well less than half of how many calories you're spending every day is, is spent on, uh, physical activity. Most of it's spent on all the other stuff that you don't even know. Okay, so, so that's metabolism, and as somebody who's interested in human evolution and in evolution generally, um, we wanna know how all those calories are spent and where... The activity part's cool, but we wanna know about the energy spent on reproduction and on, uh, immune function and maintenance, all the tasks that the body's doing. That's why I get excited about metabolism, because you're sort of doing the forensic accounting-

    9. RCDr. Rangan Chatterjee1:55:19

       Yeah

    10. SPSpeaker1:55:19

        ... of, of how the body's prioritizing the energy in and energy out. So, um, as somebody who's interested in human evolution, uh, you know, the genus Homo, we're all g- Homo sapiens, right? The genus Homo has been, um, hunting and gathering since, since its inception, since w- you know, it evolved 200 and a half, 2 and a half million years ago. And so Homo sapiens, our species, is just the latest sort of twig off this large bough of, you know, the, the primate family tree, which is our bough, the, the, you know, genus Homo. And so to understand, um, what humans are all about, and ecologically and evolutionarily, you need to understand what the body looks like and acts like and works like and metabolizes like, uh, in a hunting and gathering population. That's what you need, right? That's, that's the ecologically real, sort of relevant, um, lifestyle for us. But nobody had done it, right? So nobody had, uh, measured energy expenditures, total energy expenditures, in a hunting and gathering population before. And so in 2009 and '10, um, uh, Brian Wood and Ra- and David Raichlen, two of my good friends and, and, uh, collaborators, we went to work with one of the last hunting and gathering populations on the planet, which is this community called the, the, the... Their name is the Hadza. So the Hadza community in Northern Tanzania, um, they get- they eat all their- foods are all wild foods. You know, plants, and, uh, berries, and tubers, and wild game, and honey, and they live in grass houses in northern, you know, in the savannas in northern Tanzania. So they're, they're a, a great, intact, uh, wonderful, host of, uh, gracious, lovely folks, uh, living in northern Tanzania. And, you know, w- so we went there, and we measured energy expenditures, and the reason we did it, the reason we did all the work to go and, and, and, you know, get the funding and take time [laughs] out of our lives to go and live with these folks for, uh, for a, a long time, it was a long process, um, was to finally understand how many calories they spend every day, how, you know, what humans ex- spend every day when you're, when you're hunting and gathering. Okay. So Hadza men and women get about between 5 and 10 times more physical activity every day than men and women in the US or Europe, so they're incredibly physically active. If you're a step counter, right, uh, the Hadza get about 13,000 to 19,000 steps a day.

    11. RCDr. Rangan Chatterjee1:57:38

        Okay.

    12. SPSpeaker1:57:39

        Right? Plus, they're digging up tubers, and they're chopping into trees to get honey out of the, you know, the, 'cause the bees there put- build their hives in the, in the trees. And, uh, you know, they're carrying babies on their back, and I mean, it's, it's a lot of work. So we were sure going into it, we were certain that they would be spending tons more calories every day than we do in the West. That was the whole, that was the premise of the work, right-

    13. RCDr. Rangan Chatterjee1:58:01

        Yeah

    14. SPSpeaker1:58:01

        ... was that we were just gonna go try to document that, that deficit that we seem to have in the West. And instead what we found was that their total energy expenditures, total calories burned per day, is the same, uh, in- indistinguishable from folks in the US and Europe. And so, you know, to get back to this, well, what is, what is metabolism? The answer is, um, it's all those things. It's, it's the activity, it's the immune system, it's... But what, what, what's happening is, rather than just sort of adding them up in a kind of simple way, obviously our bodies are able to kind of manage, right, and, and make the sort of, um, economic decisions about how to spend those calories so that as someone who lives in a population like the Hadza actually don't have a top-line number of calories per day that's any different than you and me, even though they're obviously spending those calories very, very differently, lots on activity and less on other stuff.

    15. RCDr. Rangan Chatterjee1:58:53

        Yeah, I mean, you call this the constrained energy expenditure model, I think.

    16. SPSpeaker1:58:58

        Yeah, yeah.

    17. RCDr. Rangan Chatterjee1:58:59

        And we have this idea that how we utilize energy is additive, don't we? So if I, um, run for one hour, therefore I have, you know, th- th- whatever the... I- I don't even know how many calories that would in theory, uh, you, you would burn off by doing that.

    18. SPSpeaker1:59:21

        Yeah.

    19. RCDr. Rangan Chatterjee1:59:21

        But we sort of feel we can then go and eat an equivalent amount because we've just earned it.

    20. SPSpeaker1:59:27

        Yeah.

    21. RCDr. Rangan Chatterjee1:59:28

        But it sort of works the other way as well, doesn't it, in terms of if we have overeaten, we then think that, well, I can just go and, I can go for a double run tomorrow or a, or a extra long walk tomorrow to make up for it. But, but your research has shown that that just simply is not the case, at least for most of us.

    22. SPSpeaker1:59:45

        No, that's right. That's right. That's sort of the idea that you can run and earn your donuts, you know? Um, and it's a dangerous way to think actually, because when we- y- when you don't understand how clever the body is about sort of manipulating your metabolism and you have this sort of simple view of, of how it works, then yeah, you, then you can make sort of d- silly decisions like that, like, oh, well, you know, I can have the box of donuts because tomorrow I'm gonna go on a longer run. Um, and actually the body doesn't really work that way. Uh, the body is, it's, there's a long-term kind of timeframe that your body's working under, sort of a couple weeks or even maybe a couple months, and it's paying attention to how physically active you are. And if you change that, if you, if you start your exercise program and you're, you're exercising more, you might lo- lose a little bit of weight early on. But as your body adjusts to that new level of activity, your total energy expenditure will sort of moderate and end up not a whole lot different than before you started. And now you think that you're earning all these donuts, right? Because you're, you've been really good, and you're doing all your exercises. But in fact, those donuts are gonna pile on because your ex- exercise expenditure isn't doing what you think it does. It's not total- raising the total expenditure per day in the way that you think you would expect it to.

    23. RCDr. Rangan Chatterjee2:00:55

        So how much does a typical Western man, a typical Western woman burn off-

    24. SPSpeaker2:01:01

        Burn off

    25. RCDr. Rangan Chatterjee2:01:01

        ... each day compared to, uh, the, the Hadza population?

    26. SPSpeaker2:01:06

        Yeah. So, um, so the biggest predictor of how many calories you're going to burn every day is how big you are, right? 'Cause I say we have 37 trillion cells, but obviously if we're bigger, we have more, and if we're smaller, we have fewer. Um, and so a, a typical, you know, u- US or European or U, you know, UK man burns about 3,000 kilocalories, uh, a day, and so that's about 11 megajoules, if you prefer to do megajoules. Um, and that has mostly to do with how, how big you are, how many, how much you weigh, um, and particularly how much, uh, uh, fat-free mass you have. Fat, fat burns some calories. It's actually, it's, it's an active tissue. It makes hormones and that kind of stuff, but not as much. It's not nearly as active, um, as all your other tissues. So we kind of... Fat is relatively quiet, so it's mostly your fat-free mass, uh, that determines how much you, you burn. Women, uh, in the US, UK, other parts of the industrialized world burn about 2,400 kilocalories a day. Um, and the difference is the, in the, in the, in the amount of energy burned is because women are a bit smaller and, you know, tend to be a bit smaller, and also women tend to carry a bit more body fat. So for a given, you know, if you, if you have a man and woman step on the scale and they have the exact same total body weight, the woman probably will have actually a little bit less fat-free mass, 'cause women tend to carry a bit more fat- Um, and therefore her expenditures will, we, we'd expect them to be a bit lower. Not because men and women are s- fundamentally different physio- I mean, they are ph- fundamentally different physiologically, but not because the expenditures are fundamentally different, just because the body compositions and sizes are a bit different on average.

    27. RCDr. Rangan Chatterjee2:02:48

        Yeah.

    28. SPSpeaker2:02:48

        Um, and then a Hadza man and woman, they, they tend to be a short statured group of folks. Uh, and so, you know, they're, they're a bit shorter th- on average than a typical US or UK, um, man or woman. Um, so they actually burn fewer calories. Uh, women burn, like, 1,800 calories a day. Men are, like, 24, 25. They're all shifted down because they're smaller bodied. Uh, but once you accre- of course, we, we account for body size and composition whene- whenever we do these analyses.

    29. RCDr. Rangan Chatterjee2:03:12

        Yeah. I, I so want this point, the cen- one of the central points of your work to, to, to come through to people because I think it has-- There's so many people who are, you know, struggling to lose weight. They are trying, they're torturing themselves, depriving themselves, punishing themselves all the time, and they're possibly doing it with the wrong equation in mind, right? So it's, it's, it's doubly tragic. It's [laughs] it's, A, it's not working, and B, it's like it's not working because actually you're putting in all this hard work and effort, and actually that's potentially not the right equation to be using. So if we just sort of break it down again. Um, so we have, you know, let's say I'm a, you know, the typical Western man on average will burn off 3,000 calories per day, right? So 3,000 calories is what they're gonna use up, and you're saying a brain may use up, uh, 300 calories a day just to exist and do all the functions that we require off our brain, right? So there's 2,700 calories left on that sort of, um, on that very simple equation. So-

    30. SPSpeaker2:04:23

        Yeah

Episode duration: 2:22:28