Leading Scientist Reveals The Secrets to a Healthy Immune System with Jenna Macciochi

Dr Jenna Macciochi 0:00 Even if you have the best diet in the world, other things can erode away at your immune system. Stress is probably the one thing, I know that is something that you've written about a lot and it's the one thing that we don't take seriously. We think of it as being psychological, and the causes can be psychological, they can be physical, they can be emotional, but they're always biological because stress chemistry is real. [upbeat music]

Dr. Rangan Chatterjee 0:29 You know, your day job is about a subject that is really close to my heart-

Dr Jenna Macciochi 0:33 Mm-hmm

Dr. Rangan Chatterjee 0:33 ... immunology.

Dr Jenna Macciochi 0:34 Mm-hmm.

Dr. Rangan Chatterjee 0:35 Now, I did a BSC honors degree in immunology at university.

Dr Jenna Macciochi 0:39 Yeah.

Dr. Rangan Chatterjee 0:39 Uh, so I've always been fascinated with it. But I don't think I realized back then just how important it is for every single one of us.

Dr Jenna Macciochi 0:48 Yeah.

Dr. Rangan Chatterjee 0:49 You know, pretty much every chronic long-term health complaint/condition that we have-

Dr Jenna Macciochi 0:54 Yeah

Dr. Rangan Chatterjee 0:54 ... in many ways the immune system plays a central role, and I don't think people realize that.

Dr Jenna Macciochi 1:01 No, no.

Dr. Rangan Chatterjee 1:02 Why do you think that might be?

Dr Jenna Macciochi 1:03 I mean, when I was an undergraduate and learning about the immune system, it was through the lens of infection protection, and that kind of is a historical thing, you know, from maybe over 100 years ago when the first kind of ties were made between these white blood cells and susceptibility to infection. And we've just always maintained this lens through which we look at the immune system as protecting us from infection. And then suddenly you start to dive into the field of immunology and you realize it's not just protecting us from infection, it's doing a whole array of other things. And I, I kind of, um, like to move away from that m- military analogy we h- often have about the immune system as going out to battle off the germs because most of the time it's not doing that. Most of the time it's kind of like your housekeeper. You know? It's just taking care, it's working hard, it's, it's learning from your environment inside and outside, and it's processing all that information, and it's maintaining the kind of status quo-

Dr. Rangan Chatterjee 2:03 Yeah

Dr Jenna Macciochi 2:03 ... in your body.

Dr. Rangan Chatterjee 2:05 Yeah, I like that. I th- I think a lot of us do think, um, still to this day that, "Oh, if I get cold symptoms in November-

Dr Jenna Macciochi 2:13 Mm-hmm

Dr. Rangan Chatterjee 2:13 ... my immune system," in adverse commas, "kicks in-

Dr Jenna Macciochi 2:16 Yes

Dr. Rangan Chatterjee 2:16 ... to fight it off."

Dr Jenna Macciochi 2:17 Exactly.

Dr. Rangan Chatterjee 2:18 But the immune system is constantly running.

Dr Jenna Macciochi 2:21 It's constantly working.

Dr. Rangan Chatterjee 2:22 Isn't it?

Dr Jenna Macciochi 2:22 Yeah. Right now as we sit here it's working hard. It's involved in so many processes. You know, like cells in your body have a finite lifespan, so eventually they die and they have to be disposed of, and special immune cells are removing those and keeping things tidy. They're repairing damage when it happens.

Dr. Rangan Chatterjee 2:41 Yeah.

Dr Jenna Macciochi 2:41 Even if there's no infection. So last year I broke my arm, but I didn't rip the skin open. There was no infection getting in there, but there was still signs of my immune system working hard to, to knit that all back together.

Dr. Rangan Chatterjee 2:55 Yeah.

Dr Jenna Macciochi 2:55 So it's, it's sensing. It's a real kind of ... Uh, it's like a mobile brain, I think. It's, it's very dynamic and it's listening, integrating all these signals from our environment, from inside us, and then producing the appropriate response to kind of keep things in balance.

Dr. Rangan Chatterjee 3:13 Yeah. And, and what's fascinating for me is that, and I hope we get into this today, is that it's not something passive that we have no influence over.

Dr Jenna Macciochi 3:25 Mm-mm.

Dr. Rangan Chatterjee 3:25 There is a lot that we can do, a lot of it quite simple stuff-

Dr Jenna Macciochi 3:30 Yes

Dr. Rangan Chatterjee 3:31 ... that can positively impact how our immune system works.

Dr Jenna Macciochi 3:35 Yeah.

Dr. Rangan Chatterjee 3:35 And I know you've, you, you know, you, you've, you've basically s- done a fabulous job of summarizing it in your, in your book, Immunity: The Science of Staying Well, which is well worth a read, I think, for anyone who's interested-

Dr Jenna Macciochi 3:46 Mm-hmm

Dr. Rangan Chatterjee 3:46 ... in learning more about the immune system and how they can use their lifestyle to help them.

Dr Jenna Macciochi 3:49 Mm-hmm.

Dr. Rangan Chatterjee 3:50 So well done on such a great job.

Dr Jenna Macciochi 3:51 Thank you.

Dr. Rangan Chatterjee 3:52 Let's sort of dive in some. Should we, should we start with food?

Dr Jenna Macciochi 3:54 Yeah. Yeah, exactly. I think that's a good place to start. I put the food chapter at the end because I was really sick of seeing, you know, the whole immune boosting food supplement, whatever, being pushed on, you know, the media, social media, everything. So I was kind of like people are gonna want to open a book about immunity and expect to see on like the first page, "Vitamin C does this to your-

Dr. Rangan Chatterjee 4:18 Yeah

Dr Jenna Macciochi 4:19 ... immune cells, so take a vitamin C supplement or eat these vitamin C rich foods." And I kind of just wanted to emphasize it's not that simple, you know? And, and almost, um, make people look at the other aspects of lifestyle first. [laughs]

Dr. Rangan Chatterjee 4:32 I mean, be- before you dive into food, I, I just wanna ... I, I, I love that you did that.

Dr Jenna Macciochi 4:37 [laughs]

Dr. Rangan Chatterjee 4:38 And, um, it's what I did in The 4 Pillar Plan, my first book.

Dr Jenna Macciochi 4:41 Mm-hmm.

Dr. Rangan Chatterjee 4:41 I thought, I'm not ... People are expecting this'll start with food. I'm not going to start with food.

Dr Jenna Macciochi 4:45 Yeah.

Dr. Rangan Chatterjee 4:45 I'm gonna start with stress, 'cause I think that's what no one's thinking about.

Dr Jenna Macciochi 4:48 Yeah.

Dr. Rangan Chatterjee 4:49 But then I'm interested, so you did that in your book, but when the book came out-

Dr Jenna Macciochi 4:53 Yeah

Dr. Rangan Chatterjee 4:53 ... and you started to write, you know, articles or a bit of PR-

Dr Jenna Macciochi 4:56 Yes

Dr. Rangan Chatterjee 4:56 ... in newspaper columns-

Dr Jenna Macciochi 4:58 Yes

Dr. Rangan Chatterjee 4:58 ... I bet you, or I'm gonna guess, what were they wanting you to say and write about?

Dr Jenna Macciochi 5:03 Oh, definitely. Yeah. It was all about, you know, uh, my book came out in March, which was, you know, COVID pandemic, you know, going through the roof. So all of the press and publicity was, you know, how can we make ourselves invincible to COVID? What, what supplements can we take to be invincible? [laughs]

Dr. Rangan Chatterjee 5:20 Yeah.

Dr Jenna Macciochi 5:20 And I was gonna let everyone down and say, "Well, you know, nothing's [laughs] going to make you invincible," 'cause from the dawn of time we've always had this battle with, with germs. You know? Like, they're trying to infect us, we're trying to keep them out. We just cohabit this earth together, so there's always gonna be infection.

Dr. Rangan Chatterjee 5:36 Yeah.

Dr Jenna Macciochi 5:36 And a pandemic's an unfortunate situation, but it's a very real one.

Dr. Rangan Chatterjee 5:42 Yeah. I mean, I'd love people just to sit with what you said there, which is we all cohabit this earth together, us-

Dr Jenna Macciochi 5:47 Mm-hmm

Dr. Rangan Chatterjee 5:47 ... and the bugs.

Dr Jenna Macciochi 5:48 [laughs]

Dr. Rangan Chatterjee 5:49 You know, it's, it's really quite profound, that.

Dr Jenna Macciochi 5:51 Mm-hmm.

Dr. Rangan Chatterjee 5:51 You know, it's not ... I think humans have ... We've, we've often felt, I think particularly in the times that I've been around on, on planet Earth-

Dr Jenna Macciochi 5:58 Mm-hmm

Dr. Rangan Chatterjee 5:59 ... that, you know, we kind of know best and we sort of, we can dominate everything around us.

Dr Jenna Macciochi 6:03 Yeah.

Dr. Rangan Chatterjee 6:03 But I think we're learning, well, f-

Dr Jenna Macciochi 6:05 We don't always get it right [laughs]

Dr. Rangan Chatterjee 6:07 Mother, Mother Nature's pr- Mother Nature's pretty powerful and-

Dr Jenna Macciochi 6:08 Yeah

Dr. Rangan Chatterjee 6:08 ... has been around a long, long time, and there's-

Dr Jenna Macciochi 6:11 Yeah

Dr. Rangan Chatterjee 6:11 ... there's a certain ebb and flow, there's a certain dynamic.

Dr Jenna Macciochi 6:14 Mm-hmm.

Dr. Rangan Chatterjee 6:15 We are not the only, um, living species in the world. There's animals-

Dr Jenna Macciochi 6:20 Yeah

Dr. Rangan Chatterjee 6:20 ... there's bugs, and bugs, as no- no doubt we'll get into-

Dr Jenna Macciochi 6:24 Yeah

Dr. Rangan Chatterjee 6:24 ... bugs are not all bad. There's a lot of bugs [laughs]

Dr Jenna Macciochi 6:26 Yes, exactly. I mean-

Dr. Rangan Chatterjee 6:27 They're very good

Dr Jenna Macciochi 6:28 ... 99% of them wouldn't hurt us, and they're everywhere. They're, you know, right now as we're sitting here, there's, there's bugs even in the air we breathe, and they're not, you know, causing us harm.

Dr. Rangan Chatterjee 6:38 Yeah.

Dr Jenna Macciochi 6:38 So most of them are good. But there's the obvious [laughs] ones that come along and, um, you know, sideswipe you, like, um, SARS-CoV-2 has-

Dr. Rangan Chatterjee 6:47 Yeah

Dr Jenna Macciochi 6:47 ... uh, as a sort of reminder, a stark reminder that, yeah, infection protection's really important, so.

Dr. Rangan Chatterjee 6:53 Yeah, and I, I think, I think the, the thing I would sort of reiterate to people is what I think the last few months have highlighted for us-

Dr Jenna Macciochi 7:04 Mm-hmm

Dr. Rangan Chatterjee 7:04 ... is that looking after your immune system-

Dr Jenna Macciochi 7:07 Mm-hmm

Dr. Rangan Chatterjee 7:07 ... is really important.

Dr Jenna Macciochi 7:10 Yes. And I would say, I've said it's a lot in the press, like taking care of your immune system is for life, it's not just for, for COVID. You know, suddenly everybody's really interested in it, there's lots of marketing of immune-boosting products. You know, all of the supermarkets and, and pharmacies were sold out of vitamin C supplements at the start of the lockdown. Um, but it's something that we should all have been thinking of before COVID because it's, it's, it's for the long game, you know. Immunity's really entwined with how we age, so-

Dr. Rangan Chatterjee 7:41 Right

Dr Jenna Macciochi 7:42 ... you know, if you want to live a long and, and healthy life, we are as a population living much longer than the generations before us, but we're not necessarily living better. So if you want to, you know, I don't necessarily wanna live forever, but I want to be able to enjoy my years and feel well and-

Dr. Rangan Chatterjee 8:01 Yeah

Dr Jenna Macciochi 8:01 ... not be sort of burdened with chronic disease. And we can't bulletproof ourselves, but there's definitely things we can do now that, that are for the long game. And that when I wrote the book, it was before we knew about, um, the current coronavirus pandemic, so I was really hoping to try and get people thinking about the long game for their health.

Dr. Rangan Chatterjee 8:19 Yeah. Yeah. Well, and, and you know, it, I'm sure in many ways people, if they weren't gonna take it seriously before-

Dr Jenna Macciochi 8:26 Mm-hmm

Dr. Rangan Chatterjee 8:27 ... are really going to now.

Dr Jenna Macciochi 8:28 Yeah.

Dr. Rangan Chatterjee 8:28 So that would be our hope. So in terms of the things people can do-

Dr Jenna Macciochi 8:32 Yeah

Dr. Rangan Chatterjee 8:32 ... uh, if we, if we sort of dive into diet and food then-

Dr Jenna Macciochi 8:36 Exactly

Dr. Rangan Chatterjee 8:37 ... um, what are some of the things that people can do to help their immune system?

Dr Jenna Macciochi 8:42 Yeah, well, I mean, there's the, the sort of ones that people often think about, which is vitamins and minerals, and we have a whole, um, selection of essential, we call them micronutrients, so the vitamins and minerals that we need to function. And if you're deficient in any of those, you will impair your immune system. And I think that there's certain ones that are highlighted, so vitamin A, the B vitamins, vitamin C, vitamin D, and vitamin E. But you could sort of say that taking more than, than you need if you're not deficient isn't gonna make your immune system work better than it already does at its baseline. But w- the sort of subclinical deficiencies in our populations are not really clear. It's very hard to measure. You know, if somebody has an overt deficiency in vitamin D, you would see it clinically as rickets, but if they're subclinically deficient, that would sort of fly under the radar.

Dr. Rangan Chatterjee 9:35 Yeah.

Dr Jenna Macciochi 9:36 And being subclinically deficient is, in one micronutrient, is often a sign that there's other micronutrients that might not be quite at the right-

Dr. Rangan Chatterjee 9:46 Yeah

Dr Jenna Macciochi 9:47 ... um, levels.

Dr. Rangan Chatterjee 9:48 And I, I, for people who, I just wanna clarify for people that subclinical, so you know, a lot of people are used to getting blood tests-

Dr Jenna Macciochi 9:56 Mm-hmm

Dr. Rangan Chatterjee 9:56 ... and there's a normal range.

Dr Jenna Macciochi 9:58 Mm-hmm.

Dr. Rangan Chatterjee 9:58 Um, and often if you are with, you know, out with that normal range, you'll be, it was said you are deficient.

Dr Jenna Macciochi 10:05 Yeah.

Dr. Rangan Chatterjee 10:06 Um, but we're learning more and more, like B12 for example is a, a prime example for me, that the normal range is so big.

Dr Jenna Macciochi 10:14 Yeah.

Dr. Rangan Chatterjee 10:14 You know, it's something like, you know, 200-ish to 700 or 800, depending on what lab you're in.

Dr Jenna Macciochi 10:20 Mm-hmm.

Dr. Rangan Chatterjee 10:20 But for some people who are at 250, although it's technically normal-

Dr Jenna Macciochi 10:24 Mm-hmm

Dr. Rangan Chatterjee 10:24 ... actually, it, they're symptomatic with it.

Dr Jenna Macciochi 10:28 Mm-hmm.

Dr. Rangan Chatterjee 10:28 Like, they can have, um, you know, they can have all sorts of things, fatigue-

Dr Jenna Macciochi 10:32 Yeah

Dr. Rangan Chatterjee 10:32 ... they can have confusion, they can have muscle aches. And I really think medicine, I would say, has been quite black and white-

Dr Jenna Macciochi 10:39 Mm-hmm

Dr. Rangan Chatterjee 10:39 ... for a number of years. I think we need to evolve a little bit to go, there's optimal-

Dr Jenna Macciochi 10:44 Yeah

Dr. Rangan Chatterjee 10:45 ... you know, there's normal, there's abnormal, but there's also optimal.

Dr Jenna Macciochi 10:48 Yeah.

Dr. Rangan Chatterjee 10:48 And, and, and I think, I think that's just a really important concept for people to grasp.

Dr Jenna Macciochi 10:53 Yeah. And I, you know, um, if you're, if you, you know, have problems with any of these micronutrients, the vitamins and minerals, it's gonna impact your immune system, so it's not so simple as saying, "I'll take a vitamin C supplement and that's gonna make me more invincible." It's, it doesn't quite work like that. Um, the other thing about the micronutrients is if we're low in any of those, it can actually increase oxidative stress in our body. So this is kind of the balance between oxidants and antioxidants. And w- what we've actually come to realize is this can affect how badly, uh, an infection causes us symptoms. So if you're in a more oxidative state, so you're not, um, your imbalance of antioxidants to oxidants is out, that bug, if you, if you capture an infection like, you know, coronavirus, for example, it can cause a much worse pathology in you, and it can also cause that virus to be under a greater pressure to mutate, to become more virulent.

Dr. Rangan Chatterjee 11:54 So let's, let's take a, a winter flu for example, a winter flu-type virus that we are exposed to. Are you saying then that the state of your immune system at that time- Potentially can influence whether you actually get sick with that infection-

Dr Jenna Macciochi 12:13 Yeah

Dr. Rangan Chatterjee 12:13 ... or whether you fight it off with no problem.

Dr Jenna Macciochi 12:15 Yeah, and how sick you get, and whether you, y- the environment that your body provides when that infection is inside you can shape how that, um, infection behaves, how that virus might be under a more pressure to mutate or more likely to mutate because of the, the environment of your body-

Dr. Rangan Chatterjee 12:33 So-

Dr Jenna Macciochi 12:33 ... which is really

Dr. Rangan Chatterjee 12:35 ... is, is this why you can have 10 people in the same room with the same person with, let's say, a cold virus, coughing all over-

Dr Jenna Macciochi 12:44 Mm-hmm

Dr. Rangan Chatterjee 12:44 ... 10 of them, but not all 10 will get symptoms of the virus, will they?

Dr Jenna Macciochi 12:49 Yes, exactly. And we've known this for a really long time, but I think coronavirus and the current pandemic has really kind of put that under the microscope because people are like, "Why are some people getting really, really sick and others have no symptoms?" And-

Dr. Rangan Chatterjee 13:02 Yeah

Dr Jenna Macciochi 13:02 ... this is quite commonly seen with infections, that we have this huge diversity of-

Dr. Rangan Chatterjee 13:07 Yeah

Dr Jenna Macciochi 13:07 ... how we respond.

Dr. Rangan Chatterjee 13:08 Now, now you mentioned oxidative stress and this balance between the oxidative stress and the antioxidants.

Dr Jenna Macciochi 13:14 Mm-hmm.

Dr. Rangan Chatterjee 13:15 I wonder if you, we could just make that super clear for people. So what is oxidative stress exactly?

Dr Jenna Macciochi 13:19 So we have, um, oxidat- like things that are, are produced when, uh, like byproducts of, of our cells normally working, um, things in our environment, various different things can, can cause that oxidative-

Dr. Rangan Chatterjee 13:35 Yeah

Dr Jenna Macciochi 13:35 ... stress in our body. And then we have our own internal antioxidant systems. We have the micronutrients, vitamins, and minerals that support production of antioxidants, and we also get antioxidants from food. And we kind of need this to be in balance, so we don't wanna completely extinguish the oxidative side, and we don't wanna, um, have too few antioxidants 'cause they both play roles in different ways.

Dr. Rangan Chatterjee 13:57 And just being alive and functioning-

Dr Jenna Macciochi 14:00 Mm-hmm

Dr. Rangan Chatterjee 14:00 ... and going around your day-

Dr Jenna Macciochi 14:01 Yeah

Dr. Rangan Chatterjee 14:02 ... today is going to increase oxidative stress, isn't it?

Dr Jenna Macciochi 14:05 Yeah.

Dr. Rangan Chatterjee 14:05 Because it's a normal... It's like all these things. You want it, y- as you say, it's a balance.

Dr Jenna Macciochi 14:10 Mm-hmm.

Dr. Rangan Chatterjee 14:10 You want that, but you want enough going on in your lifestyle to balance that out. Is that-

Dr Jenna Macciochi 14:15 Yes

Dr. Rangan Chatterjee 14:15 ... is that what we're saying?

Dr Jenna Macciochi 14:15 I think that's a, a good way to put it. And oxidative stress is something that our immune cells do when they're fighting an infection 'cause they wanna make our body's environment very hostile to the infection, so they produce all these kind of, um, reactive oxygen species, like free radicals and stuff, to try and fight off infections and make that environment hostile. And then you have the antioxidants. It's gonna quench that and bring things back to normal once you no longer need to be fighting the infection.

Dr. Rangan Chatterjee 14:44 So is this why it's a good idea to eat, uh, a- antioxidant-rich foods 'cause it helps-

Dr Jenna Macciochi 14:50 Yes

Dr. Rangan Chatterjee 14:50 ... with this balance?

Dr Jenna Macciochi 14:51 Exactly. And a lot of the minerals and vitamins in our diet are sort of co-factors in all of the processes that are involved in achieving this balance. And then you have all the kind of phytonutrients. So these are plant chemicals that are not considered in the recommended daily allowance. Like we, we don't have a sort of reference amount that you should be taking. Uh, and there's 20-odd thousand of them recorded so far, so, um, they're kind of th- the, the things that plants use as their own defense system because they cannot run away when a, a little, um, you know, insect comes along and tries to bite it.

Dr. Rangan Chatterjee 15:27 Yeah.

Dr Jenna Macciochi 15:27 So they'll produce their own little chemicals, phytochemicals, that will try and, um, make it hostile. And when we eat these, they help our own internal antioxidant systems, and they also have their antioxidant properties themselves.

Dr. Rangan Chatterjee 15:41 Wow.

Dr Jenna Macciochi 15:41 So that's why we should focus on, like a plant-rich diet, and most of these phytonutrients are found in the pigments of different plants. So something I do with my kids is that we talk about eating different colors and, you know, red fruits and vegetables. We have leafy greens, orange fruits and vegetables, um, yellow. Then even like the browns and whites, like cauliflower-

Dr. Rangan Chatterjee 16:06 Yeah

Dr Jenna Macciochi 16:06 ... and those kind of things. Um, and, uh, the purples and the blacks, you know, the real kind of, uh, that are found in berries, and kind of trying to eat from a whole range of these foods rather than focusing on one particular phytonutrient, like curcumin in turmeric. So that's one that we commonly see in the sort of wellness arena, that people take, um, supplements of this.

Dr. Rangan Chatterjee 16:28 Yeah.

Dr Jenna Macciochi 16:28 And I think the, the, uh, most, a sort of basic thing that you should think about is that they work in concert, like an orchestra. So you don't wanna isolate one particular phytonutrient or antioxidant and put it in a pill and take it, 'cause you might actually be removing some of its power because it's not being consumed in situ of all the other phytonutrients and, um, parts of your diet that help with that digestion and absorption. So I think food first-

Dr. Rangan Chatterjee 16:59 Food first

Dr Jenna Macciochi 17:00 ... is what everyone should be thinking of when it comes to their immune system. Trying to get your nutrition from foods so that you're not deficient in any of the micronutrients, which are the vitamins and minerals, and then getting all these phytonutrients, which are kind of like the icing on the cake, to really, um, nourish our immune system, and they have their own natural antioxidant properties. Some of them are antimicrobial, antibacterial, anti-inflammatory, and they're often considered longevity compounds. So we know that we don't need a certain amount to be able to function, but we know that over the course of a lifetime, they're very important-

Dr. Rangan Chatterjee 17:36 Yeah

Dr Jenna Macciochi 17:36 ... for longevity. So I, I, you know, food first seems really simple, and if you have a chronic condition or some underlying health problem, then you might, that might not be an approach that works for you. But I think that is the best thing-

Dr. Rangan Chatterjee 17:50 Ah

Dr Jenna Macciochi 17:50 ... that we can sort of aim for.

Dr. Rangan Chatterjee 17:52 I think that's a nice approach. It's, it's saying, look, there may be some value in some supplements at some time, depending on your state-

Dr Jenna Macciochi 17:59 Mm-hmm

Dr. Rangan Chatterjee 17:59 ... of health, but let's get the basics right first.

Dr Jenna Macciochi 18:01 Yeah.

Dr. Rangan Chatterjee 18:01 Let's focus on food first.

Dr Jenna Macciochi 18:04 Yeah. And it's the pattern of your diet. It's the consistency. It's not what you ate this morning, but what did you eat all week? What did you eat all month? You know? Maybe you had a few meals that were not the best, but- If the majority, if the pattern overall is, is strong, then I think that's, that's what you need to be looking at rather than getting stressed about every meal being perfect.

Dr. Rangan Chatterjee 18:26 Yeah. And that's a very empowering message, I think, for people because, you know, we are living in stressful times.

Dr Jenna Macciochi 18:30 Mm-hmm.

Dr. Rangan Chatterjee 18:30 People do sometimes struggle with energy or motivation-

Dr Jenna Macciochi 18:35 Mm-hmm

Dr. Rangan Chatterjee 18:36 ... to, you know, cook that perfect meal-

Dr Jenna Macciochi 18:38 Yeah

Dr. Rangan Chatterjee 18:38 ... that they want to. But your approach is saying, "Look, that's okay," right? Don't beat yourself up if-

Dr Jenna Macciochi 18:43 Yeah

Dr. Rangan Chatterjee 18:43 ... if now and again you have a meal that isn't, let's say, what you would ideally have, okay, fine.

Dr Jenna Macciochi 18:48 Yeah.

Dr. Rangan Chatterjee 18:48 Maybe enjoy it, you know.

Dr Jenna Macciochi 18:49 Exactly.

Dr. Rangan Chatterjee 18:50 Don't, don't feel guilty about it.

Dr Jenna Macciochi 18:51 Yes.

Dr. Rangan Chatterjee 18:52 But try to make most of your meals as much as possible-

Dr Jenna Macciochi 18:56 Yes, exactly

Dr. Rangan Chatterjee 18:57 ... um, you know, natural, minimally-

Dr Jenna Macciochi 19:00 Mm-hmm

Dr. Rangan Chatterjee 19:00 ... processed foods. I would like, I think, so one of the, one of the tips you're saying is colors. Focus on as ma-

Dr Jenna Macciochi 19:05 The colors

Dr. Rangan Chatterjee 19:05 ... different colors?

Dr Jenna Macciochi 19:06 Yep, exactly.

Dr. Rangan Chatterjee 19:07 Rather than maxing out on one color-

Dr Jenna Macciochi 19:10 Yes

Dr. Rangan Chatterjee 19:10 ... you're saying go for variety.

Dr Jenna Macciochi 19:11 Go for variety. And the other thing is, you know, food, when you focus on food first, it's, it's conveniently packaged up with other things that your body needs.

Dr Jenna Macciochi 19:19 And one of the key things that is often not linked to your immune system, but I'd say it's, like, massive for the, the resilience of your immune system is fiber. So pills and, and potions and whatever are not full of fiber, but the fresh produce is full of fiber. And people might be thinking, why is fiber important for your immune system? Because your gut bugs, the microbiota at the interface of your digestion and the rest of your body are one of the key educators of the immune system. And again, this is something that's probably exploded in the field of, of immunology-

Dr. Rangan Chatterjee 19:56 Yeah

Dr Jenna Macciochi 19:56 ... in the last 10, 15 years. If you do not, so if you take a, an experimental animal model where the animals have a, a reduced or a minimal, um, collection of good bacteria in their gut, their immune system doesn't develop, and they're very impaired in how they can respond and heal. Um, and even things like, you know, protection from cancer because our immune system's the main cancer surveillance system. So these bugs are helping to educate and teach and mature our immune system, and this happens potentially in utero before we're born, but predominantly when we enter the world because we go from a relatively sterile, there's some evidence that there may be some-

Dr. Rangan Chatterjee 20:44 Yeah

Dr Jenna Macciochi 20:44 ... bugs in the placenta. Uh, but we go into this hugely germy world, and suddenly our immune system has to cope with that because, you know, it, it's, um, it's got all these receptors on it to, to detect pathogens as being problematic. So it has to learn to tolerate those because, you know, most of the bugs around us are safe and harmless, and we need them 'cause they're helping us.

Dr. Rangan Chatterjee 21:09 And, and that's actually how the immune system develops, isn't it?

Dr Jenna Macciochi 21:13 Mm-hmm.

Dr. Rangan Chatterjee 21:13 It is by exposure-

Dr Jenna Macciochi 21:14 Mm-hmm

Dr. Rangan Chatterjee 21:15 ... to the environment around it-

Dr Jenna Macciochi 21:17 Exactly

Dr. Rangan Chatterjee 21:18 ... to the bugs around it to sort of give it that sort of ongoing education-

Dr Jenna Macciochi 21:22 Yeah

Dr. Rangan Chatterjee 21:22 ... so it starts to learn, oh, I respond to this.

Dr Jenna Macciochi 21:25 Yeah.

Dr. Rangan Chatterjee 21:25 I don't need to respond to that.

Dr Jenna Macciochi 21:27 Exactly.

Dr. Rangan Chatterjee 21:27 Um-

Dr Jenna Macciochi 21:28 I often say that, you know, the immune system's made, it's not born. There's maybe a percentage in the genetics that we inherit, but then it's made, it's built throughout our life, and it changes throughout our life. So-

Dr. Rangan Chatterjee 21:40 That's a lovely idea.

Dr Jenna Macciochi 21:41 Yeah.

Dr. Rangan Chatterjee 21:41 It's made not born. We can, we can build and we can sort of develop it-

Dr Jenna Macciochi 21:47 Mm-hmm

Dr. Rangan Chatterjee 21:47 ... the way we want to if we give it the right-

Dr Jenna Macciochi 21:50 If we, yeah

Dr. Rangan Chatterjee 21:51 ... inputs

Dr Jenna Macciochi 21:52 ... inputs, yeah. And I, I often think about the inputs as a way to shape the immune system and I was trying, I was working on a talk the other day and I was trying to make a slide of all the inputs, some that we can control, some that we can't, that, that are shaping our immune system from birth, and then it's, this became a really busy, messy slide [laughs] because there was too much to put on there. But yeah, a, a lot of it happens in childhood. And in some ways I find that quite daunting as a mother and you think, well, you know, there's sort of first three years I would say is when you're being colonized by all these good bacteria and there's huge changes going on in the immune system during that time.

Dr. Rangan Chatterjee 22:34 Yeah.

Dr Jenna Macciochi 22:34 Um, and there's this sort of interaction happening. These bacteria, they help protect the gut barrier to keep it very nice and, and tight and stop any bacteria going into the body because they're only good bacteria if they're in the right location, so they're not meant to cross over the gut and enter our body-

Dr. Rangan Chatterjee 22:53 Yeah

Dr Jenna Macciochi 22:54 ... um, because then they, they become a problem. Um, but one of the biggest things that they're doing to help our immune system is they're, they're eating our foods. And I [laughs] often think your diet's only as good as your microbiota in your gut-

Dr. Rangan Chatterjee 23:08 Yeah

Dr Jenna Macciochi 23:08 ... 'cause they're, they're the interface. They're eating your food. They're helping you to produce these vitamins and minerals from your diet, but they're also producing these postbiotics. Um, and people might have heard of prebiotics and probiotics, but postbiotics are basically the metabolic waste of the bugs in your gut. So they're producing stuff that is their kind of, you know, waste product of eating your foods.

Dr. Rangan Chatterjee 23:32 Right. Like short-chain fatty acids.

Dr Jenna Macciochi 23:33 Short-chain fatty acids-

Dr. Rangan Chatterjee 23:34 Yeah

Dr Jenna Macciochi 23:34 ... is the classic one. I, I used to work on these when I lived in Switzerland, um, and looking at how they influence, um, inflammation in the gut and beyond. So short-chain fatty acids are kind of a metabolic by-product of the, the bugs in your gut and they directly bind to, uh, the immune cells at that site and they help- Educate them and teach them to, to sort of tolerate anything that you're throwing down your mouth, 'cause we're not supposed to, um, react to that, 'cause it should be, you know, benign things that are going in there. But they have to help strike that balance that if you did get some kind of food poisoning, they also can identify the bad bugs.

Dr. Rangan Chatterjee 24:16 Yeah.

Dr Jenna Macciochi 24:16 So they help create an environment that's what we call tolerogenic, so it's encouraging, um, tolerance of the foods that you're eating, and there's a very kind of dynamic interaction between these bugs and the immune cells. And I'd say what happens in the gut is not just staying there. This, um, influence, this sort of tolerogenic influence of-

Dr. Rangan Chatterjee 24:36 Yeah

Dr Jenna Macciochi 24:36 ... things like short-chain fatty acids is also being absorbed into your bloodstream and helping regulate the immune system at, at distal sites-

Dr. Rangan Chatterjee 24:44 Well, what-

Dr Jenna Macciochi 24:44 ... in the gut as well

Dr. Rangan Chatterjee 24:44 ... it helps make T regulatory cells, doesn't it?

Dr Jenna Macciochi 24:47 Yes, exactly.

Dr. Rangan Chatterjee 24:47 Which, as you-

Dr Jenna Macciochi 24:48 The T reg

Dr. Rangan Chatterjee 24:48 ... said before, it's the, there was, I think, I, I mean, you mentioned the term peacekeeper. I think the first time I read that, I think it was in a Nature paper in 2014, I think.

Dr Jenna Macciochi 24:56 Mm-hmm.

Dr. Rangan Chatterjee 24:56 I think, I think I used that in one of my slide decks. It's where it calls them our peacekeepers.

Dr Jenna Macciochi 25:03 Yeah.

Dr. Rangan Chatterjee 25:04 I think for the first time, when I saw it in print.

Dr Jenna Macciochi 25:07 Yeah.

Dr. Rangan Chatterjee 25:07 Um, which is kind of what they are-

Dr Jenna Macciochi 25:09 Yeah

Dr. Rangan Chatterjee 25:09 ... really. And, and I, I sort of, yeah, I mean, I th- I really think we, a lot of people talk about gut health these days, but I don't think people understand the immune system's linked to, you know-

Dr Jenna Macciochi 25:22 Yes, yeah

Dr. Rangan Chatterjee 25:22 ... they think the gut is something separate. But I, I, I often teach, uh, doctors about this triad between our diet, our im- uh, our gut bugs-

Dr Jenna Macciochi 25:31 Mm-hmm

Dr. Rangan Chatterjee 25:31 ... and our immune system, and how they all sort of cross talk.

Dr Jenna Macciochi 25:34 Oh, definitely.

Dr. Rangan Chatterjee 25:35 You know, there's-

Dr Jenna Macciochi 25:35 Yeah

Dr. Rangan Chatterjee 25:35 ... there's bidirectional communication between, you know, diet and gut bugs, diet and immune system-

Dr Jenna Macciochi 25:40 Mm-hmm

Dr. Rangan Chatterjee 25:40 ... and gut bugs and immune system together.

Dr Jenna Macciochi 25:42 Yes.

Dr. Rangan Chatterjee 25:42 It's like this, so, you know, if you, if you make certain dietary choices, you're gonna improve-

Dr Jenna Macciochi 25:49 Mm-hmm

Dr. Rangan Chatterjee 25:49 ... the health of your gut bugs, which is gonna improve the health of your immune system.

Dr Jenna Macciochi 25:53 Yes, exactly.

Dr. Rangan Chatterjee 25:54 Which is empowering, right?

Dr Jenna Macciochi 25:55 Yeah.

Dr. Rangan Chatterjee 25:55 'Cause we can do something about that.

Dr Jenna Macciochi 25:58 Yes, exactly. And I think as a nation, we're not eating enough fiber. And also, fiber in the UK has a really bad, like, image problem, I think. Like, most people, I think-

Dr. Rangan Chatterjee 26:08 Come on, let's give it some PR.

Dr Jenna Macciochi 26:09 Yeah. [laughs]

Dr. Rangan Chatterjee 26:09 Give it, give it-

Dr Jenna Macciochi 26:10 If I was, if I was to ask my husband w- uh, what he thinks fiber is, and he, he's not in any kind of medical, nutrition, wellness field. He'd, um, in fact, the other day, he came home with some crackers that said, he's like, "Look, they say they've got added fiber." [laughs] And I was like, "Okay." [laughs] Because we kind of think of it as being like, you know-

Dr. Rangan Chatterjee 26:28 Cardboard

Dr Jenna Macciochi 26:28 ... those bread, re- breakfast cereals, like cardboard with the big fiber logo on it.

Dr. Rangan Chatterjee 26:33 Yeah.

Dr Jenna Macciochi 26:33 And, um, or fiber as being one thing.

Dr. Rangan Chatterjee 26:37 Yeah.

Dr Jenna Macciochi 26:37 But again, it's the diversity. Different bugs need different forms of fiber, and it, we find it in all the plant-based foods. So it's not just the fruits and vegetables, nuts and seeds, legumes, beans, pulses, and, and whole grains.

Dr. Rangan Chatterjee 26:50 Yeah.

Dr Jenna Macciochi 26:50 And it's about trying to bring in the diversity. I think in the last few years, there's a, a publication about the, the sort of th- uh, trying to get 30 different plant-based foods-

Dr. Rangan Chatterjee 27:01 Yeah

Dr Jenna Macciochi 27:01 ... into your diet because it's, it's about-

Dr. Rangan Chatterjee 27:03 Per week

Dr Jenna Macciochi 27:03 ... per week, yeah, because it's about the diversity.

Dr. Rangan Chatterjee 27:06 But also, it's, that includes, I think, lentils and nuts.

Dr Jenna Macciochi 27:10 Mm-hmm, yeah.

Dr. Rangan Chatterjee 27:10 And, you know, and, you know, I, I think it's very achievable-

Dr Jenna Macciochi 27:13 Yeah

Dr. Rangan Chatterjee 27:13 ... once people have it in their minds-

Dr Jenna Macciochi 27:15 Exactly, yeah

Dr. Rangan Chatterjee 27:16 ... to, to do it.

Dr Jenna Macciochi 27:17 And they're very common in, in traditional diets. I remember growing up, you know, my mum would, would add lots of different, um, grains and beans and pulses to spin things out, as she put it, so that-

Dr. Rangan Chatterjee 27:28 Yeah

Dr Jenna Macciochi 27:28 ... you could make a dish go a lot further.

Dr. Rangan Chatterjee 27:30 Yeah, wonderful advice. Um, so, so far, we've said that lots of different colors, lots-

Dr Jenna Macciochi 27:37 Mm-hmm

Dr. Rangan Chatterjee 27:37 ... of different diversity of plants is gonna help your gut microbiome.

Dr Jenna Macciochi 27:40 Mm-hmm.

Dr. Rangan Chatterjee 27:41 It's gonna help your immune system.

Dr Jenna Macciochi 27:42 Mm-hmm.

Dr. Rangan Chatterjee 27:44 Eating less-

Dr Jenna Macciochi 27:45 Mm-hmm

Dr. Rangan Chatterjee 27:45 ... is also something that might be helpful, right?

Dr Jenna Macciochi 27:49 Yeah. So this is another field I've, I've just got fascinated with, um, and that's the, the immunometab- metabolism. I don't know if you've heard anything about this.

Dr. Rangan Chatterjee 27:58 I love that word.

Dr Jenna Macciochi 27:59 Yeah. [laughs]

Dr. Rangan Chatterjee 27:59 Love it, immunometabolism.

Dr Jenna Macciochi 28:01 Shipping two words together. Yeah.

Dr. Rangan Chatterjee 28:02 I like it.

Dr Jenna Macciochi 28:03 And it's only just in the fi- last five years that it's really kind of popped up, um, and people have started looking at this. But metabolance, metabolism is basically breaking down of, um, the major components of our diet, so the protein, carbohydrate, and fats, into energy and building blocks that our cells can use. And people might hear things about metabolic rate or, "I've got a good metabolism," these kind of things that people say. Um, and w- you know, metabolism and the immune system are really intimately entwined, and I don't know why it's taken us so long to figure that out, because immune responses are energetically very costly. You know, there has to be sort of triaging of resources to be like, "Right, we're gonna fight this infection," and turn on all the inflammation, turn on a- all the antibody producing and all those molecules that are being produced and the proliferation of, of immune cells. That takes a lot of resources.

Dr. Rangan Chatterjee 28:59 Is this-

Dr Jenna Macciochi 28:59 So it needs energy, it needs building blocks.

Dr. Rangan Chatterjee 29:02 Is this why we feel tired when we're fighting an infection, because the body's diverting resource-

Dr Jenna Macciochi 29:07 Yeah

Dr. Rangan Chatterjee 29:08 ... to making all that stuff that's gonna fight it?

Dr Jenna Macciochi 29:10 Exactly, and you might find that you need to kind of build yourself back up again after you've been, uh, sick, um, particularly if you've-

Dr. Rangan Chatterjee 29:18 Yeah

Dr Jenna Macciochi 29:18 ... been sick for quite a long time or if you have a ongoing illness. Your nutritional needs might be very different from somebody who doesn't have that. So im- immunometabolism is the field that's trying to understand how metabolism can shape immune responses and vice versa. So w- this happens at the level of the individual immune cell but also can happen in the environment of a tissue and in the environment of our whole body. And this is something that there's not really any kind of absolute concrete, um- Understanding yet in this area, but we know that when, uh, uh, a, an immune cell is fighting an infection, it goes through a metabolic switch. And it goes from being in this kind of resting state to suddenly sucking up lots more, um, glucose to fuel, uh, proliferation. Th- the immune cells are making armies of themselves. Building antibodies requires, you know, the building blocks of proteins. All of this kind of thing is happening, and that metabolic switch is, is known as the Warburg effect. This is also what's happening to cancer cells, but immune cells do this when... And it's perfectly normal when they're fighting an infection or fighting any kind of, um, um, problem, and then it's switched back off and the immune cells go back to normal, and they're, they don't have this huge need for metabolites anymore. But what people are starting to, to wonder is can the overall environment of a body influence, um, the, the metabolic switches inside our immune cells and switch them on aberrantly when they're not needed? So we know that, um, diabetics with poorly controlled blood sugar, so they have elevated blood sugar in, um, their body, this creates an environment that causes some of our immune cells, like neutrophils, to not work so well. So it affects... So immune cells have nutrient sensing, um, um, switches inside them. So they can sense what nutrients are in, a- are available, and they're taking in that information, and then that affects how they can work. Now, what is not known is can we feed someone different, um, macronutrients, proteins, carbs, or fats, and influence how their immune system is working? So can you switch unwanted immune responses off or on based on the different macronutrients that your body's metabolizing? I think this is where the field of immunology is gonna be headed in terms of treating chronic diseases because we know that people with chronic diseases like metabolic syndrome, type 2 dia- diabetes, heart disease, or people who are carrying too much visceral fat, that the whole environment of their bodies is metabolically different, and this might be causing the immune cells to act abnormally and be- become more proinflammatory, for example.

Dr. Rangan Chatterjee 32:14 Wow. Super interesting.

Dr Jenna Macciochi 32:16 Yeah.

Dr. Rangan Chatterjee 32:16 So a lot of research to come in that area.

Dr Jenna Macciochi 32:18 Exactly, and I think we just don't know enough-

Dr. Rangan Chatterjee 32:20 Yeah

Dr Jenna Macciochi 32:21 ... to say specifics yet, but I think that's... You know, for so long we've been focused on the micronutrients, but actually it's the macronutrients. So you could adjust someone's diet, give them different proportions of protein, fat, and carb to maybe alter their metabolism and alter immune cells that were going wrong. So somebody who had a chronic infla- inflammatory disease, we could kind of steer that around. And-

Dr. Rangan Chatterjee 32:44 It's incredibly exciting, isn't it?

Dr Jenna Macciochi 32:47 On the other side of it, l- what you said about eating less, um, another thing that I bring up in the book because I wanted to get people away from just thinking about, you know, a vitamin supplement for their immune system, is that the immune function is impacted by overnutrition and undernutrition. So if you're not eating enough or you're eating too much, this is gonna send your immune system awry, and I should context that by saying if you're doing that consistently. And then we have this field of research coming out about fasting and immune function. And I remember being at conferences decades ago, and they were talking about fasting and how it would regenerate, um, all sorts of parts of the body. It was kind of mind-blowing, and now we kind of see it more in the mainstream, and we have all these kind of forms of different diets. Um, and this again is causing metabolic switches in the body, that then when you go on to refeed after someone has had a period without food, you get an increase in, in growth hormone. You get production of fresh new immune cells from the bone marrow, um, and the stress of the lack of eating kind of causes some of the older immune cells and ones that might be more likely to malfunction to be deleted. So you're kind of replenishing your immune system, and we start to see in experimental models of autoimmune disease that this is, you know, highly therapeutic.

Dr. Rangan Chatterjee 34:13 Yeah, it's fascinating that it's not necessarily just what we're eating.

Dr Jenna Macciochi 34:18 Mm-hmm.

Dr. Rangan Chatterjee 34:19 It's, you know, how much or how little. It's are we fasting, are we not fasting.

Dr Jenna Macciochi 34:24 Mm-hmm.

Dr. Rangan Chatterjee 34:24 All these kind of different components that-

Dr Jenna Macciochi 34:27 Yeah

Dr. Rangan Chatterjee 34:27 ... all play, I guess, they all play a role in the signals the body is receiving, 'cause I guess that's all it is, isn't it?

Dr Jenna Macciochi 34:33 Mm-hmm.

Dr. Rangan Chatterjee 34:33 The immune system is trying to interpret the signals-

Dr Jenna Macciochi 34:35 Yeah

Dr. Rangan Chatterjee 34:35 ... and sort of going, "Okay, what does that mean? Is, is it-

Dr Jenna Macciochi 34:39 Yeah

Dr. Rangan Chatterjee 34:39 ... sort of safe, or is it unsafe? Do I need to take action?"

Dr Jenna Macciochi 34:42 Yes.

Dr. Rangan Chatterjee 34:43 "Or can I just stay calm?"

Dr Jenna Macciochi 34:44 Exactly.

Dr. Rangan Chatterjee 34:44 And I guess everything we do, even our thoughts, our words-

Dr Jenna Macciochi 34:50 Mm-hmm

Dr. Rangan Chatterjee 34:50 ... our sleep, our stress-

Dr Jenna Macciochi 34:52 Mm-hmm

Dr. Rangan Chatterjee 34:52 ... they're all giving a signal in some ways-

Dr Jenna Macciochi 34:55 Yeah

Dr. Rangan Chatterjee 34:55 ... to our immune system-

Dr Jenna Macciochi 34:56 Exactly

Dr. Rangan Chatterjee 34:57 ... is, "Do I need to respond, or is it okay?"

Dr Jenna Macciochi 35:00 Exactly, yeah. It's, it's always-

Dr. Rangan Chatterjee 35:01 I mean, at its core. At its core-

Dr Jenna Macciochi 35:02 Yeah

Dr. Rangan Chatterjee 35:02 ... it's that simple, isn't it?

Dr Jenna Macciochi 35:03 Yeah.

Dr. Rangan Chatterjee 35:03 At its core.

Dr Jenna Macciochi 35:04 Yes. Yeah, yeah, it's, it's this decision-making that's ongoing and constant, and it's integrating all these different inputs to decide. And I think the thing with the, the sort of so-called Western diets that, that, y- you know, we talk about as being, having a negative impact on our health, um, it's just, it's just really tasty, and we just wanna eat it all the time. It's salty. It's sweet. It's delicious. It, it's everywhere. W- we can quickly override any lack of hunger cues just to, to, to eat. We kind of pathologize being hungry. It's like you're not ever allowed to be hungry.

Dr. Rangan Chatterjee 35:40 Yeah.

Dr Jenna Macciochi 35:40 You have to have 10 snacks in your bag in case you might not be able to reach some food. And, and then we have millions of incidences of eating across a huge portion of our a- waking time. And part of the research I was involved in several years ago was looking at postprandial inflammation. So when we eat, there's an inflammation, a subtle inflammation that happens in the body, and this is quite normal. We have plenty of checks and balances in place to keep that in check, and actually dietary fiber is one of the m- best ways to kind of seal that up again and prevent that from happening, as is having a period of, um, time without food in between meals. So eating enough and the right things at one meal that you do not need to eat then till the next meal, um, is actually quite good for over- overall-

Dr. Rangan Chatterjee 36:25 Yeah

Dr Jenna Macciochi 36:25 ... gut health, but the whole body health.

Dr. Rangan Chatterjee 36:27 I, I, I'm sort of super fascinated by this research as well, and, you know- Not only do many of us eat too much, we eat too often-

Dr Jenna Macciochi 36:36 Mm-hmm

Dr. Rangan Chatterjee 36:36 ... in the day. And a- as you just said there, you know, the, the act of eating is inflammatory.

Dr Jenna Macciochi 36:43 Yeah.

Dr. Rangan Chatterjee 36:43 So that's a response to eating, is that your body will become inflamed. But as you say, nothing to worry about. It's sort of, that's part-

Dr Jenna Macciochi 36:51 Yeah

Dr. Rangan Chatterjee 36:51 ... of the process. But I guess, you know, and, you know, I know, uh, Satchin Panda's done a, a lot of look at this-

Dr Jenna Macciochi 37:00 Yes

Dr. Rangan Chatterjee 37:00 ... Professor Panda. Um, and I think when, when he started his app in 2015, I think it's called mySircadian Clock.

Dr Jenna Macciochi 37:09 Mm-hmm.

Dr. Rangan Chatterjee 37:10 I, I, I can't remember the figures offhand, but it's something like 20, 30 years ago, most people were eating three times a day in the US.

Dr Jenna Macciochi 37:17 Mm-hmm. Yeah.

Dr. Rangan Chatterjee 37:17 I think we can probably infer in the UK as well. And then in 2015 when he was measuring-

Dr Jenna Macciochi 37:23 Mm-hmm

Dr. Rangan Chatterjee 37:24 ... and people were inputting into the app, I think the top 10% of people were eating 15 times a day, and it was a-

Dr Jenna Macciochi 37:31 Yeah

Dr. Rangan Chatterjee 37:32 ... you know, so that, if we think about that, let's say, let's say I'm eating 15 times a day, and let's say in theory it is all whole food, right? It's all nice, uh, health. W- what, what is considered-

Dr Jenna Macciochi 37:46 Yeah

Dr. Rangan Chatterjee 37:47 ... you've got to be careful with the language, but what is considered sort of healthful-

Dr Jenna Macciochi 37:50 Yeah

Dr. Rangan Chatterjee 37:51 ... foods for our health? You do have to ask the question, is eating them 15 times a day healthful? That's, that's like 15 bouts of inflammation, whereas if you had the same sort of food over, you know, it's, it's not a perfect analogy, but three times a day over five days, you're still getting 15 bouts of inflammation-

Dr Jenna Macciochi 38:11 Mm-hmm

Dr. Rangan Chatterjee 38:11 ... but that's over the whole week-

Dr Jenna Macciochi 38:13 Yeah

Dr. Rangan Chatterjee 38:13 ... as opposed to in just one day. And I, I really do think societally, culturally, there's a problem with how much we're being encouraged to eat, even healthy foods.

Dr Jenna Macciochi 38:23 Mm-hmm.

Dr. Rangan Chatterjee 38:23 Like you can buy-

Dr Jenna Macciochi 38:24 Yes

Dr. Rangan Chatterjee 38:24 ... healthy snacks here and healthy snacks there-

Dr Jenna Macciochi 38:26 Yeah

Dr. Rangan Chatterjee 38:26 ... but you're, you're sort of inflaming yourself each time and-

Dr Jenna Macciochi 38:31 Exactly

Dr. Rangan Chatterjee 38:31 ... I don't know. What, what, what would you make of that?

Dr Jenna Macciochi 38:33 Yeah, no, I think that's a real, uh, issue. I think it's not well enough understood in the scientific community to really translate into a kind of clear health message for people. But from the research I was involved in and from work like what Satchin Panda has done and others, I definitely think we need to look at the incidence of eating as well as, um, you know, the, the stretch of time that we're eating. I think some of the studies show that we're spending 18 hours a day eating.

Dr. Rangan Chatterjee 39:03 Yeah.

Dr Jenna Macciochi 39:03 It's just like the whole time we're awake. Um, and I don't think that we are sort of designed to cope with that on a long-term consistent basis. You know, going back to the traditional diets, uh, you know, my grandparents weren't eating all day every day, um, because that, that just wasn't how it was constructed. And different cultures all eat in different ways, but, uh, certainly it's not common to eat all the time. And I, I want to fuse the tradition with the modern life somehow because I think that's the key that we need. We can't go back to times gone by-

Dr. Rangan Chatterjee 39:39 Yeah

Dr Jenna Macciochi 39:39 ... but we can bring bits that we've left behind and kind of integrate it into what we have to work with right now somehow.

Dr. Rangan Chatterjee 39:48 Yeah. Well, I, I, I find a very effective and powerful recommendation I use on my patients-

Dr Jenna Macciochi 39:53 Mm-hmm

Dr. Rangan Chatterjee 39:53 ... is, uh, to try not to eat for 12 hours in every 24 hours. So, uh, you know, basically eating all your food within a 12-hour window.

Dr Jenna Macciochi 40:02 Mm-hmm.

Dr. Rangan Chatterjee 40:03 Uh, which, you know, really was the norm for pretty much-

Dr Jenna Macciochi 40:07 Yeah

Dr. Rangan Chatterjee 40:08 ... everyone maybe 30, 40 years ago. I mean-

Dr Jenna Macciochi 40:11 Yeah

Dr. Rangan Chatterjee 40:11 ... you know, we, we might stop eating at 8:00 PM.

Dr Jenna Macciochi 40:14 Mm-hmm.

Dr. Rangan Chatterjee 40:14 And maybe we wouldn't have breakfast till 8:00.

Dr Jenna Macciochi 40:16 Yeah.

Dr. Rangan Chatterjee 40:16 I mean, I'm, I'm not talking about an extreme fast.

Dr Jenna Macciochi 40:18 No.

Dr. Rangan Chatterjee 40:18 I'm just saying as a, I think it's quite, I certainly know when I, uh, manage to stick to that consistently-

Dr Jenna Macciochi 40:24 Mm-hmm

Dr. Rangan Chatterjee 40:24 ... I sleep better, I feel more energetic.

Dr Jenna Macciochi 40:26 Yeah.

Dr. Rangan Chatterjee 40:26 And I think there really is this idea that, you know, you need time for the body to regenerate a little bit. Your-

Dr Jenna Macciochi 40:32 Mm-hmm

Dr. Rangan Chatterjee 40:32 ... if your gut is constantly having to use up energy to-

Dr Jenna Macciochi 40:35 Yes

Dr. Rangan Chatterjee 40:36 ... constantly digest food, that's gonna impact your immune system. It's gonna impact-

Dr Jenna Macciochi 40:40 Mm-hmm

Dr. Rangan Chatterjee 40:40 ... you know, the resource it has for something else, right?

Dr Jenna Macciochi 40:42 Yes, exactly. There's, um, you know, the, the gut lining as well. There's a kind of, um, uh, it's energetically costly because it's, there's a turnover of those cells quite regularly, and things like the short chain fatty acids we mentioned earlier that are produced when our gut bugs digest fiber, they are really nurturing to, uh, the growth of, and repair of the, the cells that line the gut barrier.

Dr. Rangan Chatterjee 41:07 Yeah.

Dr Jenna Macciochi 41:07 And those are kind of the interface cells between what's going on in the gut and what's being put in the bloodstream that could exacerbate that inflammation. And we know that certain things like, um, saturated fats, um, high fructose diets, um, fiber poor diets, um, as well as other things like stress and extreme exercise can, uh, alter the integrity of that gut barrier-

Dr. Rangan Chatterjee 41:30 Yeah

Dr Jenna Macciochi 41:30 ... and exacerbate the sort of, uh, inflammation that you see postprandially. Um, and I know that some of the work that Tim Spector recently published, um, looked at postprandial inflammation and looked at also people's microbiomes-

Dr. Rangan Chatterjee 41:46 Yeah

Dr Jenna Macciochi 41:46 ... and found that the same food did vastly different things in different people, which is why we have to kind of have a bit of intuition of our own bodies and how we're feeling, how do we feel after we eat, and not, you know, just be eating something 'cause our friends are eating it. I know we have our kind of Eat Well guide and the public health messages, which are kind of good to give the whole population, um, a safety net against certain diseases. But I guess we don't all have access-

Dr. Rangan Chatterjee 42:16 Right

Dr Jenna Macciochi 42:16 ... to personalized nutrition, but we all have a very personal response to food, and we can't just say, "Don't eat that because that's inflammatory." It might be in you and it might be not the same in me.

Dr. Rangan Chatterjee 42:28 It's, yeah, it, it's, it's, you know, as an ideology, like these public health guides- I- it's tricky actually, because I get what you're saying, I get what the idea is to give a bit of a safety net. And I guess the way I sort of feel more these days is have we sort of disempowered individuals by doing that?

Dr Jenna Macciochi 42:49 Mm-hmm.

Dr. Rangan Chatterjee 42:49 Sort of by saying, "This is the way one should eat," when it's kind of, it's always been passed down, hasn't it?

Dr Jenna Macciochi 42:54 Mm-hmm.

Dr. Rangan Chatterjee 42:55 From, you know, parents to child, from grandparents to grandchild.

Dr Jenna Macciochi 42:59 Mm-hmm.

Dr. Rangan Chatterjee 42:59 It's like, "This is how you eat." And, you know, I'm not expecting an answer from you. Appreciate-

Dr Jenna Macciochi 43:05 [laughs]

Dr. Rangan Chatterjee 43:05 ... you know, you're a, you're a lecturer and you m- you know, may not wish to get drawn into this. But I'm just sort of sharing my perspective as I sort of get that, but I think we've lost touch with ourselves. Like-

Dr Jenna Macciochi 43:15 Definitely

Dr. Rangan Chatterjee 43:16 ... I think, you know, the conversation I had this morning here-

Dr Jenna Macciochi 43:19 Mm-hmm

Dr. Rangan Chatterjee 43:19 ... was with someone called Pippa Grange-

Dr Jenna Macciochi 43:21 Mm-hmm

Dr. Rangan Chatterjee 43:22 ... who is an amazing psychologist. She works with the England football team.

Dr Jenna Macciochi 43:26 Mm-hmm.

Dr. Rangan Chatterjee 43:26 She's, you know, all kinds of high-powered business. But we were really talking about, um, kind of intuition, but-

Dr Jenna Macciochi 43:34 Mm-hmm

Dr. Rangan Chatterjee 43:34 ... but spending time understanding yourself and really-

Dr Jenna Macciochi 43:36 Mm-hmm

Dr. Rangan Chatterjee 43:36 ... sitting with how you feel. So making that relevant to what we're talking about.

Dr Jenna Macciochi 43:40 Yeah.

Dr. Rangan Chatterjee 43:40 This idea that trying to tap into, oh, when I eat this sort of meal, oh, I've got more energy, I sleep better-

Dr Jenna Macciochi 43:48 Mm-hmm

Dr. Rangan Chatterjee 43:49 ... my gut feels better. I actually personally think, and this is probably different from 10 years ago as a doctor-

Dr Jenna Macciochi 43:55 Mm-hmm

Dr. Rangan Chatterjee 43:56 ... probably evolved the more patients I see. But I sort of feel that's, I think, where the power lies for people, is to yeah, get a bit of guidance-

Dr Jenna Macciochi 44:04 Mm-hmm

Dr. Rangan Chatterjee 44:04 ... understand some principles.

Dr Jenna Macciochi 44:06 Yeah.

Dr. Rangan Chatterjee 44:07 But then sort of within those principles, kind of figure it out for yourself.

Dr Jenna Macciochi 44:11 Yeah.

Dr. Rangan Chatterjee 44:11 Like experiment and see how you feel. There's no, there's no better tool than actually figuring out yourself, "Hey, when I eat that I get bloated afterwards. I don't sleep well. But when I don't have that or I have this, I feel fine." I think that is very powerful, but-

Dr Jenna Macciochi 44:25 Mm-hmm

Dr. Rangan Chatterjee 44:26 ... I think half the problem is with many people are too busy-

Dr Jenna Macciochi 44:28 Yeah

Dr. Rangan Chatterjee 44:28 ... to actually tune into how they're feeling.

Dr Jenna Macciochi 44:30 Definitely. I think that's something I've learned as I've got older, but I can definitely see how there was points in my life when I was too busy to really-

Dr. Rangan Chatterjee 44:38 Yeah

Dr Jenna Macciochi 44:38 ... you know, and, and I'd be eating on the go, um, years ago when I lived in London, and that just became really normal. And I remember speaking to my, um, great-grandmother and she was like, "In our day, it was a, you know, it was unheard of to eat and be on the bus or be walking around."

Dr. Rangan Chatterjee 44:56 [laughs]

Dr Jenna Macciochi 44:56 "You sat down to eat." And she was outraged by all the young people eating on the go, and she's kind of got a point.

Dr. Rangan Chatterjee 45:03 Good point.

Dr Jenna Macciochi 45:03 Because now I just avoid eating on the go because I, I don't like how it, I feel, you know? It, that's rushed and I'm not really chewing my food properly and-

Dr. Rangan Chatterjee 45:12 It, it's mindless eating

Dr Jenna Macciochi 45:13 ... it's not a very nice environment sitting on a bus or somewhere. I just wait till I get to the other end. And given that's not always possible, but I think w- we have become, you know, w- we've definitely pathologized feeling hungry. Like-

Dr. Rangan Chatterjee 45:26 Yeah

Dr Jenna Macciochi 45:26 ... most of us are not going to keel over if we don't snack in between our next meal.

Dr. Rangan Chatterjee 45:32 Yeah.

Dr Jenna Macciochi 45:32 Or maybe, maybe you might keel over because your blood sugar balance has kind of gone awry-

Dr. Rangan Chatterjee 45:36 Yeah, but be-

Dr Jenna Macciochi 45:36 ... because you've [laughs]

Dr. Rangan Chatterjee 45:37 Exactly, because you're metabolically sort of, I, I don't like the term broken so much, but because there's, there's some sort of-

Dr Jenna Macciochi 45:44 Yeah

Dr. Rangan Chatterjee 45:44 ... dysfunction there metabolically-

Dr Jenna Macciochi 45:46 Exactly

Dr. Rangan Chatterjee 45:46 ... that we can hopefully fix, but that may be why you need to eat every two hours.

Dr Jenna Macciochi 45:50 Yes. Yeah.

Dr. Rangan Chatterjee 45:51 You know? Maybe if the, the, the metabolism's working more optimally-

Dr Jenna Macciochi 45:55 Yeah

Dr. Rangan Chatterjee 45:55 ... you wouldn't need to.

Dr. Rangan Chatterjee 45:57 Let's get into some more practical things. Um-

Dr Jenna Macciochi 45:59 Mm-hmm

Dr. Rangan Chatterjee 45:59 ... I think you, you've really helped people understand the immune system, how important it is.

Dr Jenna Macciochi 46:04 Mm-hmm.

Dr. Rangan Chatterjee 46:05 So food so far it's been potentially think about how often you're eating-

Dr Jenna Macciochi 46:09 Mm-hmm

Dr. Rangan Chatterjee 46:10 ... uh, how much you're eating, how you're eating-

Dr Jenna Macciochi 46:12 Yeah

Dr. Rangan Chatterjee 46:12 ... but also this diversity. You did mention saturated fats. Um, let's just quickly go through the macronutrients then. Like-

Dr Jenna Macciochi 46:20 Yeah

Dr. Rangan Chatterjee 46:20 ... 'cause there was a really nice bit in the book about protein and immunity, which I found-

Dr Jenna Macciochi 46:23 Yeah

Dr. Rangan Chatterjee 46:23 ... really interesting. Um, but saturated fat is, is a very hot topic of-

Dr Jenna Macciochi 46:29 Mm-hmm

Dr. Rangan Chatterjee 46:29 ... conversation in, uh, how can I put it? The Twitter diets wars.

Dr Jenna Macciochi 46:33 Yes. [laughs]

Dr. Rangan Chatterjee 46:34 Um-

Dr Jenna Macciochi 46:35 Definitely. You're clear of those. [laughs]

Dr. Rangan Chatterjee 46:36 Yeah. I, I, I do these days. I'm just like, "Okay, I'm, I'm over it, really."

Dr Jenna Macciochi 46:39 Yeah.

Dr. Rangan Chatterjee 46:39 I sort of, I don't find it particularly helpful. Um, but also when we talk about saturated fat, there's so many different types of saturated fat, it gets quite-

Dr Jenna Macciochi 46:48 Mm-hmm

Dr. Rangan Chatterjee 46:48 ... a nuanced discussion. But I wonder if you could, let's talk about protein maybe.

Dr Jenna Macciochi 46:52 Mm-hmm.

Dr. Rangan Chatterjee 46:52 We could talk about fats and carbs and actually-

Dr Jenna Macciochi 46:54 Yeah

Dr. Rangan Chatterjee 46:54 ... how you see them impacting the immune system.

Dr Jenna Macciochi 46:57 Exactly. So I think carbs is the quality and the quantity, so these are where we're getting the fiber to feed our microbiota. So, um, thinking of that diverse, colorful produce that we're trying to eat 30 different plant foods in, over the course of a week. Um, carbohydrates are fueling our immune responses. Um, and then protein, I think protein malnutrition is probably globally one of the biggest factors that has a negative impact on our immune system because it's, it's, protein breaks down into amino acids, and these are the building blocks to make so many other proteins in our bodies, and the immune system, uh, is a huge sink for that because it needs, you know, antibodies are made from protein. The communication molecules are made from protein.

Dr. Rangan Chatterjee 47:41 So we need protein for the fabric-

Dr Jenna Macciochi 47:44 Yeah

Dr. Rangan Chatterjee 47:44 ... of our immune system.

Dr Jenna Macciochi 47:45 Exactly, yeah. And I think, you know, that's probably one of the key things, like I say, globally, that impacts our immunity. Uh, what's sort of less understood is which particular amino acids, these building blocks of proteins, are more or less, uh, important for different aspects of the immune system.

Dr. Rangan Chatterjee 48:02 Yeah.

Dr Jenna Macciochi 48:02 And I think that's something we'll see coming out in the next few years under this kind of immunometabolism field. Um-

Dr. Rangan Chatterjee 48:09 I think you beautifully addressed animal versus plants. Uh- I- in the book where you said, you know, animal proteins are typically more complete.

Dr Jenna Macciochi 48:19 Yeah.

Dr. Rangan Chatterjee 48:20 But plant-based proteins, a lot of cultures have actually learnt how to combine them-

Dr Jenna Macciochi 48:23 Yeah

Dr. Rangan Chatterjee 48:23 ... to give you that completeness. And I thought that was a very inclusive and a very empowering way. 'Cause people, you know, people these days are choosing to eat-

Dr Jenna Macciochi 48:31 Yes

Dr. Rangan Chatterjee 48:31 ... in very different ways. And-

Dr Jenna Macciochi 48:32 Yeah

Dr. Rangan Chatterjee 48:32 ... of course, choosing how you eat is a very modern, it's quite a privileged phenomenon in the first-

Dr Jenna Macciochi 48:37 Yeah

Dr. Rangan Chatterjee 48:37 ... place to be able to choose-

Dr Jenna Macciochi 48:39 Exactly

Dr. Rangan Chatterjee 48:39 ... the diet you wish to follow.

Dr Jenna Macciochi 48:40 Yeah.

Dr. Rangan Chatterjee 48:41 Um, but I thought it was really nice how you did that.

Dr Jenna Macciochi 48:43 Yeah.

Dr. Rangan Chatterjee 48:43 And what are some of those examples of combining?

Dr Jenna Macciochi 48:45 So I think, um, I think rice and beans-

Dr. Rangan Chatterjee 48:48 I think you put that in, yeah

Dr Jenna Macciochi 48:49 ... is a good one. Yeah, and, and you find these in sort of different, uh, cultural diets as well. And the complete proteins, the, the complete proteins are the ones that contain all of the amino acids that are considered essential. We cannot make them ourself. And then there's certain amino acids that we can make ourself. Um, and there's some that are conditionally essential, so in certain situations-

Dr. Rangan Chatterjee 49:12 Yeah

Dr Jenna Macciochi 49:12 ... they become essential. So most animal products tend to, um, you know, generally speaking contain all the essential ones, whereas most plant products tend to only contain some or other of them. But you can piece them together, and I think anyone who's switching, uh, out all animal products for plant-based, uh, protein sources should really m- make sure they get some sort of nutritional advice to ensure that they're not lacking in any of these amino acids. They-

Dr. Rangan Chatterjee 49:42 And, and, and study traditional diets, I guess-

Dr Jenna Macciochi 49:44 Mm-hmm

Dr. Rangan Chatterjee 49:44 ... or traditional cultures-

Dr Jenna Macciochi 49:46 Yeah

Dr. Rangan Chatterjee 49:46 ... who eat that way. You know, there is a lot of kind of ancestral wisdom there-

Dr Jenna Macciochi 49:50 Mm-hmm

Dr. Rangan Chatterjee 49:51 ... that we've known as humans before that-

Dr Jenna Macciochi 49:53 Yeah

Dr. Rangan Chatterjee 49:54 ... we've sort of forgotten, right?

Dr Jenna Macciochi 49:55 Maybe it's the human condition, you know, like when our parents try and tell us stuff and we're like, "No, we'll do it anyway." [laughs]

Dr. Rangan Chatterjee 50:00 Yeah.

Dr Jenna Macciochi 50:00 Um, and then we're like, "Oh, yes, they were right. That's what they were trying to tell us." So-

Dr. Rangan Chatterjee 50:04 Yeah

Dr Jenna Macciochi 50:04 ... it's like that cycle.

Dr. Rangan Chatterjee 50:04 I think we all know that, yeah.

Dr Jenna Macciochi 50:06 [laughs]

Dr. Rangan Chatterjee 50:06 Exactly.

Dr Jenna Macciochi 50:07 Yeah. So-

Dr. Rangan Chatterjee 50:08 So what, what's the deal with fats then?

Dr Jenna Macciochi 50:10 So fats, um, I think for a long time we kind of thought of fat as one thing, but it's not. It's lots of different things. Um, there's the unsaturated fats, so there's the mono and the polyunsaturated fats. So olive oil is probably the best example of a mono unsaturated fat, and there's lots of, um, epidemiological research around why it's important for health, and it has lots of these phytonutrients that I mentioned earlier included in it. And my own personal bias, because of my hybrid, uh, Italian family, is like, you know, ol- olive oil is life. [laughs] So it's all that I use, and, um, yeah, hold my hands up to that. Um, so it's, it's something that's, um, really important to include, uh, in your diet. I think people get afraid of cooking with olive oil, but it's, for the short term sort of home cooking, it's been shown to be stabilized by the presence of these phytonutrients.

Dr. Rangan Chatterjee 51:04 Yeah.

Dr Jenna Macciochi 51:04 So it's, it's a good healthful oil to use. And, you know, people have been using it for millennia, and, uh, it's associated with some of the most healthful diets in the world, like the Mediterranean region. Um, then the polyunsaturated fats are kind of interesting, 'cause you have the omega-3 and the omega-6. So some people might be familiar with these. Omega-3 supplements are quite popular now. Um, and I would say th- if you're not eating oily fish, then you should really think about an omega-3 supplement. Because these are, they're making up the, the, the cell membranes of our, our cells, but our immune system is using these as a resource to produce different, um, molecules that it uses to do its job. And, um, this includes production of inflammation, but also resolution of inflammation. And resolution of inflammation was something that was really neglected in the, the field for a long time. It's only maybe 10 years ago that we started to understand, oh, it's an active process. Inflammation just, just doesn't go away by itself. Simply the act of having inflammation in the body, having the presence of certain i- inflammatory cell types, causes the switch to the next phase, um, which is the pro-resolving, um, resolution of inflammation, which is healing and repair. And this is where our immune cells utilize these omega-3 fats from their cell membrane to produce pro-resolving molecules that help dampen down this and, and heal and repair the, the body.

Dr. Rangan Chatterjee 52:36 That, that is super fascinating. So, you know, we, we, we were saying at the start that inflammation is a normal process.

Dr Jenna Macciochi 52:44 Mm-hmm.

Dr. Rangan Chatterjee 52:44 You know, it's, but it's, it's meant to be short-lived.

Dr Jenna Macciochi 52:46 Mm-hmm.

Dr. Rangan Chatterjee 52:46 So it's meant to be there to help you fight something like a, you know, like a broken ankle, you know?

Dr Jenna Macciochi 52:51 Yeah.

Dr. Rangan Chatterjee 52:51 Or sorry, sprained ankle. You get-

Dr Jenna Macciochi 52:52 Mm-hmm

Dr. Rangan Chatterjee 52:52 ... red, hot-

Dr Jenna Macciochi 52:54 Yes

Dr. Rangan Chatterjee 52:54 ... swollen for a few days, and then it resolves.

Dr Jenna Macciochi 52:57 Yeah.

Dr. Rangan Chatterjee 52:57 The, the chronic inflammation, the chronic unresolved inflammation that's behind, uh, you know, type 2 diabetes, high blood pressure-

Dr Jenna Macciochi 53:04 Yeah

Dr. Rangan Chatterjee 53:04 ... a lot of cases of depression-

Dr Jenna Macciochi 53:06 Yes

Dr. Rangan Chatterjee 53:06 ... all kinds of autoimmune diseases-

Dr Jenna Macciochi 53:08 Yeah

Dr. Rangan Chatterjee 53:09 ... is a sort of chronic unresolved inflammation.

Dr Jenna Macciochi 53:11 Mm-hmm.

Dr. Rangan Chatterjee 53:11 And you're saying that omega-3s help to resolve inflammation.

Dr Jenna Macciochi 53:17 Yes.

Dr. Rangan Chatterjee 53:18 Which is, which is, you know, it's, like it's quite nice to actually be able to draw a direct sort of link.

Dr Jenna Macciochi 53:22 Yeah.

Dr. Rangan Chatterjee 53:22 Say, "Oh, that's gonna help me," you know, in, in colloquial terms, switch this off, I guess-

Dr Jenna Macciochi 53:27 Yes

Dr. Rangan Chatterjee 53:27 ... to a certain degree.

Dr Jenna Macciochi 53:28 And you have to also consider y- whatever's stimulating the inflammation in the first place needs to be somehow removed or-

Dr. Rangan Chatterjee 53:35 Yeah

Dr Jenna Macciochi 53:35 ... contained as well. There's a lot of studies in things like heart disease, depression. I think probably, um, rheumatoid arthritis is one that springs to mind, because there's, you know, dozens of m- um, uh, clinical trials now that show that high doses of omega-3 is really be- beneficial to the overall, um, patient's quality of life and, you know, their pain, um, disease management. But yet the NICE guidelines are still not suggesting that we treat people with this. It's still that i- they're welcome to explore something like a Mediterranean diet. So for me, rheumatoid arthritis is the one that holds the strongest evidence, but it's just challenging to get that into clinical practice, I think. There's also things like allergies, where omega-3s, the, the evidence is really quite mixed. But we- Have a sort of picture appearing where what the mother is eating when she's pregnant, and the fish, um, which is a great source of omega-3s, is really important to help prevent allergies in the unborn child. So again, not a really strong, um, clinical message yet, but I think that's some- something that we're gonna see coming out in the next few years.

Dr. Rangan Chatterjee 54:50 Yeah, and I think, you know, this is one of the big problems at the moment is with how information is communicated.

Dr Jenna Macciochi 54:58 Mm-hmm.

Dr. Rangan Chatterjee 54:58 Um, we can easily get overexcited by-

Dr Jenna Macciochi 55:01 Yeah

Dr. Rangan Chatterjee 55:01 ... certain things. But at the same time, I also think we put the brakes on a lot of things as well. Of course, we often need more evidence, but I also think sometimes with some things-

Dr Jenna Macciochi 55:11 Mm-hmm

Dr. Rangan Chatterjee 55:12 ... when the risk of harm is low-

Dr Jenna Macciochi 55:15 Yeah

Dr. Rangan Chatterjee 55:15 ... we should really be starting to think about, well, look, and when you, when for example we say mixed evidence, that implies, well, some evidence is suggesting it may work-

Dr Jenna Macciochi 55:24 Yeah

Dr. Rangan Chatterjee 55:24 ... and some is suggesting it, it's not. So it could be that in certain populations-

Dr Jenna Macciochi 55:29 Yes

Dr. Rangan Chatterjee 55:29 ... it works brilliantly.

Dr Jenna Macciochi 55:30 Exactly.

Dr. Rangan Chatterjee 55:31 And in other populations, it doesn't work at all, but no, we're gonna have a global recommendation that you don't do it 'cause we don't have the evidence.

Dr Jenna Macciochi 55:36 Yeah.

Dr. Rangan Chatterjee 55:36 And I just don't think it's, I really think we need to think about a better way sometimes to communicate some of this-

Dr Jenna Macciochi 55:45 Yeah

Dr. Rangan Chatterjee 55:45 ... with the public.

Dr Jenna Macciochi 55:45 It's really hard, especially th- you know, the thing with pregnant women and, and fish because there's mixed messages about how much fish pregnant women should intake-

Dr. Rangan Chatterjee 55:54 Mercury and

Dr Jenna Macciochi 55:54 ... because of mercury.

Dr. Rangan Chatterjee 55:55 Yeah.

Dr Jenna Macciochi 55:55 But yet we- we're starting to see a picture where having omega-3s are really important during pregnancy, but pregnant women might decide to not eat fish at all during pregnancy rather than, uh, the kind of gray area of you're allowed so many portions, but not-

Dr. Rangan Chatterjee 56:09 Yeah

Dr Jenna Macciochi 56:09 ... this fish, and only so many times a week. Um, and in which case then maybe a supplement would be suitable, but that's not, again, it's, it's very difficult to communicate-

Dr. Rangan Chatterjee 56:19 Yeah

Dr Jenna Macciochi 56:19 ... um, th- this kind of information into very clear-

Dr. Rangan Chatterjee 56:23 Yeah

Dr Jenna Macciochi 56:23 ... public health messages.

Dr. Rangan Chatterjee 56:25 In terms of saturated fats-

Dr Jenna Macciochi 56:26 Mm-hmm

Dr. Rangan Chatterjee 56:26 ... um, you have written about this in the book. Uh, I think you cover it really well. Um, as I say, there's lots of different kinds of saturated fats.

Dr Jenna Macciochi 56:36 Mm-hmm.

Dr. Rangan Chatterjee 56:36 And I think sometimes I, I find it confusing in the literature as to it's a specific type or they often it's an animal study with a high sucrose, high saturated fat diet-

Dr Jenna Macciochi 56:46 Yeah

Dr. Rangan Chatterjee 56:46 ... so you're con- one might be confusing sort of the high sugar and the high fat diet-

Dr Jenna Macciochi 56:52 Exactly

Dr. Rangan Chatterjee 56:52 ... combination. And I, I sort of think some people seem to be do okay with a little bit of saturated fat in the context of a natural-

Dr Jenna Macciochi 57:01 Yeah

Dr. Rangan Chatterjee 57:01 ... sort of more traditional diet. And I think that's where-

Dr Jenna Macciochi 57:03 Exactly

Dr. Rangan Chatterjee 57:04 ... and as you yourself said at the start, it's very hard when we just go to individual-

Dr Jenna Macciochi 57:08 Yeah

Dr. Rangan Chatterjee 57:08 ... nutrients and try and say good or bad.

Dr Jenna Macciochi 57:10 Exactly.

Dr. Rangan Chatterjee 57:10 It's kind of a lot more nuanced.

Dr Jenna Macciochi 57:12 Yeah. So we do know that saturated fat can be something that causes the gut barrier to open up, uh, more than other, um, foods, and that in itself can cause this sort of transient post, post-eating inflammation. But we also know that eating it in the context of a fiber rich diet is gonna kind of counterbalance that. And I think no food is just 100% saturated fat.

Dr. Rangan Chatterjee 57:37 Yeah.

Dr Jenna Macciochi 57:37 Every food has a mix of different nutrients, so we're not just eating saturated fat on its own. Um, but you can eat foods that are higher or lower in saturated fat.

Dr. Rangan Chatterjee 57:48 Yeah.

Dr Jenna Macciochi 57:48 And for some people, it may be beneficial to, uh, eat a, a lower saturated fat diet. For other healthy people, maybe it's not even something that needs to be on your radar because your overall pattern-

Dr. Rangan Chatterjee 58:01 Yeah

Dr Jenna Macciochi 58:01 ... is, is quite balanced.

Dr. Rangan Chatterjee 58:02 And, and then it also comes down to, doesn't it, like what's your current state of health? So-

Dr Jenna Macciochi 58:07 Mm-hmm

Dr. Rangan Chatterjee 58:07 ... if you have, for whatever reason, had a lot of insults to your body, whether it's stress, poor diets, inadequate movement, insomnia-

Dr Jenna Macciochi 58:16 Mm-hmm

Dr. Rangan Chatterjee 58:16 ... maybe you worked night shifts for, for 20 years or whatever, maybe at that point, maybe the gut is a little bit more leaky than, um-

Dr Jenna Macciochi 58:24 Mm-hmm

Dr. Rangan Chatterjee 58:25 ... than we would call physiological or, or normal-

Dr Jenna Macciochi 58:28 Yeah

Dr. Rangan Chatterjee 58:28 ... or optimal. Maybe in that context, foods can start to become problematic.

Dr Jenna Macciochi 58:34 Yeah.

Dr. Rangan Chatterjee 58:35 On the background of that, compared to someone who's got their, their health and their microbiome-

Dr Jenna Macciochi 58:40 Yeah

Dr. Rangan Chatterjee 58:41 ... in a completely different states.

Dr Jenna Macciochi 58:42 Yeah, exactly.

Dr. Rangan Chatterjee 58:43 And I, I really, I so strongly feel that that nuance is getting lost in health communication. I really think it, it gets lost on social media a lot of the time-

Dr Jenna Macciochi 58:52 Mm-hmm

Dr. Rangan Chatterjee 58:52 ... where things have become black and white.

Dr Jenna Macciochi 58:54 Yeah.

Dr. Rangan Chatterjee 58:54 So it's like, uh, and I don't know, I, I, I, I'm heavily influenced by my experience as a clinician seeing patients.

Dr Jenna Macciochi 59:02 Mm-hmm.

Dr. Rangan Chatterjee 59:02 I've just realized that it's very hard to say one thing for sure that is applicable in every single [laughs] situation.

Dr Jenna Macciochi 59:10 Yes. Yeah, yeah.

Dr. Rangan Chatterjee 59:11 Um...

Dr Jenna Macciochi 59:12 And I guess that's where, you know, we're not gonna be able to deliver personalized diets to everyone, but we can help sort of nurture intuition and-

Dr. Rangan Chatterjee 59:21 Yeah

Dr Jenna Macciochi 59:22 ... yeah, and steer people towards the, the helpful-

Dr. Rangan Chatterjee 59:26 I thought for you to be a very small part of this discussion.

Dr Jenna Macciochi 59:28 [laughs]

Dr. Rangan Chatterjee 59:28 And we spent a long time off these. So I think overall pattern-

Dr Jenna Macciochi 59:31 Mm-hmm

Dr. Rangan Chatterjee 59:31 ... lots of diversity.

Dr Jenna Macciochi 59:33 Yeah.

Dr. Rangan Chatterjee 59:33 Um, you know, we, we've covered a few things there. Uh, depending how long we've got, I'd love to talk about stress-

Dr Jenna Macciochi 59:40 Mm-hmm

Dr. Rangan Chatterjee 59:41 ... emotions-

Dr Jenna Macciochi 59:42 Mm-hmm

Dr. Rangan Chatterjee 59:43 ... um, the idea of hormesis, hot stress, cold stress.

Dr Jenna Macciochi 59:46 Yeah.

Dr. Rangan Chatterjee 59:46 Like, these are really interesting. So-

Dr Jenna Macciochi 59:48 Yeah

Dr. Rangan Chatterjee 59:48 ... um, I mean,

Dr. Rangan Chatterjee 59:50 I don't know which one do you wanna go to?

Dr Jenna Macciochi 59:51 Yeah. I don't know. I mean, I guess I start by saying I'm a natural stress head. I don't know why, but I, I, I get stressed very easily by things that I probably shouldn't. I think I, my husband's the opposite end of the spectrum, so sometimes he's like, "Why, why is she getting so, uh, worried, um, about things that she doesn't need to worry about?" So it's always on my radar 'cause I know that if I let it run away with me, I will start to feel the detrimental effects of stress. Um-

Dr. Rangan Chatterjee 1:00:21 In, in what way?

Dr Jenna Macciochi 1:00:22 I think the [laughs] biggest example was, um, the time I gave myself pneumonia, [laughs] which is, um-

Dr. Rangan Chatterjee 1:00:29 Wow

Dr Jenna Macciochi 1:00:29 ... uh, kind of embarrassing, but I was very stressed. I had I wasn't someone who grew up understanding what boundaries were. Maybe that was my generation. But I'm, I'm someone who li- I, I enjoy what I do, so I get excited about proj- projects. I take on everything. I say yes to everything, so I'm like, "That sounds amazing. That sounds amazing." Then I have to realize I, I have job, I have kids, I have to have downtime, I need to spend time with family and friends, you know, all the other life admin and life load that comes with it. And, um, and it was a couple of years ago, I got a cold, and my husband got the cold as well, my son got the cold. My daughter didn't, which c- probably could have another tangent about why, [laughs] even though we're all coughing on her. Um, and they got better, and I, I took no time off. I was working every evening to finish deadlines on various projects. Um, and I wasn't sleeping well 'cause I was going to bed a bit wired from-

Dr. Rangan Chatterjee 1:01:30 Working

Dr Jenna Macciochi 1:01:30 ... working and not able to switch off my brain, and thinking about what I had to get done tomorrow because I had other deadlines and other things. And then going to work, and I had this awful hacking cough. This is pre-COVID, so-

Dr. Rangan Chatterjee 1:01:42 [laughs]

Dr Jenna Macciochi 1:01:43 ... definitely wasn't COVID. And, um, I was starting to hide it from my colleagues [laughs] and my family. I was trying to pretend that I was fine. I was just feeling awful. My chest was rattling, and then I just couldn't get out of bed one day, and I, I couldn't take care of my kids. I feel quite emotional talking about it, actually, um, because I was just there. I, I, I just literally, uh, I n- I've never had the sort of bone-ra- rattling chesty cough-

Dr. Rangan Chatterjee 1:02:09 Yeah

Dr Jenna Macciochi 1:02:10 ... um, fever. I, and I was in bed for three weeks.

Dr. Rangan Chatterjee 1:02:14 Wow.

Dr Jenna Macciochi 1:02:14 And, you know, all of those deadlines, my job, my kids, I couldn't do any of it. And I, I just ignored a cold, and I kept on going anyway, and I was so stressed. And I didn't stop and recognize that I was stressed, and the trickle-down effect-

Dr. Rangan Chatterjee 1:02:30 Yeah

Dr Jenna Macciochi 1:02:30 ... it was having on all the other behaviors, um, that I was engaging in, like my sleep and everything. And that was a, you know-

Dr. Rangan Chatterjee 1:02:37 I mean, a, a, a very powerful story, and thank you for-

Dr Jenna Macciochi 1:02:40 [laughs]

Dr. Rangan Chatterjee 1:02:41 ... opening up and sharing it. I can see it's still-

Dr Jenna Macciochi 1:02:42 Yeah

Dr. Rangan Chatterjee 1:02:42 ... you know, it's, it is very emotional. Um, so that's your immune system getting completely flawed.

Dr Jenna Macciochi 1:02:49 Mm-hmm.

Dr. Rangan Chatterjee 1:02:50 So what's going on there? I mean, let's break that down. You were overworked, over-stressed, not sleeping well.

Dr Jenna Macciochi 1:02:56 Mm-hmm.

Dr. Rangan Chatterjee 1:02:57 And all those things are impacting your immune system.

Dr Jenna Macciochi 1:03:00 Yeah.

Dr. Rangan Chatterjee 1:03:00 So what, what is going on?

Dr Jenna Macciochi 1:03:01 I think that one of the most interesting things was I was probably eating pretty well because I love cooking, and it's part of my, sort of thing that I, I enjoy doing. So that, in itself, is just evidence that even if you have the best diet in the world, you know, other things can erode away at your immune system and, and leave you open. And stress is probably the one thing, I know that it's something that you've written about a lot, and it, it's the one thing that we don't take seriously. We think of it as being psychological, and the causes can be psychological. They can be physical. They can be emotional. But they're always biological because the stress chemistry is real, the things that are being produced in our body that give us that stress response, um, that i- is having a really real impact on our body. And I've come to really start to think about how I can make stress a positive in my life because ultimately it's the thing that gets us out of bed in the morning. It gives us the get up and go to go and do-

Dr. Rangan Chatterjee 1:04:06 Yeah

Dr Jenna Macciochi 1:04:06 ... things. Um, and what I've been learning about my own journey is when you reflect on events, you d- describe them as stressful if they were negative, but you describe them as something else if they worked out, you know, well for you. So as a society, we, we think of stress as being, um, a negative thing. But if you, uh, there's experiments that have been done where they take groups of students before a presentation, and th- they're being told to recite kind of positive affirmations or, or negative affirmations about what they're about to do, and this has a huge impact-

Dr. Rangan Chatterjee 1:04:42 Yeah

Dr Jenna Macciochi 1:04:42 ... on their stress chemistry. But also, there's a trickle-down effect on your immune system-

Dr. Rangan Chatterjee 1:04:47 Yeah

Dr Jenna Macciochi 1:04:47 ... because stress is, you know, designed to save your life. So you're about to be hit by a bus. You're gonna run for your life. You're, you're, uh, you know, within seconds you're switching on that, um, adrenaline response to, to mobilize you-

Dr. Rangan Chatterjee 1:05:00 Yeah

Dr Jenna Macciochi 1:05:00 ... to safety. Then we have cortisol, one of the key stress hormones, that's gonna keep you running, keep you going. It's gonna pump glucose into your bloodstream so you've got instant energy to, to go and take yourself from safety. That's all energetically costly, and that's saying, "Well, you've got a cold, but we're gonna stop fighting the cold right now because we need to save your life. So turn off the immune system, and turn on all the other stuff-

Dr. Rangan Chatterjee 1:05:24 Yeah

Dr Jenna Macciochi 1:05:24 ... that needs to save your life." So cortisol, um, is, is sort of like the off switch for protecting ourselves. Uh-

Dr. Rangan Chatterjee 1:05:32 Yeah

Dr Jenna Macciochi 1:05:32 ... and then it really dampens our immune system. And that's okay if it's for, you know, a series of hours, but when it's hours and days and months-

Dr. Rangan Chatterjee 1:05:41 Yeah

Dr Jenna Macciochi 1:05:41 ... and over the long term, then you're constantly kind of running, running on empty.

Dr. Rangan Chatterjee 1:05:46 Yeah. It's, I mean, I, I'm, I'm glad you shared your story, and I'm glad you're making a point of this because I think in health and wellness in general-

Dr Jenna Macciochi 1:05:56 Mm-hmm

Dr. Rangan Chatterjee 1:05:56 ... there is, you know, I'm a big fan that food is important.

Dr Jenna Macciochi 1:05:59 Yeah.

Dr. Rangan Chatterjee 1:06:00 I think there is far too much focus on foods-

Dr Jenna Macciochi 1:06:03 Mm-hmm

Dr. Rangan Chatterjee 1:06:03 ... at the expense of other factors as well. And many people-

Dr Jenna Macciochi 1:06:07 Yeah

Dr. Rangan Chatterjee 1:06:07 ... frankly, their diet is good enough.

Dr Jenna Macciochi 1:06:09 Mm-hmm.

Dr. Rangan Chatterjee 1:06:10 And trying to make a 5% improve in their diet, they're much better off trying to address their stress levels-

Dr Jenna Macciochi 1:06:15 Yeah

Dr. Rangan Chatterjee 1:06:15 ... or their sleep quality. Getting a, getting an extra half an hour sleep a night-

Dr Jenna Macciochi 1:06:18 Yeah

Dr. Rangan Chatterjee 1:06:19 ... is probably gonna do them more good than tweaking their diet by an extra 5%.

Dr Jenna Macciochi 1:06:24 Exactly.

Dr. Rangan Chatterjee 1:06:24 And I, and I really think we've got the balance wrong, and I think that's also because of the way we talk about stress and how we see it in society and our food.

Dr Jenna Macciochi 1:06:31 Mm-hmm.

Dr. Rangan Chatterjee 1:06:31 You can see that. It's on your plates, right?

Dr Jenna Macciochi 1:06:33 Yeah.

Dr. Rangan Chatterjee 1:06:33 You see, you can see food. You can see the choice.

Dr Jenna Macciochi 1:06:35 Exactly.

Dr. Rangan Chatterjee 1:06:36 But, you know, you mentioned that. I mean, that was a pneumonia. Um, you know, my dad, who- Who I spent 15 years caring for. Dad, when he w- you know, he was a, a, he was a, he was a consultant doctor in this country. Um, but he, you know, he worked stupid hours.

Dr Jenna Macciochi 1:06:53 Mm-hmm.

Dr. Rangan Chatterjee 1:06:53 Right? He had a, he, he did two jobs. He had a full-time job as a consultant. He also worked nights, four days a week in-

Dr Jenna Macciochi 1:06:59 Mm-hmm

Dr. Rangan Chatterjee 1:06:59 ... another sort of medical job. So for 30 years, my dad only slept three nights a week, which-

Dr Jenna Macciochi 1:07:06 Wow

Dr. Rangan Chatterjee 1:07:06 ... and, and you know, when dad was, I think in his sort of mid to late 50s, he suddenly got unwell. He'd never been unwell before.

Dr Jenna Macciochi 1:07:12 Mm-hmm.

Dr. Rangan Chatterjee 1:07:13 And boom, all our lives changed. He came down with lupus-

Dr Jenna Macciochi 1:07:17 Mm-hmm

Dr. Rangan Chatterjee 1:07:17 ... kidney failure, and then that was 15 years of dialysis. That was me moving back to the northwest.

Dr Jenna Macciochi 1:07:22 Oh, goodness.

Dr. Rangan Chatterjee 1:07:22 It was, it's really impacted my whole adult life, and I now, the more I delve into research and the im- impacts of stress-

Dr Jenna Macciochi 1:07:29 Mm-hmm

Dr. Rangan Chatterjee 1:07:29 ... on your immune system, the impacts of sleep deprivation-

Dr Jenna Macciochi 1:07:33 Mm-hmm

Dr. Rangan Chatterjee 1:07:33 ... on your immune system, but also emotions-

Dr Jenna Macciochi 1:07:36 Mm-hmm

Dr. Rangan Chatterjee 1:07:37 ... and things like anger and pent up stuff.

Dr Jenna Macciochi 1:07:39 Mm-hmm.

Dr. Rangan Chatterjee 1:07:40 I'm like, well, of course my dad got lupus, right? And, and someone might say to me, "Oh, you can't prove that." Okay, sure. But I don't need to. Like, in my head [laughs] I like-

Dr Jenna Macciochi 1:07:49 Mm-hmm

Dr. Rangan Chatterjee 1:07:50 ... like I don't have to prove that to anyone. I know looking at my dad's life that that sort of lifestyle, and I love my dad, and I love what he's done for the family-

Dr Jenna Macciochi 1:07:57 Mm-hmm

Dr. Rangan Chatterjee 1:07:57 ... right? So I understand he was doing what he felt-

Dr Jenna Macciochi 1:08:01 Yeah

Dr. Rangan Chatterjee 1:08:01 ... he had to do to give us a great life-

Dr Jenna Macciochi 1:08:04 Yeah

Dr. Rangan Chatterjee 1:08:04 ... and he has. But it came at a cost.

Dr Jenna Macciochi 1:08:07 Yeah.

Dr. Rangan Chatterjee 1:08:07 And as you said before, there is a cost to the immune system doing what it does.

Dr Jenna Macciochi 1:08:11 Yeah.

Dr. Rangan Chatterjee 1:08:11 There is a cost, and I think in my dad's cost-

Dr Jenna Macciochi 1:08:13 Mm-hmm

Dr. Rangan Chatterjee 1:08:13 ... chronic stress, chronic insomnia-

Dr Jenna Macciochi 1:08:15 Mm-hmm

Dr. Rangan Chatterjee 1:08:16 ... I am convinced led to his lupus.

Dr Jenna Macciochi 1:08:20 Yeah.

Dr. Rangan Chatterjee 1:08:20 Um, now-

Dr Jenna Macciochi 1:08:21 And there's so many anecdotes that I hear all the time of people saying there was a stressful event, or there was something that happened, or I lost a, a partner, or you know, and, and that was a turning point in my health, started to decline. And nothing else changed but the stress. And the-

Dr. Rangan Chatterjee 1:08:38 I, I, I, I do a timeline with my patients, right? And, and I can tell you when people come down with an autoimmune illness, when you go back into that whole history-

Dr Jenna Macciochi 1:08:46 Mm-hmm

Dr. Rangan Chatterjee 1:08:46 ... and again, I'm skewed by my patient population-

Dr Jenna Macciochi 1:08:48 Yeah

Dr. Rangan Chatterjee 1:08:48 ... so this may not be applicable to everyone, but in my patient population, when I draw a timeline, it is amazing how many times within six months of them getting symptoms some significant life stressor happened.

Dr Jenna Macciochi 1:09:02 Mm-hmm.

Dr. Rangan Chatterjee 1:09:03 Could've been a lost job-

Dr Jenna Macciochi 1:09:04 Yeah

Dr. Rangan Chatterjee 1:09:04 ... bereavement, breakup. It was, it's almost like stress can sometimes not only be a contributor. Sometimes it can be the trigger.

Dr Jenna Macciochi 1:09:10 The trigger, yeah. Everything else was waiting there. And it, it has all the, the trickle-down effects as well. When I'm stressed, like I said before, I wasn't sleeping very well because there's a trickle-down effect, and you're more likely to engage in negative behaviors. So most people when they're stressed, they might say, "Oh, I'm just eating really badly because I'm stressed." Uh, it's a major kind of driver of, um, uh, you know, these negative behaviors that are, uh... Then you're in a sort of vicious cycle of things, and you can't-

Dr. Rangan Chatterjee 1:09:40 You, you are, and, and at the moment people are beating themselves up that they put on weight during this pandemic.

Dr Jenna Macciochi 1:09:44 Mm-hmm.

Dr. Rangan Chatterjee 1:09:45 And I really wanna sort of say with heartfelt compassion to people, you really don't have to because, um, there, there's a study from about 10 years ago which showed that, you know, maybe 80% of us change our eating behavior in response to stress.

Dr Jenna Macciochi 1:10:00 Mm-hmm.

Dr. Rangan Chatterjee 1:10:00 And it's roughly, I think it's roughly 45% of us eat more-

Dr Jenna Macciochi 1:10:05 Mm-hmm

Dr. Rangan Chatterjee 1:10:05 ... and 35% of us eat less.

Dr Jenna Macciochi 1:10:07 Yeah, I can imagine that.

Dr. Rangan Chatterjee 1:10:08 We-

Dr Jenna Macciochi 1:10:08 I've got friends who say, "Oh, I, when I'm stressed I can't eat."

Dr. Rangan Chatterjee 1:10:11 Yeah.

Dr Jenna Macciochi 1:10:11 And then there's other people who eat too much-

Dr. Rangan Chatterjee 1:10:14 As a wa-

Dr Jenna Macciochi 1:10:14 ... as a way, yeah.

Dr. Rangan Chatterjee 1:10:15 Yeah. And so of course, in one of the most stressful month, y- you know, few months-

Dr Jenna Macciochi 1:10:19 Mm-hmm

Dr. Rangan Chatterjee 1:10:19 ... in, in certainly my lifetime and many people's lifetimes-

Dr Jenna Macciochi 1:10:22 Mm-hmm

Dr. Rangan Chatterjee 1:10:22 ... well, of course there's gonna be a certain population who are wired-

Dr Jenna Macciochi 1:10:27 Yeah

Dr. Rangan Chatterjee 1:10:27 ... to use food to soothe their stress.

Dr Jenna Macciochi 1:10:29 Yeah.

Dr. Rangan Chatterjee 1:10:30 Um, I know I've heard you talk about before that stress impacts the, the microbiome, the, the gut bugs.

Dr Jenna Macciochi 1:10:37 Mm-hmm.

Dr. Rangan Chatterjee 1:10:37 But it also impacts the stress re- the, the cortisol receptor, doesn't it?

Dr Jenna Macciochi 1:10:41 Yes. Yeah, it's kind of like you're, you're constantly revving your engine, but you've got your foot on the brake at the same time. And it, it's, you know, we have ways and means of switching off the stress response, but that circuit gets worn out a little bit when it's constantly at play, and everything just starts to get, um, off balance-

Dr. Rangan Chatterjee 1:11:02 Yeah

Dr Jenna Macciochi 1:11:02 ... from then. And because, you know, our immune cells have receptors for all of the different hormones, the stress chemistry, they're being influenced by that as well. It's influencing the production of fresh, new immune cells from the bone marrow. So things like cortisol can have a sort of dampening effect on that. Um, and there's this, a concept of the immunological space. I'm not sure if you've heard of this, but we only have so much space in our body for immune cells, and over your lifespan your immune cells, you know, proliferate when we see an infection, or we sort of gather up more and more immune cells until it becomes full, and we kind of have to wait for the old ones to die off before our body can produce fresh, new ones. And older immune cells are more likely to go wrong. So we need to have a way of getting rid of the old ones and bringing in the new ones. And so this kind of balance, um, can be really interrupted by being stressed out all the time.

Dr. Rangan Chatterjee 1:12:01 Is there anything you do yourself, having experienced the negatives of burning the candle at both ends-

Dr Jenna Macciochi 1:12:09 Yeah

Dr. Rangan Chatterjee 1:12:09 ... you know, really trying to say yes to everyone and do everything-

Dr Jenna Macciochi 1:12:12 Oh, that's [laughs] the hardest lesson

Dr. Rangan Chatterjee 1:12:14 ... uh, yeah, getting pneumonia-

Dr Jenna Macciochi 1:12:15 Yeah

Dr. Rangan Chatterjee 1:12:16 ... when you couldn't do anything. What have you, as an immunologist yourself, but also-

Dr Jenna Macciochi 1:12:20 Well-

Dr. Rangan Chatterjee 1:12:20 ... as a human who's susceptible to the same pressures-

Dr Jenna Macciochi 1:12:23 Yeah

Dr. Rangan Chatterjee 1:12:23 ... as all of us, what have you changed?

Dr Jenna Macciochi 1:12:25 I've tried to be a bit more open, 'cause I hate seeing in, in the wellness sphere people looking like their life is perfect, and I just think we all get it wrong. Even, you know, my colleagues were like, "How on earth do you end up letting yourself get pneumonia?" Like, it's so stupid. [laughs]

Dr. Rangan Chatterjee 1:12:40 Letting, even the language-

Dr Jenna Macciochi 1:12:40 Yeah, exactly

Dr. Rangan Chatterjee 1:12:41 ... isn't it? Letting yourself. It's-

Dr Jenna Macciochi 1:12:42 Like, come on. You should know better. Um, I went on a bit of a journey to dis- dis- look at what, what helps stress. Um, and some, I obviously went into the research first of all, just being a scientist. [laughs] And what I found was, um- You know, there's sort of cultural aspects to our immune system, and what I mean by that is, you know, um, I was writing about this the other day, like the act of writing stuff down, like disclosing stressful events or traumatic events is, is seen as being very, uh, cathartic and good for our health. But what we don't realize is this is through a sort of Western perspective, and in some cultures, writing is actually more stressful because it becomes vi- visual on the, the page. Somebody might read it even if you know it's private, and that can be more stressful, and it can alter the stress chemistry. It can also alter things like their immune cells and how well they're working and how many colds and flus they're likely to pick up that year. So when I think about the current pandemic and how we know that certain populations are more susceptible to severe COVID, so the Black and minority ethnic groups, and instantly we try and look at the biology of why is that, and then we realize that it could be cultural things. The stress of, um, not having, uh, you know, living up to sort of cultural norms-

Dr. Rangan Chatterjee 1:14:09 Yeah

Dr Jenna Macciochi 1:14:09 ... of how you live your lifestyle, or not having the cultural norms of how you relieve your stress or what a support network looks like. It can be quite stressful for people.

Dr. Rangan Chatterjee 1:14:20 That is, that is one of the most interesting things I've heard, uh, Jenna. It's, it's, it's like, you know, I'm a huge fan of journaling. I think journaling can help so many people.

Dr Jenna Macciochi 1:14:29 Mm-hmm.

Dr. Rangan Chatterjee 1:14:29 But if you're journaling and you're worried that someone's gonna see what you've written-

Dr Jenna Macciochi 1:14:33 Mm-hmm

Dr. Rangan Chatterjee 1:14:34 ... well, that's a whole different experience.

Dr Jenna Macciochi 1:14:36 Yeah. It's-

Dr. Rangan Chatterjee 1:14:36 Like, and, and what's interesting is you're saying that your immune system senses that-

Dr Jenna Macciochi 1:14:41 Yeah

Dr. Rangan Chatterjee 1:14:41 ... and alters what it does based upon that perception.

Dr Jenna Macciochi 1:14:46 Exactly.

Dr. Rangan Chatterjee 1:14:47 So, so-

Dr Jenna Macciochi 1:14:47 Which is kind of mind-blowing, isn't it?

Dr. Rangan Chatterjee 1:14:48 It, it's mind-blowing, but then it's, it also, it can either be frustrating for people or empowering.

Dr Jenna Macciochi 1:14:53 Mm-hmm.

Dr. Rangan Chatterjee 1:14:53 So it basically means everything we do, the thoughts we think, the emotions-

Dr Jenna Macciochi 1:14:58 Yeah

Dr. Rangan Chatterjee 1:14:58 ... we feel.

Dr Jenna Macciochi 1:14:59 Yeah.

Dr. Rangan Chatterjee 1:15:00 Uh, and you've got this lovely bit, I think I've probably got to open it, you know, As Above, So Below, Emotional Roots of Disease, and it's page 160 of your book. Like, I really like what you put there and how, um, you know, you know, and you, you sort of say much of the medical community remains skeptical-

Dr Jenna Macciochi 1:15:17 Yeah

Dr. Rangan Chatterjee 1:15:17 ... but there's piling evidence that virtually every ill from the common cold to cancer and heart disease is influenced-

Dr Jenna Macciochi 1:15:24 Mm-hmm

Dr. Rangan Chatterjee 1:15:24 ... positively or negatively by a person's emotional and mental state.

Dr Jenna Macciochi 1:15:30 Yeah.

Dr. Rangan Chatterjee 1:15:30 And you're saying we can no longer ignore, ignore this connection.

Dr Jenna Macciochi 1:15:33 Yeah. It's just the hardest thing to study because, you know, it's subjective, it's, it's fuzzy, it's, it's, it's not any of that hard empirical data.

Dr. Rangan Chatterjee 1:15:41 But, but if you ask any cl- like, the, the, the experienced clinicians who I'm friend with-

Dr Jenna Macciochi 1:15:46 Mm-hmm

Dr. Rangan Chatterjee 1:15:46 ... friends with, um, we all get it-

Dr Jenna Macciochi 1:15:50 Mm-hmm

Dr. Rangan Chatterjee 1:15:50 ... because we've seen it. Now, I get there's a, there's often a disconnect between what we see clinically and what we're able to study and quantify.

Dr Jenna Macciochi 1:15:58 Yeah.

Dr. Rangan Chatterjee 1:15:59 But I got to tell you, you know, you see this all, all the time and, and you sort of, you summarize, I think, what was, what was the quote? "It's far more important to know what person the dis- what, what person the disease..." What, what was the quote?

Dr Jenna Macciochi 1:16:12 Yeah, so it's more important to know what person the disease has than what disease the person has. So it's kind of who is the person, first and foremost, and there's a really, uh, interesting-

Dr. Rangan Chatterjee 1:16:24 That's Hippocrates, isn't it?

Dr Jenna Macciochi 1:16:24 Yeah, yeah. There's a really interesting study that, um, it looked at sort of these five major personality types. So they are kind of roughly divided into, like, openness to experience, conscientiousness, extrovertedness, agreeableness, and neuroticism. So in psychology terms, they're kind of ways that we can be categorized based on our personality. Um, and each of these personality types have specific immunological features, and one of the most interesting thing is that, um, some of them are more likely to be pro-inflammatory and have higher levels of C-reactive protein, which is a marker in the blood for, for inflammation. Um, and things like being neurotic and, um, being, uh, sort of less introverted, it can affect the inflammation in our bodies because I guess we're all very different. We're all on a sort of spectrum of different personalities, but that's evolved from maybe different roles you might play within a community. Um, and then what your exposure to different infections might be or your risk of getting injured. Um, things like anger is known to prime the body for, um, for becoming damaged because maybe anger preceded violence, and throughout our evolution-

Dr. Rangan Chatterjee 1:17:44 Right

Dr Jenna Macciochi 1:17:44 ... we've like, okay, if you're angry, something might happen that might damage you, so we need to prime parts of our immune system to prepare for that.

Dr. Rangan Chatterjee 1:17:51 That's ... You mentioned anger, and it's something I wrote about in Feel Better in 5 is the importance of forgiveness.

Dr Jenna Macciochi 1:17:55 Mm-hmm.

Dr. Rangan Chatterjee 1:17:56 There is good research on forgiveness.

Dr Jenna Macciochi 1:17:58 Yeah.

Dr. Rangan Chatterjee 1:17:58 A guy called Fred Luskin's done the Stanford University, I think, forgiveness trial or research that I can't remember the exact name.

Dr Jenna Macciochi 1:18:05 Yeah.

Dr. Rangan Chatterjee 1:18:06 His research is incredible, and I, I shared in my last book a story about one of my patients who had high blood pressure, and which again, you know, to, to, to make it relevant to our conversation, you know, high blood pressure is a chronic-

Dr Jenna Macciochi 1:18:22 Mm-hmm

Dr. Rangan Chatterjee 1:18:22 ... non-communicable illness that, you know, will have chronic inflammation-

Dr Jenna Macciochi 1:18:26 Yeah

Dr. Rangan Chatterjee 1:18:26 ... playing a role-

Dr Jenna Macciochi 1:18:28 Yeah

Dr. Rangan Chatterjee 1:18:28 ... in some way. And you know what? She had changed her lifestyle. I was, you know, I was doing the stuff I try and, uh, talk about, food and movement and sleep. You know what? It wasn't budging.

Dr Jenna Macciochi 1:18:39 Mm-hmm.

Dr. Rangan Chatterjee 1:18:40 And it was to do with, um, you know, basically her, um, her husband of many years had cheated on her-

Dr Jenna Macciochi 1:18:48 Yeah

Dr. Rangan Chatterjee 1:18:48 ... and they had split up, and it was only once she started practicing forgiveness-

Dr Jenna Macciochi 1:18:54 Mm-hmm

Dr. Rangan Chatterjee 1:18:55 ... right, that her blood pressure started going down. It, it-

Dr Jenna Macciochi 1:18:59 Oh

Dr. Rangan Chatterjee 1:18:59 ... was incredible. And so that's a, like that's an anecdotal story from my clinic.

Dr Jenna Macciochi 1:19:04 Yeah.

Dr. Rangan Chatterjee 1:19:04 But, uh, it really, I think it does- stand, uh, firm-

Dr Jenna Macciochi 1:19:10 Mm-hmm

Dr. Rangan Chatterjee 1:19:10 ... and consistent with the research that is out there in terms of if you're holding onto resentment-

Dr Jenna Macciochi 1:19:15 Yeah

Dr. Rangan Chatterjee 1:19:15 ... and anger, that will influence your biology-

Dr Jenna Macciochi 1:19:19 Yeah

Dr. Rangan Chatterjee 1:19:19 ... and your immune system.

Dr Jenna Macciochi 1:19:20 Exactly. And it, maybe that is culturally what we see dividing different groups and how they deal with illness as well because they may feel, uh, uh, marginalized. I think social status is also really important. I know that i- in the animal kingdom, being lower down the pecking order can be quite stressful for an animal, and that can be seen in its, its blood chemistry, but also for us humans. Um, and I think that's-

Dr. Rangan Chatterjee 1:19:48 Yeah

Dr Jenna Macciochi 1:19:48 ... you know, something that w- we see playing out with the sort of lower socioeconomic, um, uh, demographics are worst hit by some of these lifestyle related diseases.

Dr. Rangan Chatterjee 1:19:58 Yeah, and-

Dr Jenna Macciochi 1:19:58 They may have more stressful lifestyles and-

Dr. Rangan Chatterjee 1:20:01 But we always, we put it down, don't we, to, oh, less access to good food, more stress, and of course, I think those play a role.

Dr Jenna Macciochi 1:20:08 Mm-hmm.

Dr. Rangan Chatterjee 1:20:09 But what if it's also related to status as it is-

Dr Jenna Macciochi 1:20:12 Yeah

Dr. Rangan Chatterjee 1:20:12 ... in the animal kingdom? What-

Dr Jenna Macciochi 1:20:13 Yeah

Dr. Rangan Chatterjee 1:20:13 ... you know, that's something I hadn't probably given as much thought to and it's probably not as common a narrative. It's h- where do you... I guess it's, you know, in many ways it's do you feel your life [laughs] has purpose?

Dr Jenna Macciochi 1:20:26 Yeah. Yeah.

Dr. Rangan Chatterjee 1:20:28 You know, how do you see your life? What's the meaning behind it? 'Cause that as well in itself has a huge amount of research suggesting it's, you know, if you feel your life has meaning and value, you tend to have a happier and healthier life.

Dr Jenna Macciochi 1:20:40 Yeah. I mean, another piece of research I came across recently was comparing, um, Samoan individuals to European individuals with, um, Epstein-Barr virus, which is a virus that almost all of us harbor, but when we activate our stress chemistry, um, this can be actually a sign that the virus uses to allow itself to reactivate and, and cause problems. And we know in the Western culture that being of a lower socioeconomic status means that you're more likely to experience viral reactivation. But in the Samoan culture, um, being on a lower socioeconomic status has a totally different impact on the stress chemistry that actually meant it was the people in the higher socioeconomic bracket that were worse affected by latent viral reactivation. And this is just an, you know, they used the viral reactivation as a readout, an empirical way of, of measuring the immune system changes. But i- in different cultures, you know, you... And we never think about this-

Dr. Rangan Chatterjee 1:21:40 Yeah

Dr Jenna Macciochi 1:21:40 ... in medicine.

Dr. Rangan Chatterjee 1:21:41 I mean, what's that like for you as a scientist and as a lecturer? These are the kind of, you know, these would be, these would be perceived as the kind of softer-

Dr Jenna Macciochi 1:21:50 Yes. Yeah

Dr. Rangan Chatterjee 1:21:51 ... aspects of health and science. But it's, you know, that, that-

Dr Jenna Macciochi 1:21:55 We need to-

Dr. Rangan Chatterjee 1:21:55 ... data is data, right?

Dr Jenna Macciochi 1:21:56 Exactly. We need to bring it together. A lot of the data is actually quite old now, but I guess it's just been parked there, and we have this real kind of biomedical model where we focus in on one cell type, and what is that cell doing, and it's really reductionist, and then we try and piece the jigsaw together. And we kind of need to fuse it with the anthropology and be like, "Okay, now how do we bring these two fields together?" Because that's the only way we can tackle, I think, where we're at-

Dr. Rangan Chatterjee 1:22:21 Yeah

Dr Jenna Macciochi 1:22:21 ... with our health.

Dr. Rangan Chatterjee 1:22:22 And, and, you know, you, you sort of, you, you really beautifully bridge it throughout the book, all these different components.

Dr Jenna Macciochi 1:22:29 Mm-hmm.

Dr. Rangan Chatterjee 1:22:30 Emotions, food, movement, sleep, stress.

Dr Jenna Macciochi 1:22:33 Yeah.

Dr. Rangan Chatterjee 1:22:33 You know, you, there's got a nice section on supplements as well, which we probably won't be able to get into today. Um, but-

Dr Jenna Macciochi 1:22:39 And the, um, the joy of the table, so the gioia della tavola, which is an Italian phrase for enjoying being at the table. And linking what we were talking about earlier with food to emotions. You know, make your table a joyous place to be because endorphins from enjoying being at your table with your family, your friends, or even on your own and just enjoying the meal, endorphins can alter the function of our immune cells because they have receptors for those on them. So those feelgood hormones, that actually helps nurture things like the T regs, the regulatory T cells. So bringing the food together with the emotion and, and enjoying that, that's so, so important.

Dr. Rangan Chatterjee 1:23:23 Yeah.

Dr Jenna Macciochi 1:23:24 I mean, we haven't had a kitchen for the last four months, so we've had no table, [laughs] no joy, but we've still been trying to cobble together as a family, you know, little meals on the floor. And it's just-

Dr. Rangan Chatterjee 1:23:35 It, it, you know what, it, I'm so delighted to hear you speak about these things because I think these are things we've missed-

Dr Jenna Macciochi 1:23:44 Mm-hmm

Dr. Rangan Chatterjee 1:23:45 ... in health advice.

Dr Jenna Macciochi 1:23:46 Yeah.

Dr. Rangan Chatterjee 1:23:46 It has been too reductionist. You know, eating at a table with, you know, your community, your-

Dr Jenna Macciochi 1:23:54 Yeah

Dr. Rangan Chatterjee 1:23:54 ... tribe has kind of always been a part of human culture.

Dr Jenna Macciochi 1:23:57 Yeah.

Dr. Rangan Chatterjee 1:23:57 And I, and I think i- and, and if you sort of extend the argument that you're making, it's kind of like, well, you could potentially eat the same foods-

Dr Jenna Macciochi 1:24:06 Mm-hmm

Dr. Rangan Chatterjee 1:24:06 ... feeling stressed out and lonely-

Dr Jenna Macciochi 1:24:09 Yeah

Dr. Rangan Chatterjee 1:24:09 ... and the same food might have a different response if you're eating it with good friends when you're feeling relaxed and calm.

Dr Jenna Macciochi 1:24:19 Yeah. Exactly.

Dr. Rangan Chatterjee 1:24:20 I, I, I'm convinced of it. You know, one thing I've really, I've, I've observed clinically maybe for two, three years now-

Dr Jenna Macciochi 1:24:25 Mm-hmm

Dr. Rangan Chatterjee 1:24:26 ... a lot of people these days are reacting or, or perceive themselves as reacting to foods.

Dr Jenna Macciochi 1:24:30 Yes.

Dr. Rangan Chatterjee 1:24:31 And I think what's really interesting for me is, and I think I really got this in the year preceding me writing The Stress Solution, was I thought, "Well, if stress changes your, uh, your gut and your GI tract and your, your-

Dr Jenna Macciochi 1:24:47 Mm-hmm

Dr. Rangan Chatterjee 1:24:47 ... digestion significantly as it does, well, are they actually reacting to the foods, or are they reacting to the fact that they're eating in a stressed state?"

Dr Jenna Macciochi 1:24:56 Mm-hmm.

Dr. Rangan Chatterjee 1:24:56 And I've seen with some patients the same food, if they do some sort of what I call a transition-

Dr Jenna Macciochi 1:25:02 Mm-hmm

Dr. Rangan Chatterjee 1:25:02 ... between, you know, action state and eating, so when they do that for one or two minutes before eating-

Dr Jenna Macciochi 1:25:08 Yeah

Dr. Rangan Chatterjee 1:25:08 ... they're no longer reacting to the same foods.

Dr Jenna Macciochi 1:25:11 Yeah.

Dr. Rangan Chatterjee 1:25:12 Which- You know, it's-

Dr Jenna Macciochi 1:25:14 I think this has even been shown with gluten as the nocebo effect

Dr. Rangan Chatterjee 1:25:17 Yeah

Dr Jenna Macciochi 1:25:18 ... which, and, and people say this all the time, "I go on holiday, I can eat the bread. It doesn't make me feel bloated, but the bread at home must be somehow different." Maybe it's different, but also you're different. You're in a different frame of mind when you're on holiday, and you're eating, and you're chewing your food as you look at the lovely vista-

Dr. Rangan Chatterjee 1:25:33 Yeah

Dr Jenna Macciochi 1:25:34 ... and you're just feeling more relaxed, and that's, uh, affecting your digestion and-

Dr. Rangan Chatterjee 1:25:39 Th- that, this stuff matters-

Dr Jenna Macciochi 1:25:40 Yeah

Dr. Rangan Chatterjee 1:25:40 ... more than people think. You know, when I, I really don't, I hardly, pretty much don't drink anymore. Um, but when I did, I used to remember that I'd go on holiday and like, you know, a glass of red wine would affect my sleep in the UK or-

Dr Jenna Macciochi 1:25:56 Mm-hmm

Dr. Rangan Chatterjee 1:25:56 ... you know, I'd feel a bit groggy the next day. But I found when I was on holiday, I could have a glass or two with dinner-

Dr Jenna Macciochi 1:26:01 Yeah

Dr. Rangan Chatterjee 1:26:01 ... and I felt nothing.

Dr Jenna Macciochi 1:26:03 Yeah.

Dr. Rangan Chatterjee 1:26:03 I thought, this is stress.

Dr Jenna Macciochi 1:26:04 [laughs]

Dr. Rangan Chatterjee 1:26:04 This is like, there's no, like, stress load on my life.

Dr Jenna Macciochi 1:26:07 Yeah.

Dr. Rangan Chatterjee 1:26:07 I'm sort of chilling with my wife and my kids, and there's a beach.

Dr Jenna Macciochi 1:26:10 Yeah.

Dr. Rangan Chatterjee 1:26:11 So it's not bothering me. But if your life is chronically overly busy, you're stressed out-

Dr Jenna Macciochi 1:26:16 Yeah

Dr. Rangan Chatterjee 1:26:16 ... the whole time, not only are you gonna get sick more-

Dr Jenna Macciochi 1:26:18 Yes

Dr. Rangan Chatterjee 1:26:19 ... or potentially, you know, you're gonna be able to not tolerate-

Dr Jenna Macciochi 1:26:23 Yeah

Dr. Rangan Chatterjee 1:26:23 ... various things. You're gonna, you're gonna, you're not gonna be able to manage those insults as well, right?

Dr Jenna Macciochi 1:26:28 Exactly. I call it the food prison, you know? I see so many people who are so stressed about eating the perfect diet that that's, that's just eroding their health. Never mind what they're eating-

Dr. Rangan Chatterjee 1:26:40 Yeah

Dr Jenna Macciochi 1:26:40 ... being, being helpful. Um, but I guess, you know, you asked me earlier about what I do [laughs] to manage my stress, and I think it's my, still my learning curve, but it's just on my radar now that I'm, I'm, I'm always experimenting. I'm learning how to say no. I think having boundaries was one of the biggest things I, I learned as an adult. Like, why are we not teaching kids this in school? And saying no is okay, and there's a time and a place for projects.

Dr. Rangan Chatterjee 1:27:07 Yeah.

Dr Jenna Macciochi 1:27:07 If I wanna get involved and it, it can't be now because that compromises my time as a mother or my time spent with family, or my time just, you know, being on my own or doing the things that-

Dr. Rangan Chatterjee 1:27:19 Mm-hmm

Dr Jenna Macciochi 1:27:19 ... nurture my day, then I have to say no and let go of that.

Dr. Rangan Chatterjee 1:27:24 Yeah.

Dr Jenna Macciochi 1:27:24 And I guess that's like, you know, the catharticism of writing or some ways of, y- you know, putting a narrative to what's stressing us out has a release to it.

Dr. Rangan Chatterjee 1:27:36 Yeah.

Dr Jenna Macciochi 1:27:36 And that you can feel that, you know, like a big physiological sigh that your body is making when you're like, "Okay." And once the decision's made, you move on from it.

Dr. Rangan Chatterjee 1:27:45 Yeah.

Dr Jenna Macciochi 1:27:45 I've said no to that. It's sad, and I wish I could say yes, but I don't think about it the next day when I've moved on and other things are, you know, forefront of me.

Dr. Rangan Chatterjee 1:27:54 It's very freeing, actually.

Dr Jenna Macciochi 1:27:55 Mm-hmm.

Dr. Rangan Chatterjee 1:27:55 You know, something I struggled with for years, and it's, I'm getting much better at it, but it's, it feels good.

Dr Jenna Macciochi 1:28:02 Yeah.

Dr. Rangan Chatterjee 1:28:02 You, half the time I used to say yes to stuff, and then I would just be stressed out. Why did I say yes? I've got to do this. I've committed now.

Dr Jenna Macciochi 1:28:09 Yeah.

Dr. Rangan Chatterjee 1:28:09 They've started advertising it. They're doing... And I, and I'm, I'm getting much better at nipping it in the bud-

Dr Jenna Macciochi 1:28:14 Yeah

Dr. Rangan Chatterjee 1:28:14 ... at source.

Dr Jenna Macciochi 1:28:15 Yes. [laughs]

Dr. Rangan Chatterjee 1:28:15 And, you know, and it's, but it's taken a lot of work.

Dr Jenna Macciochi 1:28:18 Oh, yeah. I had to learn the hard way.

Dr. Rangan Chatterjee 1:28:20 Yeah.

Dr Jenna Macciochi 1:28:20 Um, but the, I started feeling like I was doing everything badly. And when you start to feel like you're being a bad parent, probably I wasn't, but in my mind-

Dr. Rangan Chatterjee 1:28:29 Yeah

Dr Jenna Macciochi 1:28:29 ... I wasn't doing what I wanted to do. And that, I think, with my kids, I just, that had to be a firm line that I couldn't-

Dr. Rangan Chatterjee 1:28:36 Yeah

Dr Jenna Macciochi 1:28:36 ... ever cross again.

Dr. Rangan Chatterjee 1:28:37 Wow. Now, you mentioned eating, and you said, um, that, you know, there's some studies that our immune system operates differently if we're eating in company, feeling joy-

Dr Jenna Macciochi 1:28:48 Mm-hmm

Dr. Rangan Chatterjee 1:28:48 ... feeling happy. That reminds me of something else I read in your book about, it's something to do with, you were giving a, a list of strategies to people, but it was about, you know, like walking whilst listening to music. It was about putting two senses in together.

Dr Jenna Macciochi 1:29:04 Oh, yes.

Dr. Rangan Chatterjee 1:29:04 I, that I found-

Dr Jenna Macciochi 1:29:05 Yeah

Dr. Rangan Chatterjee 1:29:05 ... really interesting. Could you expand on that at all?

Dr Jenna Macciochi 1:29:07 Yeah. That, this is a, it's really interesting, actually. So this was, um, data that was generated in the 1980s. There's some scientists who were trying to disprove research that had come out of Russia around that time about conditioning. So the classical example of conditioning is Pavlov's dogs. Um, most people will be aware of that. But there, these experiments they had done where they, they had looked to try and condition the immune system. And so the scientists were like, "This, this can't be right." You know, "We, we're gonna redo the experiments much more stringently and, um, see if it is really what it makes out to be. Can you condition your immune system with various rituals and routines?" And what they did was they, they used an animal, uh, model experiment, and they gave the, the animals a s- a sweet solution to drink. And, uh, one group got the sweet solution that also had a particular chemical inside it that would modulate antibody responses. So they could measure the antibody responses in the blood and see, um, if, uh, that there was an effect happen- happening, some kind of readout, tangible piece of data that they could observe. Um, so the mice were given these, this sugar solution with this chemical for a period of time. And after a while, when they just gave the sugar solution on its own, they got the same effect happening to the immune system. So it's kind of like a placebo effect.

Dr. Rangan Chatterjee 1:30:36 Wow.

Dr Jenna Macciochi 1:30:36 It's like you expect something. The mouse expected this effect to take place in its body on some kind of subconscious level because it was so used to that happening, that the, it, the effect happened anyway, even without the chemical presence to actually cause the modulation to the immune system. And people have been scratching around to try and understand the mechanism, and I think the best we've come up with is the placebo effect. Like, it's, it, it's, there's some part of us that we don't quite understand that embodies things. And w- when there's a response expected, that the biology changes. And we can start to pair things together. So- What you were referring to in the book is, like, the kind of little stress-relieving rituals, like f- you know, playing your favorite music whilst you're doing something like taking a, a nice bath or, uh, having a s- a particular scent being in the room-

Dr. Rangan Chatterjee 1:31:38 Yeah

Dr Jenna Macciochi 1:31:38 ... while you're doing something else. And eventually then you just can play that music and you start to feel the same relaxed feeling that you do when you're in a nice warm bath, even without taking the bath.

Dr. Rangan Chatterjee 1:31:48 Yeah. You know, it makes me think about, you know, if your home is or has been a stressful place-

Dr Jenna Macciochi 1:31:55 Mm-hmm

Dr. Rangan Chatterjee 1:31:56 ... then, you know, that it kind of works that you may come into that and y- your body may start to almost-

Dr Jenna Macciochi 1:32:03 Yeah

Dr. Rangan Chatterjee 1:32:03 ... the immune system might sense that and go-

Dr Jenna Macciochi 1:32:05 Yeah

Dr. Rangan Chatterjee 1:32:05 ... "Okay, this is a stressful place," and, and react even if nothing stressful happens.

Dr Jenna Macciochi 1:32:10 Yes.

Dr. Rangan Chatterjee 1:32:11 But then you could also flip it and, you know, I'm a huge fan of ritual and sort of daily-

Dr Jenna Macciochi 1:32:15 Mm-hmm

Dr. Rangan Chatterjee 1:32:15 ... practices that even if they only take five minutes-

Dr Jenna Macciochi 1:32:17 Yeah

Dr. Rangan Chatterjee 1:32:18 ... they can be very powerful. And I think when I hear that, I think of a morning routine, and I think what if someone, you know, can design their ideal morning routine. Let's say c- let's say it was five, 10 minutes.

Dr Jenna Macciochi 1:32:29 Yeah.

Dr. Rangan Chatterjee 1:32:29 You know? A bit of maybe a minute or two of breathing.

Dr Jenna Macciochi 1:32:32 Yeah.

Dr. Rangan Chatterjee 1:32:32 Um, you know, three or four minutes of some light movement practice.

Dr Jenna Macciochi 1:32:36 Yeah.

Dr. Rangan Chatterjee 1:32:37 And then let's say five minutes of reading a positive book.

Dr Jenna Macciochi 1:32:39 Yeah.

Dr. Rangan Chatterjee 1:32:40 For example, I mean, that's, you know, I, I, in The Stress Solution I write about the three M's of a morning routine, mindfulness, movement, and mindsets.

Dr Jenna Macciochi 1:32:46 Mm-hmm.

Dr. Rangan Chatterjee 1:32:46 I think you can create one that lasts an hour. You can create one that lasts five minutes. But the point I'm trying to make is if someone started doing that in the same room, let's say they lit a candle-

Dr Jenna Macciochi 1:32:58 Yeah

Dr. Rangan Chatterjee 1:32:58 ... in the room, did that, that even on a day when they're a little bit busy or they haven't quite, they can't quite-

Dr Jenna Macciochi 1:33:05 Yeah

Dr. Rangan Chatterjee 1:33:05 ... switch off and they just, you know, sat there with their coffee with the candle on-

Dr Jenna Macciochi 1:33:08 Yes

Dr. Rangan Chatterjee 1:33:09 ... maybe that will also condition their immune system the other way and go, "Hey, things are okay because-

Dr Jenna Macciochi 1:33:15 Exactly

Dr. Rangan Chatterjee 1:33:15 ... he's got the candle on."

Dr Jenna Macciochi 1:33:16 Yeah.

Dr. Rangan Chatterjee 1:33:16 I don't know. It's quite, it's quite empowering.

Dr Jenna Macciochi 1:33:18 The smell, all the senses kind of integrating, so it might be a particular scent that you're burning. There might be a particular song or playlist that you always play when you're doing those, uh, activities for your morning routine. And then in the morning you wake up and you're just tired, and you don't wanna do your movement. You just wanna sit and enjoy a tea, but you're in that room with that space.

Dr. Rangan Chatterjee 1:33:38 Yeah.

Dr Jenna Macciochi 1:33:38 And you still may be reaping the benefits of the, the meditation and the movement-

Dr. Rangan Chatterjee 1:33:42 Yeah

Dr Jenna Macciochi 1:33:42 ... that you would normally do. And I think routine, as a, as a human being, we just seem to be anchored by routines.

Dr. Rangan Chatterjee 1:33:49 Yeah.

Dr Jenna Macciochi 1:33:49 For me, uh, especially becoming a mother, it's been, it's been hugely important, so much so that now I can buffer the lack of routine more because I can circle back to a really strong routine-

Dr. Rangan Chatterjee 1:34:00 Yeah

Dr Jenna Macciochi 1:34:00 ... that I've built over time. And I think when we went into lockdown this year, everything kind of got off kilter, and we haven't, we, we're, we're living in a building site basically at the moment, so-

Dr. Rangan Chatterjee 1:34:12 Yeah. That's stressful, right?

Dr Jenna Macciochi 1:34:13 It's stressful. The routine is, is shot. You know, it's shot. It's really done a number on us. But w- I think having been someone who needs routine, particularly as a bit of a stress head, it didn't take long for us to find a new rhythm-

Dr. Rangan Chatterjee 1:34:28 Yeah

Dr Jenna Macciochi 1:34:28 ... uh-

Dr. Rangan Chatterjee 1:34:28 It's-

Dr Jenna Macciochi 1:34:29 ... being at home, and that's anchoring. I think that's-

Dr. Rangan Chatterjee 1:34:32 I, I, I love the way you, the way you say certain things. You said, you know, we can build a routine.

Dr Jenna Macciochi 1:34:37 Mm-hmm.

Dr. Rangan Chatterjee 1:34:38 Like, you can build your immune system.

Dr Jenna Macciochi 1:34:40 Yeah.

Dr. Rangan Chatterjee 1:34:40 This, it's a very empowering words.

Dr Jenna Macciochi 1:34:43 Yeah.

Dr. Rangan Chatterjee 1:34:43 You know, build means we can do that, right?

Dr Jenna Macciochi 1:34:45 Yes.

Dr. Rangan Chatterjee 1:34:45 It doesn't mean it's fixed.

Dr Jenna Macciochi 1:34:47 Exactly.

Dr. Rangan Chatterjee 1:34:47 We, we've got some agency over that.

Dr Jenna Macciochi 1:34:49 Yeah.

Dr. Rangan Chatterjee 1:34:50 Um, it's really interesting as, as, you know, as I, as I mentioned right at the start, this is, you know, day one in the new studio.

Dr Jenna Macciochi 1:34:56 Yeah.

Dr. Rangan Chatterjee 1:34:56 And Gareth, who's videoing, uh, and sitting there in the corner, um, we've been talking about, you know, how do we create a stress-free space-

Dr Jenna Macciochi 1:35:07 Mm-hmm

Dr. Rangan Chatterjee 1:35:08 ... that allows a really deep, authentic, vulnerable conversation to happen.

Dr Jenna Macciochi 1:35:13 Yeah.

Dr. Rangan Chatterjee 1:35:13 And, you know, it's not quite ready yet. You know, bringing plants in is one thing.

Dr Jenna Macciochi 1:35:17 Yeah.

Dr. Rangan Chatterjee 1:35:17 You know?

Dr Jenna Macciochi 1:35:18 Mm-hmm.

Dr. Rangan Chatterjee 1:35:18 Um, we're gonna probably have a candle on or some sort of-

Dr Jenna Macciochi 1:35:21 Yeah

Dr. Rangan Chatterjee 1:35:21 ... you know, a nice scent.

Dr Jenna Macciochi 1:35:22 Yeah.

Dr. Rangan Chatterjee 1:35:23 You know, my, my dream is, 'cause my, this podcast is all about authentic conversation.

Dr Jenna Macciochi 1:35:28 Mm-hmm.

Dr. Rangan Chatterjee 1:35:28 It's not interviews. It's conversation. I want, um, someone like you to walk in, and within, you know, I almost wanna program it so that people feel calm and go-

Dr Jenna Macciochi 1:35:41 Mm-hmm

Dr. Rangan Chatterjee 1:35:41 ... they wanna open up and actually-

Dr Jenna Macciochi 1:35:43 Yeah

Dr. Rangan Chatterjee 1:35:43 ... do you know what I mean?

Dr Jenna Macciochi 1:35:44 Yeah.

Dr. Rangan Chatterjee 1:35:45 You know?

Dr Jenna Macciochi 1:35:45 I think you've done a really good job already.

Dr. Rangan Chatterjee 1:35:47 Oh.

Dr Jenna Macciochi 1:35:47 But also I think the, what you give off as a person really helps. So the way people's eyes feel relaxed. You know when we're angry, we, like, narrow our eyes, or if we're-

Dr. Rangan Chatterjee 1:35:57 Yeah

Dr Jenna Macciochi 1:35:57 ... feeling quite negative or stressed. And then we pick that up when we're sort of reading the body language.

Dr. Rangan Chatterjee 1:36:03 Yeah.

Dr Jenna Macciochi 1:36:03 And so if somebody has a sort of relaxed disposition, that's gonna be interpreted-

Dr. Rangan Chatterjee 1:36:10 Yeah

Dr Jenna Macciochi 1:36:10 ... by the other person and make them feel at ease as well, so.

Dr. Rangan Chatterjee 1:36:13 And interpreted by our immune systems.

Dr Jenna Macciochi 1:36:16 Yes, exactly.

Dr. Rangan Chatterjee 1:36:17 You know?

Dr Jenna Macciochi 1:36:17 As this is a safe environment. It's all about all of those millions of inputs that are going in-

Dr. Rangan Chatterjee 1:36:22 Yeah

Dr Jenna Macciochi 1:36:22 ... every minute of every day, and our immune system's reading those, shaping, and responding.

Dr. Rangan Chatterjee 1:36:29 Jenna, look, I've really enjoyed this chat. There is so much more to discover that we've not got into yet, like hot and cold and supplements.

Dr Jenna Macciochi 1:36:35 Oh, yes.

Dr. Rangan Chatterjee 1:36:35 Which it, it's all there in the book-

Dr Jenna Macciochi 1:36:37 [laughs] Movement

Dr. Rangan Chatterjee 1:36:37 ... for people if they're interested. Movements and how that impacts the immune system.

Dr Jenna Macciochi 1:36:41 Yeah.

Dr. Rangan Chatterjee 1:36:41 But, uh, but I, I really enjoyed. Thank you for opening up.

Dr Jenna Macciochi 1:36:44 Oh, no problem.

Dr. Rangan Chatterjee 1:36:45 Um, if people hear this conversation-

Dr Jenna Macciochi 1:36:47 Mm-hmm

Dr. Rangan Chatterjee 1:36:47 ... and they wanna sort of interact with you, are you sort of, um, you know, are you active online? Do you like interacting with people online? And if so, where can they find you?

Dr Jenna Macciochi 1:36:55 Yeah, I mean, I, I'm on, uh, Instagram mostly. That's sort of the easiest place to find me. That's kind of my, um, internal monologue where I, uh, [laughs] uh, I don't know, like to post about things that I've been researching-

Dr. Rangan Chatterjee 1:37:08 Yeah

Dr Jenna Macciochi 1:37:08 ... and doing, and also a bit of kind of general m- mom life and [laughs] little, little bit of what's going on at home, um, as well. I, I'm sort of on Twitter on a professional capacity, so that's mostly, like, publishing research and-

Dr. Rangan Chatterjee 1:37:22 Yeah

Dr Jenna Macciochi 1:37:22 ... interacting with academics. Um, and then I have a website too, which is just my name, which is drjennamacciochi.com.

Dr. Rangan Chatterjee 1:37:30 Fantastic. Um, so Jenna, as you know, this is called Feel Better Live More.

Dr Jenna Macciochi 1:37:35 Mm-hmm.

Dr. Rangan Chatterjee 1:37:35 Um, when we feel better in ourselves-

Dr Jenna Macciochi 1:37:38 Mm-hmm

Dr. Rangan Chatterjee 1:37:39 ... we get more out of our lives.

Dr Jenna Macciochi 1:37:41 Mm-hmm.

Dr. Rangan Chatterjee 1:37:41 So we covered a lot of different, um, topics today. A lot we didn't cover as well. I wonder if you'd mind finishing off by giving the listeners and the viewers some really practical tips. If they're inspired by what they've heard-

Dr Jenna Macciochi 1:37:56 Mm-hmm

Dr. Rangan Chatterjee 1:37:56 ... and they wanna say, "Yeah, I like that. I w- I want to take steps today-

Dr Jenna Macciochi 1:38:00 Yeah

Dr. Rangan Chatterjee 1:38:00 ... to start improving my immune system."

Dr Jenna Macciochi 1:38:02 Yeah.

Dr. Rangan Chatterjee 1:38:02 Have you got some of y- the top tips that you can share with them?

Dr Jenna Macciochi 1:38:05 Oh, yeah. I would say shut out the noise, the noise of social media, the noise of marketing, the noise of messages, and just kind of write down or find a way to, to, to, um, distill down, you know, w- what it is about your day-to-day that you think is, is making you feel a bit, meh, a bit, like, not yourself. Um, because we're, we're bombarded with so much. And when I speak to people, I realize I'm in a very privileged position because of the virtue of my field and, that I work in, that I know a lot. But other people who are with no background at all in this, they're very confused, and it's very confusing. Um, and go with what, what we talked about. S- you know, step away from the supplements and just lay out on the table, how is your diet? How many times a day are you eating? Are you overeating? Are you stress eating? Are you consistently getting all of the relevant vitamins and minerals that you need, but also g- good quality sources of carbohydrates and proteins and including, um, uh, good quality fats in your diet? And, you know, diet is not the only way to, to shape your immune system. You know, we have movements, stress, all of the different things in our, in our life. And, and your immune system's always changing. As we grow older, it changes. You know, don't really focus on one solution, 'cause health is complex. There's a lot of different inputs going into it. Your immune system's the foundation of your health, and so it needs to have all these kind of different areas targeted. So you can have the perfect diet, but like me, stressed out of your head, and then end up with pneumonia. [laughs] Don't do as I did. But, you know, take care. Take care of the, the whole sort of 360 of your health, and it's about balancing, not boosting your immune system.

Dr. Rangan Chatterjee 1:39:53 Yeah, wonderful advice. Um, you know, I wanna thank you for, you know, you, you study a lot of immunology. You've do a lot of research. You also take the time to communicate it to the public.

Dr Jenna Macciochi 1:40:06 Mm-hmm.

Dr. Rangan Chatterjee 1:40:06 And I think that is such a valuable thing if we get scientists like you-

Dr Jenna Macciochi 1:40:10 Yeah

Dr. Rangan Chatterjee 1:40:10 ... trying to communicate what you know to help educate people. I think it's a wonderful thing.

Dr Jenna Macciochi 1:40:14 Mm-hmm.

Dr. Rangan Chatterjee 1:40:14 So thank you for doing that.

Dr Jenna Macciochi 1:40:15 You're welcome.

Dr. Rangan Chatterjee 1:40:15 Thank you for making the journey up today.

Dr Jenna Macciochi 1:40:17 No problem.

Dr. Rangan Chatterjee 1:40:18 And we'll see you again soon.

Dr Jenna Macciochi 1:40:19 Thank you. Thank you for having me. [upbeat music]

Dr. Rangan Chatterjee 1:40:23 Press subscribe to get more inspiration and ideas on how to feel better so you can get more out of life. And if you have a moment, why not check out this conversation that I've picked out as a perfect follow-up? Remember, lifestyle change is always worth it, because when you feel better, you live more.