What To Eat & When To Eat! - How To Burn Fat, Repair The Body & Prevent Disease | Dr. William Li

1. 0:00 – 5:47

   How Chili Peppers Activate Brown Fat

   1. RCDr. Rangan Chatterjee0:00

      I think chili peppers, uh, and chili in general are one of these specific foods that target brown fats. Is that right?

   2. WLDr. William Li0:07

      Yeah.

   3. RCDr. Rangan Chatterjee0:07

      Can you speak to that a little bit?

   4. WLDr. William Li0:09

      Yeah. Well, listen, I, I wanna, I wanna show you. So this is a chili pepper. It's a dried chili pepper, and, you know, you might see this dried and sold in a grocery store. You might use it to cook different types of dishes, whether it's a East Asian dish or a South American dish or an Italian or Spanish dish. A lot of people like chili peppers. And by the way, here's another example of chili. This is what you put on your pizza, right? So chili flakes.

   5. RCDr. Rangan Chatterjee0:35

      Yeah.

   6. WLDr. William Li0:35

      So lots of chilies come in a lot of different forms that we actually cook with. It turns out that inside chili pepper is s- something called capsaicin. Capsaicin, it gives us the burn, that zing, the fire in our mouth. Uh, and it actually, and the reason it, it does it is because we have receptors in our tongue, taste receptors, uh, for capsaicin. They're called capsaicin receptors. So in addition to sweet, sour, salty, we've, you know, we can actually, we can activate, we can feel the, the zing. Uh, the, the receptor, just for people who are interested, 'cause I know some people who watch your podcast are, you know, really into the details, it's called the, um, TRPV1, um, receptor, and capsaicins tackle the TRPV- turn on the TRPV1, and then it's on, on your tongue. You feel the burn. All right? And what happens is that that receptor text messages your brain and, and two, and your brain releases two different kinds of hormones. One is endorphins. Endorphins make you feel good, which is why some people are in love with eating hot, spicy food. You've heard about that, right?

   7. RCDr. Rangan Chatterjee1:37

      Yeah.

   8. WLDr. William Li1:37

      "I can't wait till I get some hot, spicy food." For those people, they have, they, they, they ha- their, their reaction to, to this endorphin from spices caused by this receptor, from the capsaicin binding receptor, is one of pleasure. All right? Now, the other hormone that your brain releases is norepinephrine. Norepinephrine actually is released from your brain, and it goes down your nerves. And I, and this is what I have to tell you. Next time you eat something really spicy, if you, if you, if this is, if you're inclined to do this, do it in a quiet room and close your eyes and just feel your body. You, you, you'll feel the burn. You'll literally feel your brain activating. You'll feel it, I, I kid you not. And then you'll feel a rush of nerves being activated down your neck. Those nerves down your neck light up your brown fat, and it'll turn on your brown fat. So, uh, no- the norepinephrine from your brain from chili peppers actually turns on that h- that n- that hormone. It goes down your neck, activates a beta three adrenergic receptor in your brown fat. That turns on the UCP1, turns on the mitochondria, and starts the space heater function. You can actually feel that. And by the way, the norp- noradrenaline that forms, that's also why people get sweaty and red and flushed when they're eating hot food as well. So this is just another dimension, uh, of how foods that we eat, uh, can actually activate this. B- and so that's what we're, that's what one of the things that you alluded to earlier. Uh, I've been doing the research to figure out what exact substance in a food, what's in a caper, what's actually in green tea, what's in coffee, what's in a pear that can, uh, what's in a bean that can actually light up our fat, our, not only our brown fat, but it can also change and shape-shift our white fat in order to be able to burn down and r- and slim down the harmful fat so we can be more physiologically fit.

   9. RCDr. Rangan Chatterjee3:27

      Yeah. Fascinating. Absolutely fascinating. I love the way you walked us through that. I'm definitely gonna try that next time. Quiet room, pay attention. But as you were saying that, I, I think I know what that feels like already. I'm pretty sure I've experienced that, but I can be a bit more aware of it next time. A couple of things there, Dr. Li. You mentioned maybe 10 minutes ago how when people read your first book and they read about all these incredible foods that they can bring into their diet to help them fight disease, reduce the risk of them getting sick in the future, you were getting communication after communication saying, "Yeah, but I'm eating all those foods, but I'm losing weight, and it's great. I wasn't planning to, but I feel good now that I've lost this excess weight that I couldn't lose for years." And I think there's something really powerful about that. They weren't trying to, but by focusing on the right foods, and of course in your first book, they're all whole foods, they're all foods that come from nature, foods that have been consumed by cultures for hundreds if not thousands of years. That's fascinating to me. How does that and what you just said about chilies and how they and other foods can impact brown fat, how does that fit in with the calorie model? Because let's say, for example, Dr. Li, those people writing into you, let's say they were having lots of ultra-processed foods initially, and they then moved to a lot of the whole foods you recommend. Well, whole foods tend to keep us fuller quicker, right? It's very hard to overeat whole foods, and I'm sure some of the benefit was that they were also naturally getting full earlier, so not overeating. But some of the studies that you've referenced in your new book where they've controlled calories, you know, you've been very clear with how you write up these studies and you said they were all calorie controlled, they were all doing this so that we can actually draw good conclusions at the end. It suggests that for the same amount of calories consumed, by changing the nature of those calories, we can have a very profound impact on weight loss. Is that fair? Is that-- Have I interpreted what you said in your book correctly? Do you agree with that?

2. 5:47 – 13:41

   Calories vs Food Quality and the Role of Meal Timing

   1. WLDr. William Li5:47

      Yeah, no, absolutely. That's exactly the point, is that, um, you know, they talk about empty calories and the quality of your food and whether something's nutrient dense. Look, [clears throat] I try not to overuse the word calorie in my book because I think there's so much, um ... association in the public with calories, calories in, calories out, counting calories, that it's actually almost lost its true meaning. And so I try to, um, e- equate the idea of calories with fuel. And again, I wanna come back to how you can use your body to actually naturally burn calories, uh, burn fuel. Okay? So, uh, you know, there's this current practice that's viewed as a fad called intermittent fasting, and I write about this in my book as well. I don't call it a fad. I don't call it a, a, a, you know, it's not a, it's not a new religious practice. Look, um, intermittent fasting is one of the most natural things that we do in our lives as, as humans. And the reason is when we're sleeping, we're not eating. When we're not eating, that happens to be called fasting, and there's a key to the metabolism here that is really, really important to understand, and that is this: When we're awake and we're eating food, remember I told you, put ... You put food in your body, your insulin goes up with a dip in ect and draws energy into our body. Our metabolism is hardwired so that when we're actually eating, its focus is really on storing energy, including loading up fat. All right? When we're awake and eating, we're storing energy. We're not burning it. All right? Now, of course, if you're walking around, you're exercising, you're gonna be burning it as well, but you're usually not exercising while you're eating, right? It's sort of like your waking hours. All right? So, um, your, your-- then you'd be burning down some of that fuel. One, uh, but our metabolism is, is geared to storing, not burning. When we're sleeping, our insulin level-- uh, not eating, our insulin levels go down. When insulin goes down, our metabolism shifts gears, and it says, "Oh, you know what? We're not eating anymore. We're not, we're not getting fuel in. Let's focus now on burning calories." So in point of fact, it can draw energy from fuel, from the fat, stored fat and burn them down. So in fact, when we're sleeping and we're not eating, our metabolism is naturally shifting into fuel-burning, fat-burning mode. So that's, like, at a baseline how we actually work. Now, when we're slee- when we get up in the morning, okay, uh, and of course, the quality of sleep, we wanna get really good quality REM sleep. That actually works a lot better, and we wanna sleep as much as we can, eight hours being sort of still very much that kind of general good number. Uh, seven to eight hours of good quality sleep being very, very important for m- your metabolism as well as your immunity and so many other, uh, aspects. But here's where some of the patterns can actually make a big difference in addition to the food that we actually choose. For example, the more time we give our metabolism to burn down energy in fat-burning mode, the better off we are, okay? The more, more we are burning fuel. So here's a c- common thing. Um, if you don't get... So get e- eight hours of sleep. Let's say that you go to bed at se- at 11, and you get up at 7:00 in the morning. Let's say eight hou... I'm just using these numbers as an example. Um, that's eight hours of sleep. Now, when you eat dinner, this is what I do. When I, when I eat dinner the night before, let's say I eat at 7:00, and I put my dishes away at 8:00, I'm done eating, put my dishes away. Now, in the past, and I know a lot of people do this, I might have, earlier in my life, gone to snack in the evening or maybe even gotten a bedtime snack. Before I go to bed, I'm gonna eat one more thing. All right? I don't do that anymore. I do the-- What I do now is when I put my dishes away, whatever time it is, let's say I eat at s- I eat dinner at 7:00, I sit for a meal at 7:00. I stop eating at 8:00. When I put my dishes away, I don't eat anything after that. I'm done. Now, from 8:00 to 11:00, I've gained three extra hours where my metabolism can tap into and burn my fuel down. That three extra hours makes a difference because now I'm gonna add it to the eight hours of sleep I'm gonna get. Now I've got 11 hours of fat-burning, fuel-burning time.

   2. RCDr. Rangan Chatterjee9:54

      Mm.

   3. WLDr. William Li9:54

      Now, when I get up in the morning, I don't do what my mother told me to do when I was a kid, right? Our moms always tells us, "Hurry up, get up, eat breakfast, get on the school bus, and get to school." All right? And now when I get up, I, I... what I do is I take my time getting ready, take a shower. I get dressed. I might go for a walk. I might read a book. I might check my emails. I'll do something. I don't eat breakfast right away out of reflex like we were taught to do, conditioned to do. But I usually s- ta- wait for an hour before I sit down to eat something. Now I've gained an extra hour for my metabolism to burn it. Do the math. Three hours after dishes away to bedtime, eight hours of bedtime, and one extra hour, um, in the morning. That's 12 hours. That's half the day that I've now taken, 12 hours out of 24, that I've allowed my body to be, my metabolism, to be in fuel-burning, calorie-consuming mode. Now, it's true. We may actually have calories that have a, uh, fuel that's accumulated from yesterday, from the day before, from last weekend, from the holidays. We got more and more to do it. And it's true. We do need to be physically active. In fact, in my, in my book that I write, you can work out. You can get a trainer. But, you know, uh, but even walking-

   4. RCDr. Rangan Chatterjee11:06

      Yeah

   5. WLDr. William Li11:06

      ... for 30 minutes will actually be useful, and in fact, even fidgeting. You know, that shaky the leg, tap, tap, tap, tap, tap. Even that burns calories as well. So before even talking about what foods we should eat and the qua- volume that we should actually eat, the timing. It's not just only what we eat, but how we eat and when we eat can actually make a difference as well. That's actually quite important. It's a, it's a nuance within, you know, showing a list of 150 great foods to eat that can turn on your, your, your fat burning meta- and turn, and increase your metabolism and heal your metabolism. How, how and when we eat actually can be also very, very important.

   6. RCDr. Rangan Chatterjee11:41

      Yeah. Thank you for outlining that. I completely agree. 12 hours in every 24-hour period without foods, I have seen is achievable for most of my patients. It, it really is very, very achievable, and for those people who are unable to, it's probably because their metabolism is Maybe not broken, but, but not functioning as well as it could do, and, you know, we need to make some improvements so that they can go for 12 hours without food. So I think that's a very safe and consistent recommendation that pretty much all of us would benefit from. There's also studies, circadian biology studies, Dr. Li, showing people having the same amount of food in the day, but at different times. There was one study, I think in Spain, when they front-loaded the food, so you'd have most of your food quantity in the first half of the day. I think by 3:00 PM they'd had most of their food in a very light dinner. And when they did it the other way, when they had a heavy dinner, same foods, there was a significant change in body fat composition for the better when people front-loaded. Again, it's highly individual. You know, everyone's gonna react slightly differently. We've gotta figure out what works for us. But I think this nuance that you speak to in the new book, I think is so important because it's not just as simple as, you know, looking at the calorie counter on the food that you're taking in. Yeah, I, I will acknowledge that for some people that seems to work. Fine. I've never found it helpful in practice with patients, but I'm, I'm not gonna, you know, write something off that let's say some personal trainers have found useful with their clients, right? I, I understand there's different ways to meet your goal of losing excess fat. But I think this idea that certain foods can certainly stack the odds more in your favor, I think is a very powerful argument for people to take. And a lot of these foods are frankly delicious.

3. 13:41 – 20:11

   Mediterrasian Eating and a Tour of the Grocery Store

   1. RCDr. Rangan Chatterjee13:41

      What is some of your favorite foods to talk about in relation to this? You mentioned chilies.

   2. WLDr. William Li13:46

      I get asked this question all the time, "Dr. Li, what diet do you-- are you on?" And I say, "I'm not on a diet." They say, "Well, then what do you eat?" And I actually say, "You know, it's very different. I, I, I eat different things every day, so I can't give you the one food that I eat all the time that's my secret. But I will tell you my secret," uh, which is no longer a secret 'cause I write about it in my book, is there's a, is there's a way, a style I eat, I call it Mediterrasian eating. Mediterrasian is I naturally gravitate because I've lived in the Mediterranean. I also have an Asian background. These are two foods that I actually really resonate with. Um, I love the taste. And by the way, they happen to come from two of the healthiest culinary traditions in the world, right? Mediterranean and Asian, at least traditional cultures, have been always very, very health-healthy and healthy ingredients, um, healthy combinations. And so to me, there's like... You can't go wrong by choosing either Mediterranean or Asian genre foods. This isn't necessarily fusion, by the way. I-- It's a, it's a spectrum.

   3. RCDr. Rangan Chatterjee14:46

      Yeah.

   4. WLDr. William Li14:47

      And I, I-- Even though that's my answer in present day, I will tell you what's really awesome about Medi- the idea of Mediterrasian, um, uh, foods eating is that it's been done thousands of years ago. Because back in the day of the Silk Road, which was the greatest human trading route in history, uh, it connected China, uh, Asia, with Europe and the Mediterranean specifically. People on camelback were trading goods and selling silk and many other goods, but they were sharing their ingredients and sharing their recipes and sharing food together. And really, this is this blending and amalgamation dating back two thousand years of, of culinary heritage that tastes really great. So let me just take you through the grocery store quickly of some of the things that catch my eye. I go into the grocery store, in the produ- first thing I go to the produce section. I love fresh foods. I'll look at tomatoes. Okay? Tomatoes are originally from Latin America, but they've been-- they're now popular not only in the Mediterranean, but also even in, in Asia. In China, they cook with tomatoes now, and they grow them. I will look at tomatoes, um, uh, during the summertime. Avocados. I love avocados. A great source of dietary fiber, surprisingly, 'cause they don't taste very fibery. Um, and they've got avocatin B, a substance that actually, um, fights, uh, white fat and lights up brown fat. Tomatoes have lycopene, by the way. Uh, lycopene, uh, is a fat-soluble substance. It actually dissol-- it fights-- it lights up brown fat. It fights harmful body fat. The f-the really cool thing about lycopene in tomatoes, and this has been studied in humans, when you eat lycopane-- lycopene-containing foods like tomatoes or watermelon or guava or papaya, actually the lycopene gets absorbed in our bloodstream. And you know where it goes? It immediately goes to the fat in our body. First in our belly fat, then in our thighs, then in our butt. It's... And, and there, it's kind of like a, sort of like a fat-fighting bomb that gets implanted into your fat to fight fat right where it needs to be fought, the battle needs to be fought, which is pretty cool. Um, uh, I look at, uh, greens. I like leafy greens. Brassica, uh, you know, what-- people think about, uh, broccoli. But I, I, I write about broccolini, gai lan, uh, bok choy, baby bok choy. Again, these are vegetables you sauté with a little garlic and extra virgin olive oil. Um, you know.

   5. RCDr. Rangan Chatterjee17:09

      Yeah.

   6. WLDr. William Li17:09

      Uh, you, you blanch it. You can stir-fry it, add a little oyster sauce or soy sauce. Man, you can make amazing tasty dishes with it. Um, you can make a stew out of it. You can make a smoothie out of it. You can make a soup out of it. So many delicious ways of, of looking for chili peppers. I actually like to cook with chili peppers. Um, uh, and there's a whole gamut.

   7. RCDr. Rangan Chatterjee17:27

      Yeah.

   8. WLDr. William Li17:27

      Hundreds of chili peppers out there you can buy in a market. You have to find the ones that actually suit your tolerability and your, your taste buds, uh, to be good. Mushrooms. Love mushrooms. Maitake mushrooms on the grill, roasted. Um, whi- simple white button mushrooms, porcini mushrooms, morels, um, enoki mushrooms. Put them into some miso soup with soy, edamame in the market. These are some of the fat-fighting ingredients. I'm putting them in the context of how I would love to see them on my plate or, or on a menu of what I would actually order. All very reasonable. Middle aisle. I talk about studies with canned beans that can actually shrink your waistline by fighting visceral fat, um, by eating them. Lentils, other legumes, dried chili peppers again, uh, dried mushrooms. In the wintertime, when you find it hard to find really fresh, a diversity of fresh mushrooms, get the dried ones. Amazing. Uh, tomato paste, tomato powder, canned tomatoes all have lycopene in them. There's, uh, olive oils, extra virgin olive oils. Look for the high polyphenol type, uh, with the monovarietals. I look for Picual from Spain, uh, uh, Moraiola from Italy, Koroneiki from Greece. I look for those monovarietals. You can read it right on the bottle if you look for those. Barley, buckwheat, soba noodles, these are just some of the examples of the foods, the ingredients that are found in either the Mediterranean or Asian kind of, um, genres that are absolutely delicious, and it's a small piece of what I write about that are-

   9. RCDr. Rangan Chatterjee19:01

      Yeah

   10. WLDr. William Li19:01

       ... delicious and good for you.

   11. RCDr. Rangan Chatterjee19:03

       Yeah. There's, there's a section in the book which is beautiful, where you put the 10 principles for eating Mediterranean. I won't go through them all. You've covered a couple of them. Skip a meal or two, go for fresh. Respect tradition, I really like that section that you wrote about, and you ended it with something that I think speaks to what you, what you just said. Take advantage of the wisdom of centuries. When it comes to healthy foods, newer inventions are rarely better. That was profound, Dr. Li, because, you know, it's been said many ways, like, eat the foods that your grandparents would eat or however we wanna talk about it. But, you know, there's nothing that fancy and new. Like, if we eat in that old-fashioned way, most of the time we're gonna benefit. So that's a very powerful section in the book, which I think people are gonna benefit from. I wonder if we've got time to squeeze in a couple of quick things, which I think-

   12. WLDr. William Li19:56

       Sure

   13. RCDr. Rangan Chatterjee19:56

       ... would really benefit the audience. One is fish and omega-3s. First of all, I wanna cover fish, but then also metabolism and these four different areas which you write so beautifully about. I think those would be two really lovely things to sort of end this conversation with, if we have time.

4. 20:11 – 26:22

   Fish, Omega-3s and the Iceland Cod Study

   1. WLDr. William Li20:11

      Let's dive into the seafood. So, when I set out to write Eat to Beat Your Diet, I had these conversations with my publisher, and I said, "You know, I, I really need to write about, uh, seafood, fish, because omega-3 fatty acids happen to be, uh, uh, fat fighting, metabolism activating, and they activate brown fat as well." And the feedback I got from the editor was, "You know, be very careful about seafood. Many people don't like fish, uh, so we don't wanna be, oh, you know, putting too much information on it." I decided to write an entire chapter about it, okay? And the reason I decided to do it, because it's so important when you think about delicious foods that adequately represent, uh, eating tradit-- culinary traditions. You know, so much of humanity lives on the coast, and those people who live on the coast live off the sea.

   2. RCDr. Rangan Chatterjee21:06

      Yeah.

   3. WLDr. William Li21:06

      And to, to, to the point that, you know... and they, they eat seafood all the time. It's second nature to them. I do think that responsible, sustainable, um, fishing is something that needs to be, uh, practiced. You know, so much of the, uh, disruption that we have in our ecosystem has to do with mechanization, industrialization, this sort of, you know, overage and excess, uh, without, without being mindful of, of the consequences. So let's talk about, let's assume that we, we-- that you're able to go to a fishmonger or a seafood section in your store and find responsibly sourced, uh, seafood. There is amazing... So everybody knows that oily fish are healthy for you, right? And, and most people go, "Eh, I don't like oily fish." What are those oily fish? Salmon, uh, mackerel, anchovy, sardines, right? They're like, "Oh, those are pretty fishy fish. I'm not sure I like that." Well, I happen to like seafood, all right? And I've been fortunate to be able to travel to many places and experience different seafoods in the places where it's naturally caught-

   4. RCDr. Rangan Chatterjee22:08

      Right

   5. WLDr. William Li22:08

      ... cooked, and eaten as part of the culture. Whether it's in Italy, uh, uh, whether it's, you know, uh, off, off the coast of Naples or whether in the Adriatic Sea or, or whether it's in, uh, off, you know, Hong Kong. You know, I've had the opportunity to eat all these incredible dishes. And I tell people, "If you don't like seafood because you don't like the way it tastes, don't worry. You just haven't yet had it properly cooked for you yet."

   6. RCDr. Rangan Chatterjee22:31

      [chuckles]

   7. WLDr. William Li22:32

      When you find that opportunity, you're going to love it, like the millions of other people that love this kind of food. So the study that you're referring to that I think is amazing shows us that we don't need to have the oiliest of oily seafoods in order to get health benefit for omega-3. So this is a study in Iceland that, that did break out into four groups. I just wanna, uh, isolate the most important ones. They wanted to study the fat-burning weight loss po- possibility of salmon. And so they were looking at an oily fish like salmon. Uh, by the way, how much omega-3 does salmon have? About fifteen hundred milligrams per five ounce serving of salmon. It's about the size of a, a couple of decks of cards. Uh, not too much. Uh, and they wanted to-- And their, their initial idea was like, "Well, let's compare salmon with a non-oily fish like cod." Cod is a white flaky fish, not very oily, not, not terribly tasty, actually. It's very mild, actually. I, I like cod, and, um, and, and, and how much omega-3 does it have? Two hundred and ninety-four milligrams of omega-3 in about five ounces serving, same size serving. So literally, you know, seven times less than, than, uh, salmon does. And they gave these people, uh, this, this, these res- research subjects, either salmon or cod or fish oil or nothing three times a week for eight weeks. They gave them a little bit of a calorie restriction so that you can really see, uh, weight loss or not weight gaining. But then to see if you add the fish on, do you actually get more out of it? Does the gas pedal go even harder if, if you have salmon, the oily fish? Well, guess what they found They found that in fact salmon did cause weight loss quite dramatically in conjunction with, with restricting some calories, about 15 pounds over eight weeks, just three times a week, two decks of cards of salmon. Pretty profound. By the way, they have to eat the skin 'cause most of the omega-3 is actually in the skin of salmon, not so much in the flesh. Now, but the real surprise is that the people who had the least oily fish, the cod, that has seven times less omega-3s than salmon per serving, okay, they actually lost 10 pounds in eight weeks eating cod only three times a week. So the, the, the real kind of jaw-dropping, eye-opening discovery here is that we don't need to have the oiliest of oily fish in order to get benefit when it comes to our metabolism and fighting body fat.

   8. RCDr. Rangan Chatterjee25:00

      Information is not enough to make change in your life. You have to take action. So to help you take action after watching this video, I've created a Free Nutrition Guide for you. This contains the five most important practices I've seen in over two decades of seeing patients. They work for you no matter what your dietary preference. There's a step-by-step action plan to help you implement those changes in your life. If you wanna receive that free guide right now, just click on the link in the description box below.

   9. WLDr. William Li25:30

      You can lose 10 pounds in eight weeks by eating cod, which is not that oily. So that opens up-

   10. RCDr. Rangan Chatterjee25:37

       Yeah

   11. WLDr. William Li25:37

       ... the gate, heaven's gate, to looking at other seafoods. 'Cause remember, we used to say, "Well, you know, you gotta go for the oiliest of the oiliest seafoods. All the other ones, nevermind. They're not oily enough." Well, if cod's good enough to do it without enough... If, if the omega-3 in a cod, 284 milligrams is enough to do it, then we can then figure out how many other seafoods do you need to eat in order to get the same amount as, uh, uh, five ounces of cod? Well, I'll give you some examples, and I, and I pepper my whole section on-

   12. RCDr. Rangan Chatterjee26:05

       Yeah

   13. WLDr. William Li26:05

       ... seafoods. So if you're a seafood lover, please read my chapter. You're gonna find out amazing-

   14. RCDr. Rangan Chatterjee26:10

       Yeah

   15. WLDr. William Li26:10

       ... seafoods there that I enjoy, that most people have. I'm quite sure this is the only book with the word diet on the cover that talks about mitten crab and mantis shrimp and razor clams. But, uh [laughs] -

5. 26:22 – 30:02

   Seafood Equivalents and Omega-3s for Vegans

   1. RCDr. Rangan Chatterjee26:22

      It's a de- it's a deep dive, that chapter. I mean, I was reading about types of seafood I, I wasn't even aware existed, so it's really, really fascinating. We, Dr. Li, we must just cover for that person who's listening, who is choosing to be vegan. For whatever reason, they're choosing to be vegan, and you just said all the benefits of fish and omega-3s. You do cover this in the book, but could you just explain what you would ask them to do to, to try and get those health benefits?

   2. WLDr. William Li26:50

      Sure. Look, uh, omega-3s are originally in seafood. They're, they're in plankton, so it's sort of the plant of the sea. So you can actually get the, uh, pr- omega-3 precursor, ami- amino levulinic acid, actually from, uh, certain plants as well.

   3. RCDr. Rangan Chatterjee27:07

      Okay.

   4. WLDr. William Li27:07

      Or you can actually... Which then your body will process and create to a certain extent omega, uh, omega-3s very similar, uh, uh, uh, to what you would get in fish if you're a vegan. But honestly, what I tell my, uh, the people who are vegans who ask me, it's totally fine to get a high quality marine omega-3 supplement. You, you can actually have the supplements as well if you're not getting enough from your diet. It's so important to eat this because that actually improves your immunity. It has effects on your telomeres for lon- for longevity and good quality of life. Um, I, I think that it's, it's, uh, not a big deal if you are not eating seafood.

   5. RCDr. Rangan Chatterjee27:43

      Yeah.

   6. WLDr. William Li27:43

      But just find other sources, uh, to eat it as well. So, uh, but so just to, just to really, um, complete an arc here that I think people will be interested, if cod is good for you, can help you fight body fat because of the omega-3, the amount of omega-3s you get, uh, it's similar to a cod, four medium-sized gulf shrimp, eight oysters, one forkful of mackerel, half of a serving of, of a size of a deck of cards of halibut. This is an example, like if you wanna find out what the dose of seafood you need to get exactly what they found in this research study, I- it's packed with it.

   7. RCDr. Rangan Chatterjee28:20

      Yeah.

   8. WLDr. William Li28:20

      I'm quite certain this is the only, only book that's ever done this because I looked for other examples, and then I had to put together a research team to, to crunch out all these calculations. But the point being that I think that most people who go into the grocery store, it may not be, uh, a reflex to stop at the seafood counter unless you already normally eat seafood. But I'd encourage you to really look for... It's a little bit of adventure in a grocery store to look for all these metabolism useful foods. So if you're of the mind and you eat seafood, and you're, and you're open to it, um, please do stop-

   9. RCDr. Rangan Chatterjee28:53

      Yeah

   10. WLDr. William Li28:53

       ... by the seafood counter and, and compare the notes and see if there's something that might catch your fancy.

   11. RCDr. Rangan Chatterjee28:57

       Yeah, brilliant. Uh, you cover metabolism in, in a, in a bit deep way in the book, which people can read about. Just to finish off this conversation, um, one of the key reasons I wanted to bring this up is you outline some research which has shown that there are these four very stable stages of metabolism in our lives as humans. And it really fights against this idea that many of us have that, you know, in our 30s, when we get into our 40s, of course our metabolism starts to slow down, and we start to put on weight. That evidence is absolutely suggesting that is not the case. Also, the caveat there is I know, uh, women, when they become perimenopausal and menopausal, there can be a consequence sometimes on people's weight. So I am aware of that, just bringing that into the conversation. But just to finish off, Dr. Li, how would you explain that top line view of metabolism and why so many of us think we're going to put on weight as we get older?

6. 30:02 – 36:18

   The Four Stages of Human Metabolism

   1. WLDr. William Li30:02

      Yeah. This was the most jaw-dropping thing that I researched when I was writing this book. Um, first of all, a few commonly held Uh, f- uh, thinking ideas about metabolism. We're either born with a slow or a fast metabolism. My sister was born with a, with a fast metabolism, what, so she's skinny as a stick and can eat anything. Me, I was born with a slower metabolism. I've struggled with food my whole life. How commonly, uh, uh, do-- how common do we actually hear that kind of sentiment? Um, the other thing that we believe is that, you know, when kids are teenagers, um, they're, uh, they're eating two or three meals, they're bouncing off the walls, uh, their metabolism must be going off the, off the charts. Um, and then, of course, as you just alluded to, that, uh, when we reach our middle age, um, we're naturally gonna expand our middle because our metabolism naturally slows down. It turns out all of those ideas are false. They're incorrect, scientifically incorrect, because within the... And the discoveries, by the way, to show they're incorrect have been made just within the last two years. To me, this is the, the, the cool part about science, is that we're still beginning to discover more about our own human nature. So, um, two years ago, published in the journal Science, which is one of the most credible, scientific, rigorous journals that focuses on discovery, a study was published by a researcher named, uh, with the lead author of Herman Pontzer, who worked with ninety researchers. They were stud-- They did the most ambitious study of human metabolism ever undertaken in history. They looked at six thousand people coming from twenty countries, young and old, men and women, different, different back-- racial backgrounds, different dietary backgrounds, and they studied the metabolism in all exactly the same way, which is one of the distinguishing features. They gave them all a drink of water in which the water, which is H2O, hydrogen and wa-- uh, oxygen, they tweaked the chemical hydrogen, they tweaked the chemical oxygen, so they can measure it. So when they, when the, when the subjects drank the water, their metabolism worked on the atoms, and they can measure their metabolism in the breath or in the blood or in the urine. The other remarkable thing is they studied people, humans that were two days old, newborns, and they studied people who are ninety plus years old at the end of, at the, at sort of the tail end of life. So this is the six thousand people of the entire human spectrum. When they actually looked at the results of metabolism, the first results that came out, the raw data, showed that metabolism, everyone was all over the map, just like you'd expect, right? But then we now live in this er- era of supercomputing and really be able to really crunch data. What they did is for every person's body size, they were able to remove from the data the impact of extra body fat, excess body fat. They were able to subtract from the result. And when they removed the effect of excess body fat from all of these individuals, all six thousand individuals, it was like pulling the cloak off the statue of David for the first time. They saw that humans all go through only four phases of metabolism from birth to the end of life. Well, the first thing is that everyone's born with the exact same metabolism. And from age zero to first year of life, our metabolism's skyrocketing to fifty percent higher than what your metabolism's gonna be when you're an adult. From age-- That's first phase. Second phase, from age one to age twenty, metabolism goes down, down, down, down, down to adult levels. This is right through adolescence, right through, you know, people's super energy, the teenager's high energy mode. Metabolism's going down. The real mic drop here is that from age twenty to age sixty, human metabolism from twenty to thirty to forty to fifty to sixty is rock solid. It's stable. It does not decrease. Human metabolism is hardwired. The metabolism is hardwired to be completely stable through the mainstay of our adult lives. And aft-- And I, and I do know people gain weight, and I'm gonna come back to explain why. And then the last phase, that's the third phase. The last phase is phase four. From sixty to ninety, your metabolism slowly sags a little bit to about only seventeen percent that, that by the time you're ninety, what it was when we were sixty. All right. By the way, that middle part, phase three, means that sixty can be the new twenty if you follow your natural metabolism. So why do people actually gain weight? Why do some people have more trouble gaining weight than others? Because during those periods of time, from twenty to thirties to forties to fifties to sixties, life happens to us. Our-- A-and, and so think about it. Our metabolism is hardwired.

   2. SPSpeaker34:35

      Mm-hmm.

   3. WLDr. William Li34:36

      It's like the operating system in your laptop. It's gonna do what it's gonna do. However, uh, in our thirties and forties and fifties and sixties, life happens to us. We have stressors that prevent us from getting enough sleep or from exercising regularly. We have horm- hormonal changes that can change our mood. We've got relationship pressures. We've got emotional pressure, financial pressures, job stresses. All these kinds of changes slow us down, and it turns out that, that, that it, it leads us towards behaviors that allow us to grow extra body fat. So in this research, when they added the effect of extra body, body fat back into the system, back into that stable metabolism, guess what happened? When you add extra fat into the system, it crushes your metabolism. So excess fat slows your metabolism, not the other way around. It's not the slow metabolism that at the beginning of life causes you to ga- gain extra fat and extra weight. It's completely the inverse. Why is that surprising, and why is that good? Well, I'll tell you why it's good news. It's surprising because people don't think about it. It's good news because it means that we now have the power to be able to effect some change to fight that extra body fat in our middle years. We can now have the awareness that our operating system, our hardwiring, is intended to actually be rock stable. So if we fight our extra body fat, that visceral fat, and if we actually stay active, okay? And if we lower our stress and do all these things that actually help our fat be its normal, healthy self-

   4. SPSpeaker36:04

      Okay? Um, then it'll actually allow our metabolism, our suppressed metabolism, to rise back to the surface-

   5. RCDr. Rangan Chatterjee36:10

      Yeah

   6. SPSpeaker36:10

      ... to where it wants to be. We can be aspirational for our, our metabolism. It's not our genetic fate. It is in our hands.

7. 36:18 – 41:38

   Circadian Timing of Meals and Blood Sugar

   1. RCDr. Rangan Chatterjee36:18

      There's quite a lot of research that I've read which is showing that if we consume the bulk of our calories in the first half of our day compared to the second half of the day, that can have powerful effects on our circadian clock, on weight, on sleep, on immune function, all kinds of things.

   2. SPSpeaker36:35

      Yeah.

   3. RCDr. Rangan Chatterjee36:35

      And so, you know, there's obviously a phrase, is it there, breakfast like a king-

   4. SPSpeaker36:38

      Yeah

   5. RCDr. Rangan Chatterjee36:38

      ... lunch like a prince, dinner like a pauper, which I think works really well for a lot of people, actually.

   6. SPSpeaker36:45

      Yeah, yeah.

   7. RCDr. Rangan Chatterjee36:46

      But how does that fit in with what you've just said, which is that we are wired to maybe feel hungry later on in the day, maybe late afternoon, early evening? Because on the face of it, it might seem as though these things are quite opposing.

   8. SPSpeaker37:01

      Yeah, so when I say that, it's not that we are saying that people should just consume food in the evening.

   9. RCDr. Rangan Chatterjee37:07

      Okay.

   10. SPSpeaker37:07

       Uh, they'll still... [laughs] Uh, it's true that in the first half of the day, uh, our blood sugar control is much better. And, um, as physician, you might have seen that if you do a oral glucose tolerance test, which is looking at blood glucose, uh, X number of hours after, um, a bolus of sugary drink, then, um, the same person may s- may look normal in the morning when the glucose tolerance test is done, but in the evening, that person's glucose will shoot up. Uh, on late night it will shoot up, and you may diagnose that person as diabetic. Uh, so there is this aspect of how glucose regulation, particularly insulin-producing cells, have their own clock so that, um, blood glucose level-

   11. RCDr. Rangan Chatterjee37:56

       Mm

   12. SPSpeaker37:56

       ... uh, shoots up in the evening. So that brings up what we should eat at different time of the day. And the analogy that, that I give, uh, again, another thing is our hunter-gatherers, uh, when they were lighting of the fire, they're not lighting a fire to actually eat berries. They're lighting a fire to eat meat or-

   13. RCDr. Rangan Chatterjee38:17

       Protein

   14. SPSpeaker38:17

       ... complex carb that needed a little bit of, uh, cooking so that that-

   15. RCDr. Rangan Chatterjee38:21

       Yeah

   16. SPSpeaker38:21

       ... would become palatable. They were not actually lighting fire to, um, warm up their chips and ice cream to eat. [laughs]

   17. RCDr. Rangan Chatterjee38:29

       Yeah, that's a good point.

   18. SPSpeaker38:30

       So that means, uh, the biology and, and the social aspect still holds good that in the first half of the day, they're more likely eating food that was easily palatable, which already had a lot of simple sugar or easily digestible food, which typically raises our blood glucose. And-

   19. RCDr. Rangan Chatterjee38:51

       Right

   20. SPSpeaker38:52

       ... so that, uh, our insulin-producing cells can manage that, whereas the late night or l- late evening, whatever they were eating, they were mostly, um, food that was rich in fat and maybe m- protein, and that would help them to go through the long period of fasting overnight.

   21. RCDr. Rangan Chatterjee39:12

       Yeah. That makes a lot of sense, actually. It also brings up this idea that when we're trying to compare modern humans with our evolutionary biology in hunter-gatherers, there's another big piece that we miss, which is many of us these days have broken metabolism.

   22. SPSpeaker39:31

       Yeah.

   23. RCDr. Rangan Chatterjee39:31

       You know, if you look at the numbers in terms of how many people, yes, are Type 2 diabetic, but also pre-diabetic-

   24. SPSpeaker39:36

       Yeah

   25. RCDr. Rangan Chatterjee39:37

       ... which means fundamentally we have issues already with our ability to maintain our blood sugar, and, you know, our, our body's not functioning optimally. I d- I can't remember what the stats are now, but it's... I don't know.

   26. SPSpeaker39:48

       So in the US now, almost half of the adults are pre-diabetic or Type 2 diabetic.

   27. RCDr. Rangan Chatterjee39:54

       Do you know what it is in the UK?

   28. SPSpeaker39:55

       Yeah.

   29. RCDr. Rangan Chatterjee39:55

       I think it might even be-

   30. SPSpeaker39:56

       It might be similar because it's, uh-
8. 41:38 – 50:49

   Benefits of a 10-Hour Eating Window

   1. RCDr. Rangan Chatterjee41:38

      Can you summarize, if most people, if anyone listening to this or watching this goes, "Okay, I'm going to now try and, uh, eat all of my foods that I'm gonna consume, whatever diet that might be-

   2. SPSpeaker41:51

      Yeah, yeah

   3. RCDr. Rangan Chatterjee41:51

      ... within a 10-hour eating window." So first thing I want to clarify... Well, within a 10-hour eating window, can you list what are some of the benefits they may get?

   4. SPSpeaker42:04

      Yeah, so, well, once people eat within 10-hour eating window, um, what we find is, uh, within few days- Um, that may be two to three weeks. They may find their sleep will improve, and this is something that we find in many of our patients, uh, who self-report how is their sleep. Um, it may not increase the number of hours they sleep, but it may just improve their sleep satisfaction. They might actually get into a better sleep.

   5. RCDr. Rangan Chatterjee42:35

      Mm-hmm.

   6. SPSpeaker42:35

      Quality of sleep will improve. Um, then those who have acid reflux, I don't know the numbers in the US... in the UK, but in the US, um, there are 65 million prescription for acid reflux written every year.

   7. RCDr. Rangan Chatterjee42:49

      Yeah.

   8. SPSpeaker42:50

      And there is a lot of over-the-counter acid reflux medication. So that means almost more than half of the adult population experiences some kind of acid reflux or s- stomach issues every week. Uh, so we also hear that, um, people have much better, um, gut health. Uh, within two to four weeks, um, they will feel that. Um, so sleeping better and then having better gut health will also improve the sense of energy in the morning and throughout the day. So these are the... We think that these three benefits are the positive feedback loop that helps people to sustain with 8 hours or 10 hours-

   9. RCDr. Rangan Chatterjee43:29

      Yeah

   10. SPSpeaker43:29

       ... eating window. Then those who have pre-diabetes or type 2 diabetes, um, with, um, minimal medication, for example, metformin, um, they may also find that blood sugar control will improve, particularly the nighttime or the, the time period in which they are fasting. Um, at least in that period, 14 hours or 16 hours, um, the blood sugar will remain, uh, much better under control. Then, uh, surprisingly, in many studies, although we haven't connected how it works, we find that people with hypertension, uh, they improve both their systolic blood pressure and diastolic blood pressure, and that can happen between six to eight weeks after trying this, um, regimen. So the flip side is if, uh, people are already on hypertensive drugs, then after four to six weeks, they should actually check their blood pressure to make sure-

   11. RCDr. Rangan Chatterjee44:28

       Yeah

   12. SPSpeaker44:28

       ... that they should do some mid, uh, dosage adjustment.

   13. RCDr. Rangan Chatterjee44:32

       Uh, I think this is just... I think we should pause there because I think this is an important point. There are all these incredible benefits on the other side of this.

   14. SPSpeaker44:40

       Yeah.

   15. RCDr. Rangan Chatterjee44:41

       And so one of my cautions with patients, uh, and again, I'd caution anyone listening or watching, if you have type 2 diabetes or if you are on any blood sugar-lowering medication from your doctor-

   16. SPSpeaker44:55

       Yeah

   17. RCDr. Rangan Chatterjee44:55

       ... you might wanna just have a chat first because-

   18. SPSpeaker44:58

       Yes

   19. RCDr. Rangan Chatterjee44:59

       ... because your blood sugar starts to come down, you may not need that. So what I've always done is I would stop, like something like glipizide, for example-

   20. SPSpeaker45:06

       Yeah

   21. RCDr. Rangan Chatterjee45:06

       ... which can drop blood sugar.

   22. SPSpeaker45:07

       Yeah.

   23. RCDr. Rangan Chatterjee45:07

       I would usually stop that-

   24. SPSpeaker45:10

       Yeah

   25. RCDr. Rangan Chatterjee45:10

       ... when we're transitioning over and then revisit this in a few weeks to see, you know, or a few months, you know, what do we need now? Metformin usually is okay, I've found.

   26. SPSpeaker45:18

       Yeah, metformin is okay.

   27. RCDr. Rangan Chatterjee45:19

       Um, but blood pressure medicines-

   28. SPSpeaker45:21

       Yeah

   29. RCDr. Rangan Chatterjee45:21

       ... you would agree with that.

   30. SPSpeaker45:22

       Yeah, yeah.
9. 50:49 – 1:01:07

   Teen Sleep, Late Homework and Screen Light at Night

   1. RCDr. Rangan Chatterjee50:49

      I rarely come to London anymore to do podcasts, right? But for whatever reason, I'm here this week, and I've got, you know, a busy day, and I know I'm aiming to get a train home tonight from Euston Station at around 7:00 PM, which kinda means I probably won't walk into my house till 9:30.

   2. SPSpeaker51:08

      Yeah.

   3. RCDr. Rangan Chatterjee51:09

      Now I... That, that means I've got two options. One option is I can wait till I get home and have a really nice kind of healthy meal that technically you would say is better for me. You know? I know the ingredients.

   4. SPSpeaker51:21

      Yeah.

   5. RCDr. Rangan Chatterjee51:21

      I know what's in it. Maybe it's something my wife cooked earlier for her and the kids that I'm, I can eat when I get back. I've done that before, but I realized for me, either I skip dinner, but if I'm hungry, I'm better getting something as healthy as I can at Euston Station-

   6. SPSpeaker51:37

      Yeah

   7. RCDr. Rangan Chatterjee51:37

      ... eating it on the train, and finishing eating by about 7:00, 7:15, something like that. And I've found for me, I can have a... And this really speaks to this idea you said before, that you can make healthy foods junk by eating it at the wrong times.

   8. SPSpeaker51:53

      Yeah.

   9. RCDr. Rangan Chatterjee51:54

      I've realized for me, I'm better off getting something where I compromise on, let's say, nutrient quality a little bit and have it at 6:45, 7:00 PM rather than wait and have a, a better whole food meal later in the evening, which I think really speaks to the point that you're making.

   10. SPSpeaker52:11

       Yeah.

   11. RCDr. Rangan Chatterjee52:12

       Uh, the other thing I wanted to comment on is my son's 11, and one thing me and him do most Saturday mornings, if not every Saturday mornings, go to the local park run, which is a 5K run-

   12. SPSpeaker52:24

       Yeah. Yeah

   13. RCDr. Rangan Chatterjee52:24

       ... around the local park, right? Which, you know, these park runs are transforming communities and people's-

   14. SPSpeaker52:28

       Yeah

   15. RCDr. Rangan Chatterjee52:28

       ... people's lives in so many ways. And what I'm trying to do with my kids is help them start to pay attention to what happens when they do certain things. For example, "Oh, I feel tired and sluggish. I don't wanna go." "Oh, now that we've gone, how do you feel now?" Rather than, you know, daddy telling him-

   16. SPSpeaker52:45

       Yeah

   17. RCDr. Rangan Chatterjee52:46

       ... it's like, "Oh, yeah, I've got more energy now. Even though I didn't wanna come-

   18. SPSpeaker52:49

       Yeah

   19. RCDr. Rangan Chatterjee52:49

       ... I've got more energy." And now I've also asked him recently, say, "Just pay attention now to what time we eat the night before, and how you're doing, and how your time is on a Saturday morning."

   20. SPSpeaker53:00

       Yeah, yeah.

   21. RCDr. Rangan Chatterjee53:00

       And I think he's already started to draw the comparison. Uh, when we stick to the early meals on a Friday evening, my sleep's better and I'm running better on a Saturday-

   22. SPSpeaker53:11

       Yeah, yeah

   23. RCDr. Rangan Chatterjee53:11

       ... compared to... Do you know what I mean?

   24. SPSpeaker53:12

       Yeah.

   25. RCDr. Rangan Chatterjee53:12

       So I'm, I'm taking your science and I'm trying to actually, instead of teach it to my son, I'm trying to just help him start to pay attention to, oh... Do you know what I mean?

   26. SPSpeaker53:21

       No, actually, this is, uh, you're doing the right thing because, um, this is a time, particularly teenage time, that's when the, the kids, uh, after they, after they get into late middle school and high school, um, this is when all of our circadian disruption happens.

   27. RCDr. Rangan Chatterjee53:39

       Right.

   28. SPSpeaker53:40

       Um, because that's when they get a lot of homework. They have to stay up late into the night, and when they stay up late into the night, they think, and often they're also told, that your brain cannot function unless you have a late-night snack. And [laughs] they get used to that late-night snack and staying up late in the night, and in the morning they are sleep-deprived, and, uh, they have to rush to the school. And I don't know what is the school start time here, but in the US, for example, um, most of the school start time used to be 7:30 in the morning before the pandemic started. So, um, in collaboration with Horacio de Iglesia, who's a professor at, um, in Seattle, um, he did a very simple study. Uh, what he did was he was looking at sleep, and we know that many teenagers, starting from middle school to high school and college They're sleep-deprived, and, uh, that's also the time when their, their circadian clock tells them to wake up a little later than, um, adults and also, uh, toddlers. So, um, the experiment was to delay the school start time by an hour, um, and to track the students be- uh, before and after, uh, the school start time was delayed. So we tracked nearly 200 students in two different schools, um, their sleep habit, their activity, and their academic performance, and when school start time was delayed by an hour, these kids got 35 minutes, uh, more sleep, extra sleep. And when they got that 35 minutes extra sleep, then many parents would think that now kids are sleeping more, so they're not doing their homework, [laughs] and that-

   29. RCDr. Rangan Chatterjee55:30

       Yeah

   30. SPSpeaker55:30

       ... 35 minutes is coming from their homework time, so their grades might go down. But actually, what we found was their grades improved by 4%, and a 4% grade improvement is, is... can be pretty big for people who are struggling, or those who are getting B grade, they can go to A grade. So this is an example where small change, uh, starting from middle school or high school, can have a huge impact, not only on their health, but also on their academic performance. And if we go back to now, actually in the pandemic, uh, quite a few things happened. One was, uh, the kids were, uh, at least in the US, many kids were always on Zoom-
10. 1:01:07 – 1:10:35

    Melanopsin and How Blind People Sense Light

    1. RCDr. Rangan Chatterjee1:01:07

       What, what a-

    2. SPSpeaker1:01:07

       [laughs]

    3. RCDr. Rangan Chatterjee1:01:08

       What a time to be alive, eh?

    4. SPSpeaker1:01:09

       [laughs]

    5. RCDr. Rangan Chatterjee1:01:11

       Of course, there are many benefits. I'm just, you know, having a joke.

    6. SPSpeaker1:01:13

       Yeah, yeah, yeah. And, uh, you know, we are also talking now, we are thinking about metaverse where [laughs] the light will be actually attached to our head. [laughs]

    7. RCDr. Rangan Chatterjee1:01:24

       [laughs]

    8. SPSpeaker1:01:25

       Looking at rectangular pieces is not enough. We have to actually attach it. So, uh, this is kind of the silent epidemic, um, that has begun, and I think from circadian point of view, we are at the same point as, uh, what used to be the... what I call the lead and asbestos moment. So this is a time when we realize, when we're beginning to realize what is the widespread health impact or disruption of circadian rhythm disruption by having exposure to too much light, ambient light, and also screen time, and reducing sleep or reducing sleep quality and eating at the wrong time. All of these three are conversing. But just like smoking cessation or lead and asbestos took almost a generation to correct, I guess we are at the very beginning of that correction phase, and it will take us almost a generation, but at least few things that we can begin to implement in every family, and you are doing pretty good, uh, awesome setting an example for your kids, is to come up with, uh, simple rules that, uh, two to three hours before bedtime, there should not be any bright light exposure. So at home, for example, now is a good time to put almost all, all your lights in dimmer so that you can dim the light, not flip, switch it on or off, and then use indirect light. So that means light that doesn't illuminate your face, but actually the workspace.

    9. RCDr. Rangan Chatterjee1:03:00

       Yeah

    10. SPSpeaker1:03:00

        Um, table lamps, for example, in the old days. Um, so those kind of lights. And also for all of your devices, uh, make sure that your, all your devices are set to the minimum brightness.

    11. RCDr. Rangan Chatterjee1:03:12

        Mm-hmm

    12. SPSpeaker1:03:12

        Because if that is your default, um, setting, then during daytime, of course, most of the devices will crank up the brightness to, uh, compensate for the ambient light. But at nighttime, at least they will go back to the minimum brightness.

    13. RCDr. Rangan Chatterjee1:03:27

        So you mean that, that... So go into your computer or your phone-

    14. SPSpeaker1:03:30

        Phone

    15. RCDr. Rangan Chatterjee1:03:31

        ... and change the setting so that it automatically starts low.

    16. SPSpeaker1:03:34

        Yeah, yeah

    17. RCDr. Rangan Chatterjee1:03:35

        Or are there settings you're talking about where it, it changes according to the ambient light?

    18. SPSpeaker1:03:39

        Yeah. So, uh, most of the devices now will change according to ambient light, but they will always come back to, uh, in the dark, they'll come back to your default setting.

    19. RCDr. Rangan Chatterjee1:03:49

        So make your default setting really low.

    20. SPSpeaker1:03:51

        Default setting really low.

    21. RCDr. Rangan Chatterjee1:03:52

        Yeah

    22. SPSpeaker1:03:52

        And then almost all rectangular pieces of glowing objects [laughs] also have night shift feature. And this is really gratifying for me personally, because 20 years ago, uh, in 2002, December, actually, we published this paper showing, uh... demonstrating that this blue light receptor called melanopsin is important for resetting our clock and, and also important for, uh, sleep regulation, alertness, and depression, all that stuff. And seeing that being translated to billions of devices is very gratifying. But so now you can go back to all your devices and set the night shift or night light, whatever feature it is. So that means it'll actually change the color composition of the... of your screen to, from white balance to a little bit orange in color.

    23. RCDr. Rangan Chatterjee1:04:41

        So even if you are working at night on your computer-

    24. SPSpeaker1:04:43

        Yeah

    25. RCDr. Rangan Chatterjee1:04:43

        ... your job requires you to, even if your kids have to do homework-

    26. SPSpeaker1:04:46

        Yeah

    27. RCDr. Rangan Chatterjee1:04:47

        ... at that time, their school requires them to, you're saying that by doing this, we can mitigate the effect that that's gonna have on our sleep quality and on our, on our sort of circadian rhythm.

    28. SPSpeaker1:04:58

        Yeah. So at least, uh, you know, j- just like for waking up, we have an alarm clock. For going to bed, these are the nudges that will come in automatically that, um, our screen will become a little darker and change its color. So at least for me, personally, I feel like, okay, so it's time to wind down-

    29. RCDr. Rangan Chatterjee1:05:18

        Yeah

    30. SPSpeaker1:05:18

        ... and prepare for bed.
11. 1:10:35 – 1:21:51

    Compressed Eating Windows and the Mouse Lifespan Study

    1. RCDr. Rangan Chatterjee1:10:35

       just to close off then the evenings, right?

    2. SPSpeaker1:10:37

       Yeah.

    3. RCDr. Rangan Chatterjee1:10:37

       Because there's, there's a really nice symmetry where you want, at the start of the day, one hour without eating, get some light, get some movement if you can.

    4. SPSpeaker1:10:47

       Mm-hmm.

    5. RCDr. Rangan Chatterjee1:10:47

       Those things are great. At the end of the day, you're saying two to three hours before bed not to eat, so you almost kind of start and the end are quite similar in some ways-

    6. SPSpeaker1:10:57

       Yeah

    7. RCDr. Rangan Chatterjee1:10:57

       ... but very different in other ways in terms of in, you know, instead of bright light in the morning, you now want dim lights in the evening.

    8. SPSpeaker1:11:04

       Yeah.

    9. RCDr. Rangan Chatterjee1:11:04

       Um, candlelight, firelight. If you are on your screens, change that. One thing we've also done at home which has made a massive difference, I have these low blue light bulbs now-

    10. SPSpeaker1:11:15

        Yeah

    11. RCDr. Rangan Chatterjee1:11:15

        ... in all the bedside lamps.

    12. SPSpeaker1:11:17

        Yeah.

    13. RCDr. Rangan Chatterjee1:11:18

        It's... And you could feel it. And actually, once we ran out recently, and we changed it to a normal-

    14. SPSpeaker1:11:23

        Yeah

    15. RCDr. Rangan Chatterjee1:11:23

        ... l- like, low-wattage bulb, I couldn't believe how bright it was.

    16. SPSpeaker1:11:28

        Yeah, that, that-

    17. RCDr. Rangan Chatterjee1:11:28

        I thought, "Wow, for years, this was what it was."

    18. SPSpeaker1:11:30

        Yeah.

    19. RCDr. Rangan Chatterjee1:11:30

        Uh, it makes such a difference.

    20. SPSpeaker1:11:32

        Yeah.

    21. RCDr. Rangan Chatterjee1:11:32

        And you feel it. You feel more relaxed. So I think, again, that's a very simple thing that people can do that will make a difference. Going back to eating windows-

    22. SPSpeaker1:11:41

        Yeah

    23. RCDr. Rangan Chatterjee1:11:41

        ... okay, so we've said that 10 hours-

    24. SPSpeaker1:11:44

        Yeah

    25. RCDr. Rangan Chatterjee1:11:44

        ... appears to be a pretty good universal recommendation that most people tend to find works around social life, work life, and what they're able to do. Now, there's a huge trend these days in the kinda low-carbo, um, keto community to skip breakfast, uh, and maybe go even more aggressive, like eight hours, and maybe, uh, you know, first meal at 12:00, finish eating by 8:00 PM, or I know some people go even later. They use coffee to get them through in the, in the morning.

    26. SPSpeaker1:12:18

        Yeah.

    27. RCDr. Rangan Chatterjee1:12:18

        And they don't feel hungry at all, so often it'll be 2:00 or 3:00 PM they start, but they'll eat quite late, till, let's say, 10:00 PM. So they've actually got a compressed eating window, but it's towards the end of the day.

    28. SPSpeaker1:12:31

        Yeah.

    29. RCDr. Rangan Chatterjee1:12:31

        So I just wanna get into some of the subtleties here. Compared to what most people are doing, which is eating across 15 hours, right?

    30. SPSpeaker1:12:39

        Yeah.
12. 1:21:51 – 1:35:37

    Inflammation, Mental Health and the Gut

    1. RCDr. Rangan Chatterjee1:21:51

       I wonder if you would explain how you view inflammation in the context of our physical and mental health. Uh, but then also really split it up into body inflammation and brain inflammation, and how those two things sort of link together.

    2. SPSpeaker1:22:05

       For sure. Inflammation is a, a very important system. It- it's what protects us, it's what keeps us safe. Inflammation is really at the root of our immune system and how our body recognizes threats and injuries, and then eliminates them. Um, however, because there are a lot of things stimulating us, whether that's noise of the city or air pollution, by the way, very, very strongly linked to your risk of depression, or whether it is a stressful or toxic work environment, we are always wired and, and, and revved up. There's a lot that is stressing us and, and because of that, it's a little bit like... I, I, I make the analogy sometimes, it's like if you went in to take a test in school and the fire alarm went off. And instead of leaving, they said, "Yes, [laughs] this test is important. You gotta sit there, take your test." And you're taking the test, and then the sprinklers come on, you know, and it's, and it's messing up your work, and the, the proctor of exam says, "Sorry, you know. It's a tough exam." Having too much inflammation is a little like that. You can probably still finish the exam, but you're just, your, your alarms are preventing you from, uh, uh, really living your best because they're going off inappropriately. Uh, inflammation is, uh, uh, very tightly linked to our food, 'cause the, the largest part of our kind of inflammatory or immune system is our gut. And so you think about food as, as really a set of signals and, and as a way to really fuel and nourish your immune and inflammatory system, and, and also to regulate it. There's also this concept that a lot of people have heard about now called the microbiome or the idea of the microbiome. Uh, these... And these... The reason we're hearing about these two ideas, these are very linked. The microbiome is the set of organisms, primarily bacteria, that live in your gut, and mostly in your colon, and they're at the center of really helping regulate a lot about our body, but in- including our inflammatory response.

    3. RCDr. Rangan Chatterjee1:23:57

       Yeah. I mean, super helpful to, I think, explain that to people.

    4. SPSpeaker1:24:02

       I'm curious what you feel is really one of the best ways to explain inflammation, because you've heard so many people talk about it, and I really agree, it's one of those words that's easy to pass around, and I'm wondering how, how it sits with you in a way that makes sense or resonates with patients and people.

    5. RCDr. Rangan Chatterjee1:24:17

       Yeah. You know, uh, as, uh, uh, I'm sure you would agree, you know, the way we explain things often depends on who we're communicating with. Um, uh, as I'm sure you do, I change my communication style in clinic depending on who that patient is in front of me, their level of understanding, the sort of, the energy I get from them, the sort of, uh, the pr- you know, the prior interaction. It all plays into it. But I guess in a, in a sort of public setting like this, how would I explain inflammation? Yeah, not dissimilar to you. I'd say inflammation is the way that the body, um, tries to protect itself. So, uh, you know, we all understand, everyone knows the feeling if when they've cut themselves, and they cut their ankle and it's bleeding, and then the body needs inflammation to try and repair that ankle, right?

    6. SPSpeaker1:25:03

       Uh, yeah, it reminds me, I remember once, uh, talking about anxiety and, and writing about it, and really talking about how it's a superpower. And it, it's funny, as you're talking about, you know, an- inflammation is a superpower. I mean, when you think that you can get cut or trip and sprain your ankle, and, and the body, you know, protects itself, then repairs itself while you're just, you know, you're sitting on the couch-

    7. RCDr. Rangan Chatterjee1:25:23

       Yeah

    8. SPSpeaker1:25:23

       ... you know, snacking. [laughs]

    9. RCDr. Rangan Chatterjee1:25:25

       Exactly. We don't, we don't have to do anything. You know, that, that our bodies are built to thrive, right? They, they will take care of that cut without us doing anything, which really is the miracle, I think, of the human body, and something we sometimes, I think we sometimes forget that in medicine, just how intrinsically powerful our bodies are. But that inflammation, I think, in the short term, you know, to, to s- to, to fix that cut, fantastic for your skin to repair and heal. I guess what we're talking about with, um, w- when inflammation is, is, is linked to lots of these chronic diseases, including depression and anxiety, we're talking about that chronic inflammation, that sort of low-grade, unresolved inflammation. And I often describe it to patients as saying, "Look, it's almost as if your body is trying to protect itself from attack every day, but it's protecting itself from the attack of your daily lives," whether it's your diet, it's your lack of physical activity, the, the chronic stress, the air pollution, you know, whatever it is, lack of vitamin D. All these things are... The body's interpreting that as a- an insult in some way, and it's, it's mounting its immune response through inflammation. Well, inflammation is one of those mechanisms to try and calm it down, but actually, if it's happening day in, day out, that's when it can start to become problematic.

    10. SPSpeaker1:26:49

        Yeah. And that, and that's where as you ask and, and, and, and we should point out, talking about mental health, there is a real strong, uh, link and set of evidence now linking inflammation and chronic inflammation to depression and anxiety a- and as well as brain fog. You know, we really think those are symptoms increasingly people have kind of identified and complained. And also, those are symptoms that often get explained in all kinds of incorrect ways and treated in all kinds of incorrect ways, both by conventional medicine and, and also by the wellness industry and supplement industry. So I think it's really im- important to talk about the reality of it. So the, the, the simple truth is, uh, when you have inflammation, a lot of us, we've experienced this, when you've had the flu or when you've been sick, you get a, a sense, a, a feeling of, um, uh, anhedonia, loss of pleasure, loss of engagement. You kind of retreat and isolate. Uh, a- and, and oftentimes our mood goes down. You just feel really sad and wanna kind of curl up and rest, and that makes a lot of sense from your body's standpoint. They're kind of shutting things down, uh, saying, y- you know, "Hey, we need to heal and fight this bug." Um, anxiety comes on board, where when we get ill, we get a little hypervigilant, meaning that we're looking around. We don't, you know, we don't wanna be messed with, right? We wanna heal. Um, and then there's the little brain fog, where as you think about it, you know, y- if you're sick, you don't wanna be having all your best ideas, super creative. You should run to do this or, you know, take care of those errands or... Right? Because i- there's a, a kind of almost intention of your body's alarm system shutting down some of that process and having a little bit of brain fog. So in real life though, when we're having those symptoms, i- it's, it's horrible. So there's some data, large meta-analyses looking at if anyone who's been taking an antidepressant, if they're also on any anti-inflammatory agent. And, and, and I do wanna note something a lot of people don't know, I didn't really know, is, is that SSRI antidepressants, which are the most common prescribed medication, are, they're often thought of as serotonin medications. They are, but they also, uh, help, uh, fight inflammation in a way that's really kind of interesting when you think about how they work. But, uh, back to this meta-analysis. Individuals on, uh, antidepressants who were given any type of anti-inflammatory medication got twice as better if you are on anti-inflammatory medication with your antidepressant. And so just to me as a clini- clinician treating depression and anxiety every day, it just brings that right into the clinical room. All right, how do you do that in a patient's life? Where is the inflammation coming from? How do you eliminate it? Can you? Um, how do you measure that? So-

    11. RCDr. Rangan Chatterjee1:29:29

        Yeah

    12. SPSpeaker1:29:29

        ... that's, I think, how, how it relates.

    13. RCDr. Rangan Chatterjee1:29:32

        What I think is really interesting for, for many of us is this idea that what we do to our bodies can affect our brains. So this idea that if we can reduce inflammation in our body, that can also reduce inflammation in our brain, or certainly help symptoms in our brain. And you have mentioned the gut-brain axis before. Um, but I guess I'd like to tease out how exactly food is impacting what's going on in here, because there is, yeah, I guess, structural components. Let's say you, you're having an omega-3 fat, and that's involved in the structure and many other things in the brain, but there's also this communication pathway where this is kind of sending signals as well, and I'd, I'd love to just unpick that a little bit and, and also really understand, uh, Drew, when you have got patients in front of you who presumably by the time they're referred to you as a specialist psychiatrist, you know, they're presumably struggling in, in some way, in quite a significant way with their health.

    14. SPSpeaker1:30:39

        Isn't that, by the way, totally, totally F'd up about the mental healthcare system-

    15. RCDr. Rangan Chatterjee1:30:43

        Yeah

    16. SPSpeaker1:30:44

        ... all over the developed world? Like, you talk to me when it's like, "Well, got serious, so you had to go see a psychiatrist." That is such BS that needs to change because, y- you know, everybody needs to see you once a year and be like, "Hey." And like, if they're not paying attention to their health, you say, "Hey, you know, in some way you should pay attention to your health. I'm gonna take your blood. Hey, look, here's some stuff that you're doing well. Here are some things you need to work on." We don't do that in mental health.

    17. RCDr. Rangan Chatterjee1:31:08

        Yeah.

    18. SPSpeaker1:31:08

        The only time you get to see a mental health, a psychiatrist, is if you have significant symptoms. And, and it, I just wanted to point that out to everyone. I think it's a, it's a really shift we all need to make, to think about mental health and mental fitness and our own mental fitness, and how do we prevent these conditions? And then if we have them, really use everything that we have to treat them. So s- s- sorry to just jump in there about that. And I also wanted to say, 'cause I'm a psychiatrist, that thing you're saying, like the brain and the body being different, I don't think like that. I, I don't, I don't in any way separate my body from my brain. When we're talking about inflammation in the body, that's, that's synonymous with me.

    19. RCDr. Rangan Chatterjee1:31:44

        Yeah.

    20. SPSpeaker1:31:44

        There is no inflammation in the body without inflammation in the brain.

    21. RCDr. Rangan Chatterjee1:31:47

        I get it. Me too. I don't, I don't really think like that. It's more about, I think a lot of people I've spoken to really do see the body like that, or they've been conditioned to see the body like that. And therefore, it's about trying to help people understand that actually if your body's inflamed, your brain's inflamed. Uh, but what, do you need to get certain buy-in with your patients? Like, do certain patients come in and you're trying to help them change their diet to help their mood, their happiness, their depression, their anxiety, whatever it is. Are some people skeptical? And if so, how do you overcome that?

    22. SPSpeaker1:32:22

        Well, I, I think everyone should be skeptical because it's mental health, and I think so many, because it's a subjective field, so many people have ideas and opinions and experiences of it. And so, my, the first thing that I, I do is I, I- I'm a general psychiatrist. I take a good psychiatric history and I, I, I treat the patients in front of me. Um, I don't think about medications as really different than psychotherapy, as different than lifestyle. These are all really important tools to battle depression and anxiety. And I, I wanna try and understand for each individual, how do those fit in? Some people come in and they're like, "Zoloft worked for my brother. I need it. I want it now." Other people come in and, and, that's an antidepressant, you know, come in and they're really, you know, they're against medications, for whatever reasons. Uh, when it comes to food, I wanna be curious what people think, what they've heard. I wanna be clear about my intention that, you know, I, I have my own set of values and biases about how food can work and can't work when it comes to mental health. And so the first thing I do is try and check in and assess where is someone around those ideas, and where are they as an eater. And then in terms of buy-in, I, uh, try and have it be part of the ongoing conversation, uh, where I'm both, um, showing some enthusiasm about, uh, how nutrition impacts mental health. I'm trying not to be annoying. I find that doctors in general are really awful about food. We're really fear-based, right? [laughs] "Oh, don't eat that 'cause you're gonna get a heart attack," you know? "Don't do this," or, "Whoa," you know? And, and, "No salt." It, it's not loving or kind, and, and I've really done away with that. I think people who talk like that from a medical perspective really aren't doing any good for public health. I, I think fear-mongering is just silliness. You can eat all kinds of different foods and, and, and, and have a reasonably healthy life. I really try and focus on the hopefulness of it, that let, let, if we think about depression and anxiety in modern terms, in, in, in, in Eat to Beat Depression and Anxiety, I have a big, uh, graphic here, the new science of depression and anxiety. Like, let's just stop thinking about this as, you know, mental health is basically suicide and SSRIs. Let's really start thinking about mental health robustly. We, we incorporate these different factors in, in, in how we approach patients. So with food, um, what, what you see oftentimes is, first of all, mental health affects it, you know? We should be talking about it because, a- and we do talk a little bit about symptoms, right? Has, has depression affected your appetite? And a lot of patients say, yeah. And we say, "Oh, that means you have depression." Like, right, but what does that mean for us as clinicians? It means that your patient isn't nourishing themselves in the most important period of recovery, as they're trying to get better from depression and anxiety. So what do you do in that situation? Well, in nutritional psychiatry and, as we talk to and, and train clinicians, and we now have a really nice clinician community of nutritional psychiatrists, we think about all of the ways that you get more nutrients into, uh, a brain f- in, in different, uh, different ways. Like, if you don't have an appetite, soups and smoothies are really great for you. Uh, nuts, a handful of nuts is a great, great handful of nutrition, right? There's all kinds of ways to, uh, help accommodate where someone is in terms of, uh, th- th- their illness with nutrition and to incorporate that into treatment.

13. 1:35:37 – 1:58:33

    Antidepressant Food Scale and Nutrient Profiling

    1. RCDr. Rangan Chatterjee1:35:37

       I think one of the things I've, I've always loved when I've heard you speak, uh, or seen you on Instagram, is there's a real open-mindedness, there's a real humbleness. Uh, I imagine your patients really, really enjoy their interactions with you, I would imagine, from, from the sort of, um, the tone with which you speak, and I've seen you speak. What I'm really curious about is you obviously have a very personalized approach to each of your patients, you know? Everyone has a different set of life experiences, family background, genetics, desires, needs. Yet you've also written this quite fantastic book, Eat to Beat Depression and Anxiety, and I'm asking this 'cause this is something I've struggled with in, in my publishing career, is I believe in personalized medicine, but then you're trying to write a book that's gonna help masses of people. Uh, I know how I've tried to do it, and I'm interested to, you know, how was that for you? Was that a struggle? Did you... Was that something you had to think a lot about because it's a great book, it's helping a lot of people, but how do you deliver that personalized approach in a book that's written for everyone?

    2. SPSpeaker1:36:50

       I, I hope in this book, Eat to Beat Depression and Anxiety, chapter six, Eater Heal Thyself, it does a good job of approach, helping people see how I approach food. This isn't a diet book. This isn't a, uh, this isn't a gimmick. This is really trying to ha- ask you as a reader, as an eater, to take a step back There's been so much chatter, misinformation, so much removal that people have had from their culture, uh, of origin, uh, when it comes to their nutrition. Our, our, our sense of taste and, and sense of what's healthy for us has really been abdicated by a mix of big food and, and big science. In terms of food, nutritional psychiatry and, and the evolution of those ideas as I worked specifically with, um, Laura Lachance, who's a, a colleague who came up to me at a conference and said, "I wanna, I wanna, I wanna do some work together," and we started trying to create a manual of nutritional psychiatry of sort of how do clinicians do this. We created the Antidepressant Food Scale, and we just really asked a simple question. All right, with all this nutritional information, what nutrients matter for depression? And we found there were 12 that had significant levels of scientific evidence that they could help prevent depression and help treat depression, things like zinc and magnesium and B12 and omega-3 fats and folate, uh, and iron. And, and then we said, "What foods on planet Earth, just natural, whole foods, have the most of these 12 nutrients per calorie?" Really simple question. And that led to a list of the top plant foods and the top animal foods. And, and I, while I don't love listing foods like that, it, it led... Because everyone says, you know, "What's number one? Watercress." And it's like, "Oh, I should eat more watercress to fight my depression." And, and, and what it really led me to understand, uh, is, these are called nutrient profiling systems, and the Antidepressant Food Scale was the first nutrient profiling system that was ever created specifically for mental health. And, and what Dr. Lachance and I understood is that if you looked at food in terms of food categories, and this is what n- nutrient profiling systems really encourage you to do, and what you see is what's, what's in the top five animal foods, you know? Three of them are bivalves: mussels, clams, and oysters. Why is that? Well, if we look at one of the most important nutrients for mental health, it's vitamin B12, the largest vitamin we, uh, we eat. You'd think we'd all know the, what is the top source of vitamin B12 in the natural world, and I certainly did, didn't. It's clams. I mean, who's called clam a superfood, right? [laughs] It's like who said like, "Oh, you know, I'm going out tonight. I wanna make sure I recover from my hangover. I'm, you know, getting a B12 injection"? It's like, hell no, I'm having pasta vongole. Get my B12 levels up. I mean, it, it's [laughs] ... So, uh, uh, l- looking at, uh, to get to your questions, how as an author do I personalize recommendations, I think one, in, in trying to let people know the, my approach and goal of the book and the limitations of that, and then two, to try and replicate as much as I can the way that I, I think about this information with w- what I feel I, I hope you and I can, can bring to authorship, which is the experience of a clinician. Because of clinical experience, you and I have the privilege of, of hearing and sharing thousands of individuals and their families and their stories. And oftentimes, especially when it comes to mental health, uh, and especially on social media, what's getting talked about and shared is an individual story. And there's real importance in that in terms of, you know, today if you have bipolar disorder or borderline character disorder or addiction or any substance use disorder, rather, uh, you can put in a hashtag and you see an advocate, see a, you know, someone who's recovered. You can reach out to resources. I mean, it's really... You can direct message someone and be, you know, chatting with, um, a mental health advocate or even a clinician pretty quickly. So I think that's wonderful. And at the same time, though, what you're talking about is that w- when you see, um, uh, the aggregate of many, many stories, um, it, it does create, I think, a humility of understanding, um, the importance of our commitment to patient autonomy, our commitment to health, and then the many ways that humans define that. It's really, it, uh, I think sometimes early in my career I sound a little almost anti-vegan, and, and I really shifted, one, as I, I was employing a number of vegans. [laughs] But, but also, um, as I began to really, uh, think about, um, freedom and choice, and again, wh- where I wanted to be in the conversation, which is helping people no matter what they're deciding to eat feed their mental health and take care of their mental health and prioritize that. And that, that, that should really be the top tier of our goal because that, that's the best, it's the... I mean, that's why we separate the brain and the body, or people traditionally do, is just the brain's the best part. That, that's all of it. That's like, that's the whole game, right? There's like [laughs] you know, there's a lot of other organs you can replace. I always kind of joke sometimes. I say, "You know, when you go to, like, the home improvement store, there's a lot of body parts you could buy, right? You can buy, like, your kidneys, like filters. You can buy, like, pumps, like your heart." It's like consciousness, hopes, dreams, generator, you know, are, uh, like, I, you know, there's none of that anywhere except the human brain, so.

    3. RCDr. Rangan Chatterjee1:41:59

       Yeah, I think you've done a great job in the book, actually. I think the... W- one of the things I really liked, actually, is this focus on dietary patterns. I think you're a fan of the traditional dietary pattern rather than labeling it around a particular country necessarily. I mean, we can maybe expand on that, but also you do focus in on these 12 nutrients, these 12 nutrients that can help us all build healthier, more vibrant brains. So, you know, that I really like the interplay between the specific nutrients, but also the, the dietary pattern. So I wonder whether we could spend a bit of time on what some of those nutrients are and then-

    4. SPSpeaker1:42:36

       For sure

    5. RCDr. Rangan Chatterjee1:42:37

       ... you can talk about how they fit into certain patterns.

    6. SPSpeaker1:42:40

       Yeah. I, I remember the dietary pattern I think is a really brilliant shift that researchers made and, and you've had Felice Jacka on. She's-

    7. RCDr. Rangan Chatterjee1:42:47

       Yeah

    8. SPSpeaker1:42:47

       ... really, uh, you know, one of, uh, the founders of this field. I mean, she's done some of the best research and led, I think, really our movement. Felice, um, uh, Dr. Jacka ha- had actually the first real nutritional psychiatry paper ever published in The American Journal of Psychiatry, what we called the Green Journal, really kind of one, one of the top journals in mental health, and it was actually her, her PhD dissertation. I think a real inspiration for anybody out there who's in graduate school or thinking about a career. Dr. Jacka shifted careers, became an epidemiologist, got her PhD. Her, her dissertation gets published in The American Journal of Psychiatry, a paper based on it, which was a correlational study showing that dietary patterns, so it's not about just B12 or this or that, but a dietary pattern, so the pattern of all the foods you eat. Uh, um, uh, a traditional dietary pattern, so those are, you know, foods everybody's gonna recognize. Where everyone's heard that phrase, you know, foods like grandma ate, right? So potatoes, tomatoes, you know, okra, salmon, beef, right? Stuff that is real food, compared to a modern or a Western dietary pattern. And, and a traditional dietary pattern was correlated with a significant decrease in depression and anxiety. So it's just a correlational study, but really fascinating. A- and I like this shift because it allows us to eat pizza and chocolate cake and have the occasional beer and, a- and not freak out because we have a dietary pattern that's consisting found-- that has a foundation on really what are called nutrient dense foods. Again, those foods on the antidepressant food scale, like, you know, uh, leafy greens. You're always gonna have a lot of nutrition, not a lot of calories, and that's what we look for in nutritional psychiatry. And then in terms of individual nutrients in the book, I really try and, and break it down with these, um, illustrations.

    9. RCDr. Rangan Chatterjee1:44:32

       Yeah.

    10. SPSpeaker1:44:32

        Because, one, I, I found it was a lot to keep in my own head. Like, oh, like what's the top source of vitamin B9? Like, ah. And I, I just liked having a set of foods. A- and from that, you know, your question earlier, how do you sum it up? I found that that iterative process of writing with, a- a- and working with my editorial team really helpful of like, look, you do... You know, we, we talk about the thinking and the power players, but if somebody's just getting started, what's a food they can pick up in the grocery store today? And that really inspired me to get very specific. And so in, in this book we have a, a list of the power players, and the power players really represent each food category. So, um, red peppers are on there because they're one of my son's favorites, but they're also really, really high in vitamin C. They're easy to add into any dish. I, I find they're easy to snack on. They're easy to dip in hummus. They're easy to throw in your frittata. They're easy to throw right there, and they last forever in the fridge. So that's one of those foods that for me is power player. And in nutritional psychiatry and eating for mental health, there's some other usual suspects, wild salmon. But really a- as a clinician, I find, all right, the real challenge is anchovies and sardines. Those were a challenge for me. I'm like an Indiana farm boy.

    11. RCDr. Rangan Chatterjee1:45:41

        A- as, as a clinician or as a parent or both?

    12. SPSpeaker1:45:45

        Well, I, I think first they were a challenge as an eater-

    13. RCDr. Rangan Chatterjee1:45:47

        Yeah

    14. SPSpeaker1:45:47

        ... where all that omega-3 data came out and I'm like a low fat vegetarian who, like, turns up my nose at fish. And I was a little bit of a picky eater. I might have had some weird... You know, like I didn't like pie until I was like 12. I thought it was very strange. So, but fish was really hard for me. I didn't eat any fish until I... I don't know. I, I ate a little piece of sushi there every now and then, but not like any cooked fish, not any bivalves, oysters, ugh. I, I had no idea. And then I just... I dunno. The data compelled me to get a little more curious. Um, my wife and I were living in New York, and I kinda like had this realization. I don't realize, you know, New York's great in all kinds of ways. It's also an island o- in the sea, [laughs] and there's all kinds of amazing seafood, and started meeting a lot of people in the restaurant industry and having a lot of friends who were young chefs and just sort of introduced me to simple ways to prepare fish, and I started developing my palate. One of the things I really encourage people to think about in, in the book, just like the way to think about your mental health and evolution, to think about your palate and evolution. And there are a lot of foods that I, I think we've lost. A lot of us have lost the tradition of, of, uh, of, of, of seafoods or nutrient dense foods or how leafy greens are used. A lot of us don't have that knowledge of, of how to prepare and cook foods at home in very simple ways, that are very easy and economical but that support our health. And, um, so the, the hope is to translate those nutrients, get people excited about these nutrients and what they do in our brain, but really translate them into foods and then help people get those into our lives. That's what our, our, our newest program in our clinic, we have a virtual cooking school, the Mental Fitness, uh, Kitchen, and it's been so much fun. Uh, anybody can, uh, is welcome to, to join our classes. We're, we're really trying as a clinic to help people actualize this-

    15. RCDr. Rangan Chatterjee1:47:31

        Yeah

    16. SPSpeaker1:47:32

        ... that if you need coaching around how to take care of your brain with nutrition and, and integrate these foods, if you need to learn some new recipes, if you need, um, some community support, that we really wanna, as a clinic, try and replicate some of the data. There's a great study, the Healthy Med trial. Um, and I don't know, I s- feel like geeking out on science with you for a minute, so let's just talk about the randomized trials.

    17. RCDr. Rangan Chatterjee1:47:53

        Let's do it.

    18. SPSpeaker1:47:53

        But it's like, all right, so there's all this correlational data, but like you and I know, like correlational data is great, but it's not gonna convince anybody. You know, I, I'm a Columbia psychiatrist. It's a very... It's a great department, but it... I wouldn't say it's conservative, but it, it, it is historical in the sense that it, it's seen a lot of things come and go, and it's not gonna be impressed by correlational studies. It wants, you know... The, the, the serious clinicians, policy makers, they need to see randomized trials. So now there have been, there have been five trials of food specifically used to treat people with clinical depression. The first was by Felice Jacka. It was the SMILES trial.

    19. RCDr. Rangan Chatterjee1:48:29

        Yeah.

    20. SPSpeaker1:48:29

        Felice has been on the show. She talked about the SMILES trial. The SMILES trial's incredible. What it does is it goes into a mental health setting, m- about s- 67 patients. The majority of them are already taking an antidepressant or in some type of psychotherapy, so kinda like a clinic like our clinic, and they give people seven individual, uh, therapy sessions around dietary change by a nutritionist over 12 weeks. What they see is a third of individuals go into full remission from their depression. If this were a medication, it would be a multi-billion dollar blockbuster drug. It's all we would be hearing about. So food does this. That's one trial. That's the-

    21. RCDr. Rangan Chatterjee1:49:06

        Just, let's just, let's just... That was... I mean, I love the SMILES trial. I think it was a landmark trial when it got published, and let's just, just repeat what you just said at the end there. A third of the patients, like a third of the patients went into full remission.

    22. SPSpeaker1:49:22

        32.3% go into full clinical remission, and l- look, this is-

    23. RCDr. Rangan Chatterjee1:49:26

        That is incredible. Absolutely incredible

    24. SPSpeaker1:49:27

        ... this is, and, and in this trial, so remission is a very important idea and I, and I think that... Let's sort of tease that out, 'cause there's response, like, oh, like how are you feeling? Like, "Oh, you know, those avocados, that weird stuff Ramsey gave me, those brain food smoothies, like I'm feeling a little more energy. Like I'm not crying. Like I'm feeling a little better." But that, that's just response. Remission is actually you don't have depression anymore And so it, it do- it does feel like an important thing to note that people go into full remission. Let's talk, how do they do that? It wasn't a lot. If people started eating, like, one more seafood meal a week and, like, a half serving of vegetables a day more or... And like a, actually it's, like, a serving of vegetables, one more serving of vegetables, half serving of fruit, couple servings of beans and legumes a week, a serving of fish a week, and then the big thing they did is 21 fewer meals of highly processed or, quote-unquote, "unhealthy food". And-

    25. RCDr. Rangan Chatterjee1:50:17

        20, 21. Oh, so per week. So basically-

    26. SPSpeaker1:50:19

        21 fewer meals-

    27. RCDr. Rangan Chatterjee1:50:20

        Yeah

    28. SPSpeaker1:50:20

        ... per week, or fewer, you know... So that's snacks, that's, you know, that, that's the difference between, you know, going out and getting a burger and fries and, I don't know, making yourself a vegetable stir fry. Um, uh-

    29. RCDr. Rangan Chatterjee1:50:30

        Yeah

    30. SPSpeaker1:50:32

        ... so that's the SMILES trial. Great trial. I- in America, to get a medication approved, you need two good quality randomized clinical trials. So this is number one. Uh, it's what, 2017, I think, is this comes out, so four years ago. Also interesting, like, translation to clinical practice. And we're, we're jumping up and down about this. We've trained, um, over 200 clinicians around nutritional psychiatry in, in our, um, we have a, an e-course and a live training that we do. But it's interesting how it takes a long time to translate. A lot of questions we get from clinicians, like, "Am I allowed to talk about food?" It's like, wow, it's, like, one of the most foundational pieces of mental health and brain health and, and we're not even sure that we're allowed to talk about it sometimes.
14. 1:58:33 – 2:05:00

    Randomized Trials of Food for Depression

    1. RCDr. Rangan Chatterjee1:58:33

       let's go back to some of those studies. You, you started off with the SMILES trial. Uh-

    2. SPSpeaker1:58:37

       SMILES trial. Healthy Med then comes out. Healthy Med, I love it. It really is what we try to replicate with our Mental Fitness Kitchen cooking class. So it, uh, the Healthy Med trial, uh, took individuals with depression. Uh, if you look in detail at this study, there's a couple things that are important. The first, oftentimes people think, oh, like, food is for, like, mild depression. Like, so this study, 86.3% of the people in the trial have severe or extremely severe clinical depression. So, so this isn't mild depression. They get a little tiny dose of fish oil, not really n- enough in any way to make a difference with depression. The data on fish oil and depression is mixed, but it's a much higher dose. They get a couple hundred milligrams of fish oil, and they get a Mediterranean-style cooking class. What they see over, uh, three months and then at six months is a significant reduction in, uh, depression and anxiety scores that stay low. They drop quickly, and they stay low. And, and individuals are no longer severely depressed. And so a- again, in terms of risk mitigation, well, what was striking about this trial is antidepressants take a months to work. A lot of these individuals were already on medicines. They, again, had a resistant depression that wasn't working. They get given a nutritional intervention and encouragement to eat better, and I think it's a 45% reduction in their formal anxiety rating scales and, and about the same for their depression rating scales. So that's the Healthy Med trial and, and that's in some ways what we're trying to do with our cooking class is really, you know, uh, once a month give people a feeling of cooking together, of, um, uh, you know, kind of sh- sharing the, the spirit of really trying to care for our mental health in an active way with our nutrition. Um, and then the joyfulness. You know, a big, big part that, um, Samantha brought to our practice and, and, and brings to our clinical work and our clinic, and, and you see her influence in the book, is really around an idea of joyfulness. As we, as we sat in the food space maybe five years ago, started working together and saw all the... I don't know. We're, we're both very peaceful, I, I think, kind of people, and we just saw this, there's a, a tone in the debate around food that we really wanted to try and transcend with a sense of joyfulness that we felt around, um, eating and nutrition and being really, um, in a, a, a sense of engagement and in a sense of a conscientiousness about o- our nutrition and the impact it has on our, our health and our mental health.

    3. RCDr. Rangan Chatterjee2:01:09

       You mentioned there was another trial which is showing that changing the food that we eat or certain dietary patterns can help reduce the likelihood of developing depression in the future. That sounded interesting.

    4. SPSpeaker2:01:20

       Yeah. Yeah. You're not g- that's, so the, the, the... I think the best trial in that is, is back to a cor- a prospective correlational trial, which was an epidemiological study of 10,000, I think it's like 930-some-odd, uh, university students in Spain, and what that study showed is that i- if you look at them at the beginning of college or, and, and you look at the, how Mediterranean their i- their diet is. So it's a nine-point Mediterranean dietary pattern scale. If you look at people in the top half of that, so they're eating a fairly Mediterranean diet in their freshman year, and follow them over four and a half years, kinda checking in about who gets depressed and then a- a- and, and, and what they're eating, they found that there was between a 30 to 52% reduction in the risk of getting clinical depression. And, and they ran... This is a really interesting study. They, they, they did a number of different models. For example, they looked at anybody who got, um, an anti-depressant in the first two years of the trial and just, you know, take- took them out of the data set to really try and see, we're really looking for people over the span of their college career eating a poor dietary pattern versus a Mediterranean dietary pattern. The, the trial that I was thinking about in terms of prevention, it's 'cause I think a lot about college depression. I treat a lot of college students, really love working with young adults. Uh, such a challenging time. I think for me it was a challenging time with my mood. Um, eh, such an exciting time of life for people, too. And, and depression, I mean, it's so crippling for individuals, um, you know, during their late teen and early 20s. Uh, there's a trial in Australia, it was really fascinating. Heather Francis led the team. They looked at college freshmen that had poor eating habits and, um, had depression, and they did a very simple intervention. Th- this is, I, I sort of joke with clinicians, like if, if, if, if this can work, boy, we've gotta be able to be effective. This was just a 13-minute video and then a five-minute phone call a week later, and then a second week, uh, uh, one week later, so two weeks after the video, uh, another five-minute phone call. And the five-minute phone was like, "Hey, Rangan, how are you? Like, you eating some veggies, man? How's dorm life? Like, you using the turmeric? How about the nuts?" And so they gave people a little box of nuts, nut butter, olive oil, and then cinnamon and turmeric. And so they send these into the college dorm and, and, and with, like, a lot of encouragement in the video like, "You, you can improve your mental health with food. Eat more vegetables, eat more plants." The cinnamon and turmeric, there's a little bit of data about those being good for brain health and brain growth. What, what they found is that w- just with that minimal intervention, individuals significantly shifted their diets. There was a significant reduction in anxiety, depression, and stress rating scales at three months and at six months. And this is like a, this is like 21 minutes and there's like... or 23 minutes, and there's no actual face-to-face human intervention. So very, very, you know, cost-effective intervention in terms of pr- potentially preventing college depression. So that's the trial I think that probably relates most to depression, those two, the Sun Navarro and, um, uh, and then Heather Francis's trial in Australia.

    5. RCDr. Rangan Chatterjee2:04:36

       Yeah. I mean, we'll get a hold of those and put them in the show notes for anyone who wants to sort of read those, uh, uh, further. There's a concept in the book I really liked, which was you like to help your patients put their brains in grow mode. [lips smack] And I thought that was a really interesting way of thinking about it. So what is grow mode, and how do you help your patients get into that state?

15. 2:05:00 – 2:18:49

    BDNF, Supplements, Probiotics and Cost

    1. SPSpeaker2:05:00

       Well, I encourage my patients and, and really everybody with a brain to think beyond serotonin, our beloved serotonin, a wonderful, wonderful neurotransmitter. But it feels like the conversation about depression gets reduced, like that's the brain molecule that's involved with mental health, that one and maybe dopamine. And I, I think that really above all of these players is BDNF, and BDNF is a neurohormone. R- Rangan, you, you brought up connection earlier, and it's really a, for me, a driving core principle of my own personal life, of how I, I think about my mental health and my happiness and in my family's happiness and, uh, b- but also how I think about my patients, what I value. You know? It's, it's the kind of tentacles of your life reach out. Like, where do they go and what are the qualities of those connections? And, and, and, uh, as a psychiatrist, I, I love this notion also that like, like that's exactly what our brain cells do. You know, when you're learning, your brain cells are reaching out and, you know, like making, making new connections.

    2. RCDr. Rangan Chatterjee2:05:54

       Yeah.

    3. SPSpeaker2:05:54

       And that's what memory is. That's where our memories, like, live in these connections between our neurons. It's really-

    4. RCDr. Rangan Chatterjee2:06:01

       Wow

    5. SPSpeaker2:06:01

       ... just, uh, fascinating to, to think about the brain as this... Not, not what even I learned in medical school 20 years ago. I'm sure they, you learned the same thing, right? Hey, you get like 90 billion brain cells. Like, don't mess with them, bro. Like, don't mess up. Don't do bad things [chuckles] 'cause you don't get any more. And then we learn that's wrong, that your brain is always, not a lot, but making some new brain cells. And, um, another Felice Jacka study, great study, and you're, uh, showing that between 60 and 65, individuals with a healthy diet, you could see a significantly bigger brain. Like, like a, a couple cubic millimeters more brain in the left hippocampus compared to individuals who are eating a very unhealthy dietary-

    6. RCDr. Rangan Chatterjee2:06:46

       Wow

    7. SPSpeaker2:06:46

       ... Western dietary pattern, right? That's a lot of brain cells, like two cubic millimeters. I mean, so that's exciting to me as a clinician and, and, and I try and bring that hopefulness and enthusiasm because often when we are struggling with our mental health, we really feel badly about ourselves. We feel very down. We feel very stuck. Um, so the idea that, you know, this brain that I'm lugging around that's not really serving me [chuckles] so well right now in this moment, I have the power to change that, and those things that I know help me feel better, exercising, sleeping well, um, eating well, connecting with loved ones, and playing, playing... I've got my... [object clanks] I was feeling nervous for that. I like playing a little instrument, playing a little music. They... All, all those things, uh, support my brain making more connections in a very intentional way. And so I, I love the idea of neuroplasticity. Uh, it's really the, the most powerful way that food and lifestyle medicine can work for us, like literally giving us more brain resilience, more brain repair, and more brain power. That, that's what BDNF does.

    8. RCDr. Rangan Chatterjee2:07:52

       Yeah. It reminds me of, uh, just a few hours ago I was having my morning coffee in the living room and I was, uh, reading your book. I was trying to, you know, prepare for the, for the, for the conversation today. And my daughter came down, and I was on the page with BDNF on it, and so these, these illustrations in the book are fantastic, so let's see if I've got this right. But she came in and said, "Daddy, what are you doing?" I said, "I'm reading this book. I'm, uh, talking to a guy called Drew later." She goes, "Oh, okay, what's Drew about?" I said, "Oh, well, you know, he helps people improve how they feel, uh, through many ways, but one of the things he does is help people choose better foods." She goes, "Ah, cool." And so she came and had a look. She's only eight, and so she read out brain-derived... She couldn't quite make out neurotrophic, [laughs] so I helped her out with that. Brain-derived neurotrophic factor. But these illustrations are great because there were four foods that you'd listed in this, you know, gorgeous graphic, and we went through, you know, said, "Hey darling, how many of these are you having?" So there was, I think, nuts, there was wild type seafoods, um, there was berries, and there was dark chocolate. I think I remember that right. Because of these graphics, and she did as well, so then when my son came down later, we ticked off how many he does as well. So I wanna say thank you because I love chatting to my kids about all this stuff because, you know, I hope that by sort of feeding them this information at a young age, hopefully this will just sort of seep into their, you know, their subconscious minds as they get older. So we out-- all of us now in the family know the four foods that according to Dr. Drew Ramsey, and the research of course, help us increase levels of BDNF. So thank you for that.

    9. SPSpeaker2:09:35

       Well, I put it, and, and the best data behind that is the nut data. It's a really interesting part of that. Uh, I think it's the Sun Navarro dataset. Maybe I'm not getting that right. But, but it, it was a study looking at, um... They gave people olive oil who are on the Mediterranean diet supplemental olive oil versus supplemental nuts, and literally, like, delivered it to the door. And they're like, "Drink as much olive oil as you can. Eat all these nuts every day." And, and in terms of BDNF levels, what they found, a- and BDNF's not a perfect biomarker for mental health. I don't want everyone to think you should run out and get your BDNF levels measured, but, uh, just as a disclaimer. But, but th- they found is there was a protection, so almost like 78% fewer people had, uh, who ate the nuts there, um, had severely low levels of BDNF. And so there's something there, and that's really the only, one of the only studies that's shown a real specific correlation. It's one of the reasons, again, when I hear patients are snacking and they're hungry in the afternoon, or they're a little noshy and they need something, you know, a quick handful of nuts, or I'll mix like some, you know, nuts and dark chocolate chips and, and y- you know, you've got, you've got a nice, a nice mix to keep you going that probably is good for your brain health.

    10. RCDr. Rangan Chatterjee2:10:42

        What is your view on things like supplements and probiotics?

    11. SPSpeaker2:10:48

        Certainly there are some supplements I think are important, like vitamin D. You know, is the data great around vitamin D and depression? No, it's horrible. There's no good data that vitamin D prevents winter depression. Do I still think giving a little vitamin D in winter is helpful for my patients? I do. Um, so I, I ha- um, uh, omega-3 fats, if you don't eat fish at all, um, and you're willing to take an omega-3 fat supplement or a liquid and, and you want a more naturalistic approach to try treating depression or anxiety, I certainly will use fish oil supplements, um, in that scenario. There are a few other couple natural antidepressants that, like St. John's wort, that have some good data on them. So, uh, a- at the same time, what I often see is that people are using supplements to avoid mental health treatment or to a- to kind of supplement or augment mental health treatment or replace it, and that always concerns me because it means you're working on your mental health alone. And I think it's always best to work on your mental health w- in partnership, whether that's with somebody you love, or a friend, or a counselor, or a therapist, or a psychiatrist. But, but because a lot of times I find people are taking things without effect, and, and that's medications, right? They've been on this or that medication forever, and they've still been chronically depressed, or they've been taking the supplement forever and they're still not feeling well. In terms of the gut, I think probiotics are a good example. There's, there's very little data that there's a, you know, specific intervention in terms of probiotics that, that help with mental health. There's some data certainly that some strains of bacteria in our gut help us improve our cognition and help decrease anxiety, and that people who get depressed have different organisms living in their gut than people who don't. We know that right now. So how do you get a kind of better mix of bacteria in the gut? I think you do it the way that humans always have done it, and that's we ferment stuff, and then we eat it, and then we eat a lot of plants. And, uh, that, that's really it. If you look at how do traditional diets kind of line up and how are they different from the Western diet, they include more plants, they include more olive oil or some type of natural oil, they don't have processed foods, and they often have a lot more seafood, but they almost always have fermented foods.

    12. RCDr. Rangan Chatterjee2:12:55

        Yeah.

    13. SPSpeaker2:12:55

        Whether a traditional Japanese diet or an Indian diet, right? There, there's all these ferments that happen, and that's what we seed the gut with in terms of these healthy bacteria. I just think, uh... And I like prescribing food better than supplements. I just trust it.

    14. RCDr. Rangan Chatterjee2:13:09

        Yeah. It's, it's a tricky one I think because, you know, I, I also adopt a food first approach. Uh, I do think supplements have a role for certain people at certain times, for sure. Um, and then, you know, again, just sharing what I've found with certain patients, I, I, I've got some patients with anxiety that, that come to mind who will tell me that there's a particular liquid, uh, probiotic that they take, that when they're taking it, they really feel that their symptoms completely change, that they don't feel anxious anymore, and then when they stop, um, they come back. And, you know, that is not a clinical trial, but on that one-on-one individual basis, it makes you think. So, well, we know there's a gut-brain axis. We know certain trials have shown that s- different compositions of gut bacteria uh, impact what is going on in the brain. And then so I just think, well, could it be that in some of these trials we've got people with vastly different microbiomes? And so

    15. SPSpeaker2:14:09

        Yeah, I, I mean, I think you just said it accurately. In our clinical trials, we've never paid attention to the microbiome or inflammatory markers, so w- we're hoping that randomization works to really just separate out and, and make the populations equal. But it, it is kind of a curious thing.

    16. RCDr. Rangan Chatterjee2:14:27

        Yeah.

    17. SPSpeaker2:14:28

        And, and I think increasingly going-- increasingly we're seeing in the data, right? Here's a trial, and one of the other things we looked at, there was a great trial in bipolar disorder, and w- it's a probiotic trial. So it was a trial at Johns Hopkins. They looked at, at 80 individuals who were admitted for mania, so they have bipolar I disorder. They've been hospitalized. They get treatment as usual, usually lithium, Depakote, or an atypical antipsychotic, so their medication, and then half of them got a placebo, half of them got a probiotic. What they f- a- and they measured something called an inflammatory index. Uh, th- this is not used a lot, but it's looking at how, uh, sort of the, the amount of, um, uh, I think it was antibodies to certain things, uh, certain viruses that kind of give a sense of, you know, how much inflammation somebody has. Um, what they found is individuals who had a high inflammatory index who got the probiotic, there was a 90% reduction in the rehospitalization rate over six months compared to the placebo. We, we don't see effects that big usually in medicine. So, uh, you know, the idea there is that part of a manic episode, potentially, is related to a kinda inflammatory dysregulation or s- or storm somehow that is some- somewhat regulated or influenced by the microbiome. So that, that's really exciting research. And I think in terms of your patient, what I get excited about in those stories is regardless of kinda the evidence, what you have there is somebody who's noticing something really empowering-

    18. RCDr. Rangan Chatterjee2:16:00

        Yeah

    19. SPSpeaker2:16:00

        ... something really good for patients with mental health concerns. There's this symptom I have, and I got this tool that works. Boy, I love supporting that, and I love, and I love trying to also then s- extend that. Wow. Huh. So what else can we do to improve your microbiome?

    20. RCDr. Rangan Chatterjee2:16:15

        Yeah.

    21. SPSpeaker2:16:15

        So you got the probio- right? Which I'm sure you did once you started thinking about are there prebiotic foods, right? Can we-

    22. RCDr. Rangan Chatterjee2:16:19

        Yeah

    23. SPSpeaker2:16:20

        ... are there things that are hurting your microbiome?

    24. RCDr. Rangan Chatterjee2:16:24

        Is eating for better mental health expensive, or does everyone have access to it?

    25. SPSpeaker2:16:35

        No. I think if you start eating for mental health, you're gonna save money. And, and according to the research, that's, that, that's true. The SMILES study, individuals saved, I think it was $140 a month. It was around $1,000 a year, if I remember correctly, um, uh, was estimated in terms of their savings as they began to eat a more Mediterranean-style diet. The, the key to eating for better brain health, again, is to really take a step back and think about the myths that exist around food, that it's complicated, that it takes a lot of time, that it's way too expensive. One of the power players in the book is red beans. Uh, you can buy those dried, soak them. I mean, you g- two, two, three bucks a pound. In the UK, you know, a couple pounds, I would guess, um, uh, for a kilogram. Um, [laughs]

    26. RCDr. Rangan Chatterjee2:17:19

        Yeah.

    27. SPSpeaker2:17:19

        So i- you know, uh, there's a, a, certainly cost is a factor. Uh, we, we have a, a resource command on our website for, uh, brain food on a budget, where we, uh, break down all of some of the, the, the best foods. And then, then I think it's, again, it's that challenge. Like, I really like wild salmon. Wild salmon can be, like, between 10 and $20 a pound, unless you buy it canned. And if you buy it canned, boy, it's, it's, it's cooked right after it's pulled out of the ocean. It's in there. It's super fresh. You make it into salmon salad. You make it into salmon burgers. Uh, great value. That wasn't something that I ever really did until I got into this work, or a c- a can of sardines or anchovies. So, um, and then I, I always think, look, of the things we have to spend money on, I wanna invest in my brain health, and I wanna invest in my family's brain health to the best of my ability. And I think working on that, not, not with, like, extreme and harsh constraints, uh, and lots of guilt and shame, not, not any of that, but working on that with a sense of, again, joyfulness.

    28. RCDr. Rangan Chatterjee2:18:25

        Yeah.

    29. SPSpeaker2:18:25

        How can I engage my family in a loving way with food? How can we cook together? How can I, um, based on maybe a limited palate of one of my family members, you know, still get a lot of brain nutrition in there?

    30. RCDr. Rangan Chatterjee2:18:37

        Yeah.
16. 2:18:49 – 2:40:59

    Eating Fish and the Environment, Plus Closing Reflections

    1. RCDr. Rangan Chatterjee2:18:49

       We should cover the environment at some point in this conversation because I know that all this talk of fish, um, for a lot of people, they get very upset because they're very keen to try and help the environment, the climate, and they don't like people promoting fish or they, you know, I feel we should at least have that conversation.

    2. SPSpeaker2:19:10

       There should be environmental concerns about what we eat. I think the environmental debate has really been framed in a way that revolves around some misinformation.

    3. RCDr. Rangan Chatterjee2:19:21

       Yeah.

    4. SPSpeaker2:19:22

       And I think it's really concerning. For example, the misinformation regarding things like fake meat and Impossible Burger. Maybe misinformation is a strong word, but the way that that kind of a way of creating food is being framed as somehow healthy when essentially it's food processing of the same ingredients that are being used for the last 50 years that have ruined our health, um, compared to, you know, something like grass-fed beef, a local beef. And, and that the environmental, you know, kind of debate is like these plant foods are good, and meat food and seafood is bad. Um, and I think that's really overly reductionistic. I think it leaves out, for example, some of my clear experiences. Like, where does your organic kale come from, folks? So it's all grown in manure from dairy cows, or most of it is. Just they scoop it up in the conventional dairies, and they, they ferment it or they get it, you know, really hot to kill all the chemicals and reduce everything down, and they spread it on the field. And, and, and that's where organic kale comes from. And there's somehow that, like, that organic kale is, like, revered and pulled out separate from the system that supports its growth, which largely revolves around manure. Because if you're not using manure on your fields, then you're just using chemical fertilizers, which usually the same people who... or the same kind of, let's say, groups or movements that are really supporting plant foods and not eating animal foods, I don't think have spent a lot of time growing food. And if you spend time growing food, you spend, uh, especially on farm, small farms, you spend a lot of time with poo and manure and animals. Small farms have always worked that way. I think that the concerns about the way the meat system exists are 100% valid, right? We have a system that wastes meat. We have a system that repurposes and process meats into foods that are horrible for us from, you know, all ki- horrible for us, all kinds of, um, you know, meat pockets and meats with fried breading around them and sweet meats. Um, i- in terms of seafood, the seafood, uh, uh, i- is a really, um, to me, important place to be an eater because it gets me at least minimally involved in the system by using my food dollars to support people who are, for example, taking care of oyster beds or to support, um, farmers who are growing mussels, a very environmentally friendly way of producing food. Um, uh, I certainly appreci- if I'm being conscientious of the fish that I'm buying. I'm not buying things like, I don't know, farmed tilapia or farmed shrimp. Uh, I'm trying to buy mostly wild type seafoods. I'm trying to buy small fish and encouraging people to buy small fish, more anchovies and sardines, you know, less tuna, less wild salmon. So, um, those are all ways I think that we can work to improve-

    5. RCDr. Rangan Chatterjee2:22:18

       Yeah

    6. SPSpeaker2:22:18

       ... um, uh, our impact. I, I, I, I also think there is lots of other new concerns that we don't have many answers to, but I'm gonna go down with the fish, is kinda what I've decided. If we're gonna, like, destroy their environment and fill them up with plastic, I'm... I don't know. I'm just gonna suffer the same fate as they do. [laughs] Maybe that's, maybe that's strange, but, um, uh, uh, I certainly think there's also things like, you know, I don't eat fish from lakes or fish from rivers 'cause those are all polluted. Um, but again, we know about that because people were eating those foods. And then because of that and because of our interest in nutrition, there's a lot of cleanup efforts that have come-

    7. RCDr. Rangan Chatterjee2:22:59

       Yeah

    8. SPSpeaker2:22:59

       ... in terms of how do we reduce and im- you know, the environmental impact on our water supply.

    9. RCDr. Rangan Chatterjee2:23:04

       Yeah.

    10. SPSpeaker2:23:05

        Um, I think overfishing is a, is a huge concern. I think slavery in the fish industry is a huge concern. I don't wanna minimize these concerns. Um, but for me personally as an eater, and then I guess for me as a nutritional psychiatrist looking at the data, and then also somebody interested in brain health and brain development, there's a great, uh, book on, uh, uh, human brain evolution by Bret Stecka, Stetka. And, and he talks about and, and writes about the science of how our human brains evolved and the importance of small fish and shellfish. So I think I also eat those foods in some ways out of respect of our history and genetic history and evolutionary history as I've, as I've understood it through experts like Bret. Um, and, a- and to really, um, you know, do my best, uh, to, to be responsible in those seafood choices. I don't think that's in any way a complete answer, but, um, it, it's, it's where I am now-

    11. RCDr. Rangan Chatterjee2:24:03

        Yeah

    12. SPSpeaker2:24:03

        ... which is trying to eat three to four seafood meals a week. For me, that consists of a mix of anchovies and sardines, usually on gnocchi or over a pasta, um, [laughs] or on a Caesar salad. Um, usually like a oven-roasted wild salmon filet, probably trying to get maybe six ounces or so into every family member at least once a week. And then trying to eat mussels or other bivalves, particularly u- uh, uh, ones that are farmed in the US. There's some concern about increased microplastics in the stomachs of bivalves, particularly in the report I saw coming out of China.

    13. RCDr. Rangan Chatterjee2:24:37

        What, what is bivalve? Could you just explain that for people? I didn't know that term till I, till I read your book.

    14. SPSpeaker2:24:42

        Bivalves are mussels, clams, and oysters, and so they're a grouping in the seafood family, mollusks. And, and, um, they, they're filter feeders. And so, you know, i- if, uh, understandably, people have concerns. Are they filtering out all the plastics and the toxins? And, and, you know, it depends the water that they're grown in. The, uh, truth is that when you... that these foods that are very good for us bioconcentrate nutrients. And so by, by doing that, if you grow food in a toxic environment, it's gonna bioand concentrate some of those toxins, and that, that data is really getting misused to then vilify these foods. Um-

    15. RCDr. Rangan Chatterjee2:25:21

        Yeah

    16. SPSpeaker2:25:21

        ... as opposed to focusing on, all right, how can we all stay clear on this is a really important food supply. 70% of the planet's an ocean, right? You don't have to do anything. I'm, I mean, think about it, es- especially when people are like, "Oh, no fish. Eat more plants." It's like, have you grown some plants? 'Cause I have. You know how freaking hard that is? You know how much diesel fuel it takes? You, first you gotta level that field, right? Then you, then you disc. Then, uh, depends on what you're planting. You're either seed, uh, uh, drilling or you're, you're planting seedlings by hand, right? Then you're weeding. Weed, weed, or you're spraying. Then, then you're fertilizing either with manure or top dressing, right? Then you're tending to the plants. Then you're, you're harvesting. Then you're processing that food. Then you're driving to market, right? This is so energy intensive. Um, and, and just compare that with, you know, it certainly takes a lot of energy, but catching anchovies. Right? Uh, uh, you don't have to plant it. Um, you don't have to tend to it. You just catch it. So, uh, you know, I, I think that, um, the sea makes a lot of sense to me. And then there's also more than fish that comes out of here, uh, out of there. There's seaweed, um, you know, which I think is, is a really interesting and important, uh, human food.

    17. RCDr. Rangan Chatterjee2:26:37

        Yeah. What you're speaking to is that lack of connection. You know, that lack of connection to the food supply, and you're someone who has literally spent a lot of time growing food, so you, you understand what it takes to grow different types of food. Whereas I think many of us are trying to enter the environmental debate from a theoretical position, from sitting on the fence looking down, going, "Oh, this is what we need to do," whereas I guess it's probably the farmers who know best how we can actually [laughs] , you know, improve the food supply in a much more environmentally friendly way.

    18. SPSpeaker2:27:12

        Well, I mean, uh, uh, the reason I don't like to trash talk about food in that way is that farmers are the number one group after physicians in terms of suicide risk, and that in India and America there has-

    19. RCDr. Rangan Chatterjee2:27:24

        Yeah

    20. SPSpeaker2:27:24

        ... been thousands of farmers who've died by suicide in the last two to three years. And so there's a way that as we trash talk, and, and I would agree in a kind of, you know, uh, polite and educated, but often, you know, minimally informed way, it's easy because it's confusing and there aren't clear answers to take strong positions, and that's where I've really, um, really worked hard to, to get into [laughs] more of a stance, um, with a show on male mental health with my friend-

    21. RCDr. Rangan Chatterjee2:27:55

        Yeah

    22. SPSpeaker2:27:55

        ... uh, psychiatrist Greg Scott Brown. And Greg and I talk a lot about this idea of curiosity before judgment. I really wanna be curious and not make a judgment of things and, and, and realize that some of this stuff is too big for me to have a full comprehensive understanding of, and I'm gonna just... I'm gonna do the best that I can given my limitations-

    23. RCDr. Rangan Chatterjee2:28:16

        Yeah

    24. SPSpeaker2:28:16

        ... and, and, and the possibilities in front of me.

    25. RCDr. Rangan Chatterjee2:28:19

        Curiosity before judgment. I really, really like that. I was gonna ask you what is the, um... what is the most important lesson that you have learnt in over 20 years of seeing patients? Uh, I'm not sure if you've just answered that or not without realizing it, but I mean, if I were to ask you that, what would you say?

    26. SPSpeaker2:28:39

        Spending important time with your partner and your kids. I think that's the least valued, most important thing that I've learned. Nobody's gonna give you a spot on your resume 'cause you're a good dad or a good partner. Nobody's gonna give you a promotion or give you more money for that, but I, I think that that's the most, um, deeply gratifying, uh, human experience, at least for me, in terms of what I've been doing with my life around kind of family.

    27. RCDr. Rangan Chatterjee2:29:04

        Yeah.

    28. SPSpeaker2:29:04

        Um, for other people, um, if that isn't your, your structure, I, I think really being intentional about the quality of interaction. I'm just struck that I talk to many people for 45 minutes once a week, and over time I realize I know them better than, you know, many people in my own life, simply by just really listening to all of the nuance and intricacy going on in their inner world.

    29. RCDr. Rangan Chatterjee2:29:30

        Yeah.

    30. SPSpeaker2:29:30

        And, and how hard it is for us to get into that space with people these days.

Episode duration: 2:43:16