Feel Better, Live More with Dr Rangan Chatterjee - #10 Reviving NHS General Practice and Lifestyle Medicine with Dr Ayan Panja

Episode Date: March 21, 2018

Dr Chatterjee talks to Dr Ayan Panja, NHS GP, Lifestyle Medicine advocate and health communicator about the current pressures on GPs and the exponential rise of Lifestyle Medicine. Show notes available at drchatterjee.com/ayanpanja Follow me on instagram.com/drchatterjee/ Follow me on facebook.com/DrChatterjee/ Follow me on twitter.com/drchatterjeeuk Hosted on Acast. See acast.com/privacy for more information.

Hi, my name is Dr. Rangan Chatterjee, medical doctor, author of The Four Pillar Plan and BBC television presenter. I believe that all of us have the ability to feel better than we currently do, but getting healthy has become far too complicated. With this podcast, I aim to simplify it. I'm going to be having conversations with some of the most interesting and exciting people, both within as well as outside the health space, to hopefully inspire you, as well as empower you with simple tips that you can put into practice immediately to transform the way that you feel. I believe that when we are healthier, we are happier, because when we feel better, we live more.

So it's a huge pleasure for the guest i've got on the podcast today it's someone who's a very very close personal friend and almost like a member of my family somebody who i have actually known since childhood but we reconnected over the past few years having lost touch after university it's somebody who is a at the coalface nhs gp it's somebody who is a at the coalface NHS GP. It's somebody who is an advocate for lifestyle medicine, very much like myself, as someone who has a keen interest in health communication. It is Dr. Ayan Panja. Ayan, welcome to the podcast. Thanks, Rangan. It's great to be here. Honestly, it's, you know, I can't believe this is the stuff of dreams, dreams you know in a room with someone who's effectively a family member talking about stuff that we're both passionate about top stuff yeah it's superb and uh and one of the things i wanted to try and tackle

today is the term lifestyle medicine is gaining in popularity it's really getting some traction out there you know on social media but also within the profession and I will come later to the course that we have have created together recently I will come to that later on in the conversation but you know why do you think lifestyle medicine is really striking a chord with people in 2018? That's a really good question. And I think lifestyle medicine generally, I think it'd be good to go back a few years to 1989,

which is when I think in the modern era in medicine, lifestyle medicine was first coined. It was by a guy called James Ripp, who is a cardiologist who was educated at Harvard and actually runs a lifestyle medicine institute in Florida. And really, that was the birth of modern lifestyle medicine. But one of the problems was that it was seen as a Cinderella specialty in many ways. And actually, the uptake of lifestyle medicine has been quite weak. It's not seen as a specialty in itself,

not like the big specialties like surgery or cardiology or gynecology. But what's happened in recent years and what's happening now in 2018 is I think that clinicians, doctors, nurses, pharmacists, all across the board are realising that the kind of medicine that we practise doesn't always work and it doesn't always get our patients better. What we're very good at doing in medicine is downstream stuff we're good at replacing hips putting in joint injections giving people life-saving treatments what we've not been good at doing historically is keeping people well and and that is really what lifestyle medicine is about it's it's a sort of a 360-degree approach, looking at someone's health, looking at etiological factors,

and I think that's something that's been forgotten largely in modern medicine. Yeah, I would agree with that, no doubt. And, you know, has society changed? Is that why lifestyle medicine is taking hold now as a term, as a movement? Is it purely because of interest or is it actually because of simple necessity? I think it's both. And there is something about the planet changing. So one of the conversations I have a lot with patients in the consulting room is about, this is one of many things, but about gut flora, for example, and how our parents' generation had better gut flora than we did in terms of diversity of their microbiome and how we are likely to have better gut flora than our children's generation. Now, that is just one thing that has changed societally, which has an impact on our internal health. So

our grandparents' generation, for example, they were much more likely to contract infectious diseases like tuberculosis or malaria. Those things actually we've got on top of largely, and there's been a shift in the type of diseases that we see. we see a lot more non-communicable disease. And this is something that arises from environmental factors and also what your constitution is like in terms of your immune system and other factors and all the things that are at play, you know, your hormones and your immune system, your skeletal system, your cardiovascular system and how they interact. So I now see things in 15 and 16 year olds that I only ever used to see 20 years ago in a 70 or a 75 year old. Joint pains, migraines, bloating after

meals, these non-communicable symptoms. And I think it's wrong for us as a profession to think that these things just happen. There are etiological reasons. And if you're a good detective and you're, if you're like a nosy sort of doctor and you actually, which is what you did in your programme, you followed people around, so you got a really brilliant kind of insight into their life, you will often find factors that are really easy to modify that have massive effects on how they feel, on their symptoms.

And that's what this is about. Yeah. It's interesting you say detective i i i think more and more that my job is you know a health detective with my patients it's it's it's yes it's hearing what those symptoms are but you know more and more i'm not trying to label those symptoms like maybe i was 10 years ago um you know like a collection of symptoms i'm not trying to label it does like maybe I was 10 years ago, you know, like a collection of symptoms. I'm not trying to label it. Does that fit the criteria for depression or not? You know, for me, and I know for you, it's always been about, you know, what's going on there? What is going on in that person's life that is leading to those symptoms? And that, I think, is a fundamental shift in where medicine

has to actually go now because I think we're becoming redundant actually in some of the things that we are doing you know we are doing a very good job with many acute diseases but I think many of us would would recognize we're not quite as good with these kind of vague symptoms, these chronic symptoms. And we talk a lot about medically unexplained symptoms. I remember being at a GP course 10 years ago. I can't remember when it was, but it actually wasn't as a GP. It was just as a junior doctor, but saying that I think 60% of what will come through the door is medically unexplained. I thought, well, you know, I didn't think much of it at the time. I thought, okay, yeah, sure.

But I've realised more and more, particularly over the last years, as I've studied etiology more than I ever have done in my career, I've realised that often you can determine a cause, and there normally is a cause that we can look at and modify and i don't think we're taught that much at medical school about that i think that's because because things are changing and i think that you know yes society is changing you you mentioned it's it's pretty harrowing the thought of that that actually our microbiomes are going to be worse than our parents and actually our children's are going to be worse than ours. That's not a pleasant thought, is it? No, that's right. And I think you've hit the nail

on the head. I mean, one of the things that we're very good at in medicine is managing patients. So asthma is a really interesting one for me. There's a very protocol driven way of managing asthma and most doctors and nurses are good at that but the thinking in terms of what's driving asthma I recently saw a patient of mine who is same age as me 44 about to become 45 suddenly developed asthma out of the blue no one in his family has it he's never smoked cigarettes and he works in an office environment what the heck is going on there so he'd seen a couple of my colleagues and it turned out i mean i was asking questions about his diet his lifestyle it turned out that he works from home more now

instead of going to the office and he's got a real damp problem in two of his rooms so he got rid of the damp and his asthma is effectively gone so that that's an example i'm not saying i'm some sort of genius but that's just an example of asking the question and being inquisitive thinking about all the things that lead to symptoms but that's just an example of asking the question and being inquisitive thinking about all the things that lead to symptoms but that's just such a simple thing and isn't it such a but but for people listening who maybe are not medical or even if you are medical i think it's really important to understand that often we're not often we're not trained to look for those things but even if we are, what tends to happen

once you start practicing medicine, you know, rather than the teachings of medicine, the actual practice of medicine often tends to be, oh, you now, you've got the diagnosis of asthma, this is the treatment protocol, you know, and we've got a beautiful stepwise progression of how to treat these people and manage their symptoms, and's the key isn't it manage their symptoms we can do that very well but often we're not looking at some of these etiological causes and in some cases it's pretty straightforward once you start digging around right absolutely absolutely and and and it's you know moving moving on to you know the course that you and i have developed you as you know, we've come up with this framework that makes it very easy for a busy, battered NHS GP like myself to actually think in that way, thinking about these factors that lead to symptoms. I think that's the thing about general practice as well.

And I'm such a fan of the job in the sense that I think it's a very important role. And I keep saying this, we save lives in slow motion in general practice. We haven't got the big stories that our surgical colleagues have. But it's really important to catch these little clues early on to stop someone becoming more ill later on. And that ties in with investing in true preventive medicine. This is one of the reasons why the NHS struggles so much. You know, you can put in accountable care organisations, integrating care in terms of having care at home and all of that stuff.

Yes, that's great. But what about upstream? What about this flood of non-communicable disease that is coming our way? We need a different approach. And I think you and i felt the power of that because we live it um and and and it works you you mentioned the the prescribing lifestyle medicine course that we've created together that you know we you know we were delighted when the royal college of gps gave it their official accreditation. So now we've, for one of the very first times, got a prescribing lifestyle medicine course where doctors and other healthcare professionals,

but primarily we focus this on doctors because I know that we felt that there are other healthcare professionals who are getting some of this training, not all of them, but some of them are. And our goal was to, by getting that accreditation, was to give it that real credibility piece that actually this is, especially asking in its own right, this needs to be taught at a high level. And I think getting that accreditation has really helped. So what you just said about saving lives in slow motion reminds me of one of the one of one of the cases you spoke about on the course which we ran for the first time in January and I know because I spoke to a lot of the doctors afterwards and this really resonated with them is that people come in with those vague

symptoms in their 20s we don't know how to manage them if we're lucky we might suppress their symptoms with medications but those but those symptoms actually are a sign of something not working well in the body which if left untreated and unmanaged will lead to a disease five ten years down the line and i think that's a very key point we need to get across to the public but also to health care professionals absolutely and there is a lot of science around this and i think this is where um that's almost the the penny dropping moment in the course where it's not just about these people that come in and are often labeled as heart sinks it's the fact that actually there is there are very early

hallmark signs that their body is in a state of dysfunction it's going wrong and they are inflamed or they are their endocrine system's not working properly whatever it is you know and they as you know more than anyone in your book highlights beautifully these often present as things like insomnia or joint pains or digestive issues or a headache or a headache exactly these sort of soft symptoms that you know even a patient centered gp would often take a pharmaceutical approach eventually. And I think that's the thing. We're very good at patient-centredness, but not in the molecular sense. We do not get training on that. And actually, there is so much

science and there is evidence behind it. And once you demonstrate it with these cases, I think it's very powerful. The other thing is I have a lot of colleagues who are doctors themselves, and they understand it when they get ill themselves. They realise there's this big disconnect between the medical model, and when I say medical model, I mean, you know, biopsychosocial model, which is what we're taught, isn't it, at med school, between that and what we're doing, which is really a much more 360 degree approach there's nothing clever about this is there it's just it's very simple in many ways it's just we're just it's

just a different way of thinking and the way that um you know the way that i put it is that it's like a piece of software that you can install if you're already a clinician because these guys you know everyone you know all these colleagues of ours are practicing medicine they just need this different way of looking at things and it can make massive change i mean one of the other things i would say that you know i know you know is the feedback we've had has just been astonishing i mean i've i've almost been moved to tears by the kind of things that people have written because i think a hundred percent of people would recommend it to a colleague and you know i don't know any other course that has that level of

feedback i would agree and it's it's just been incredible um to see those feedback forms come in and because you know you when we set out to create this you never know how it will be received you you know you try your best and you know i think we both underestimated how much work it is to create a brand new course, a brand new framework for people from scratch. And that's the key here. This wasn't a course that was just, you know, five or six. It wasn't a conference where five or six people came up to talk about their passion. There was a very clear narrative throughout the day of the goal being at the end of this one day masterclass you know we want all the clinicians there to have a new you know a bigger toolbox to supplement their existing toolbox which is very good so that they can apply on Monday morning and crucially within the confines of a 10-minute NHS consultation. And that leads me to my next question, Ian, which is,

you are, you know, in the trenches there as a GP partner with all the pressures and stresses and workload that that entails, trying to apply a model of medicine and patient care that can often take a lot of time is there a role for lifestyle medicine in the national health service 100 there is because um two of my colleagues from my practice actually came to the course and not a day goes by when one of them doesn't stop me in the corridor and say and says guess what i've used i've used the framework again and it's worked and this has happened. And they're so enthused. I mean, there are so many wins here. Firstly, for the patient, you're actually the difference in lifestyle medicine is that the patient is very much a partner. They have to be invested in what the plan is for them because and usually they are because they're desperate and they they've come several times with symptoms that haven't gone away so they're willing to try things that you're going

to suggest and that and that means that they're invested and they're more likely to be compliant secondly for the practitioner rather than people coming back after six weeks going oh you know what doctor it's just my joints are still aching or i still feel really tired all the time or it hasn't got better I've been to the gastroenterologist and he says everything's normal but I still feel awful well guess what they come back after six weeks and they say I've just come back to say thank you you've completely changed my life and that is just such a wonderful feeling for whatever kind of practitioner you are whether you're a GP or a hospital doctor or a nurse or a physio or a

pharmacist it's just a wonderful feeling and in general practice particularly because we are at the coalface that doesn't happen very often yes of course at Christmas we get lots of Christmas cards and thank you presents for support that we've given patients but actually getting someone better from a non-communicable symptom is a real challenge and I think any colleague of mine listening will identify with that that there are sometimes you you go in in the morning thinking oh you know a certain patient's coming in and you see their name on the list and you think what am I going to do now you know I'm stuck and actually the beauty of this framework is that not only does

it work you can repeat it every time they come so it it's repeatable and it's scalable and it works better each time you apply it and we and we we've been blown away haven't we by the feedback because you know we've created this framework we created this lifestyle prescription and and you know and how one feeds into the other and you know I remember at our meetings just sitting around you know trying to come up with trying to tease it out it's just such a wonderful feeling now to know that there are nearly 200 clinicians around the country and actually some people came from outside the UK using this framework and prescription tool that we have put together which they're able to do many times within 10 minutes which is giving them a lot of satisfaction i remember that the week after the

course um we got that bit of feedback didn't we which we shared amongst the team by uh one gp said it's the first monday morning uh sorry the first monday that i've been as a gp that i've not felt burnt out at the end of the day I've left energized I've left energized and this is a key point you know burnout and stress as you well know it's a big issue and I know full well is a huge issue in in medicine per se but in modern day general practice um I think you're absolutely right we are at a crunch point at the moment in medicine for several reasons. And if you look at where we are in terms of the profession itself and in terms of

lifestyle medicine, there's a real opportunity here for one to affect the other. One of the big issues in the NHS is not actually training up more doctors. It's not actually getting more medical students through. It's about retaining them and retaining their professional satisfaction you go and talk to any level of doctor now in the nhs and morale is low we know this because of the press and we know this because we have lots of friends who work in medicine and that is a shame that i'm not going to get political because there are lots of reasons, including underfunding that we know about. But one of the things that actually this model helps with is it actually helps you. You can use all of these tools on yourself. And I think we've seen that, you know, that the power of this is not just on your patients. You can apply these principles to

yourself. And that whole adage of, you happy patients happy doctors it it works it goes round in in that kind of circle so i think i think this is a great time to really educate people around the benefits of thinking slightly differently empowering you know doctors and other clinicians to to use this model and that will empower patients to use it on themselves and a little bit like your book word just spreads you know i've a lot of my patients have bought your four pillar plan and um it's amazing that one of them came in the other day and hadn't even read it but just because he had it in his bag he sort of whopped it out and showed it to me he already sort of feels better it's almost like he knows he's got to make some changes

to his lifestyle and this book is going to help him. And in the same way, practitioners can make enormous amounts of change with very small tweaks. You know, a little bit like the chap with mould in his bathroom and his asthma going away. You know, it's not complicated, but it's beautifully simple and it works. It is beautifully simple. One thing I would say, just I think it's really important to say is the word lifestyle medicine can potentially come

across as being a bit soft okay absolutely so yeah we all know about eating better and moving more and stuff you know but i think it's as you were saying right at the start that there's a lot of really quite complex science now demonstrating what these various lifestyle interventions do but the take-home can be quite simple but it is much more than just eat better and move more there is some real complex science there you, we can talk about how these interventions change our genetic expression, how it changes our hormone profiles, changes the levels of inflammation, you know, very quickly in the body. The sort of things that we would have thought only we could do with drugs in the past, we now realize we can do with lifestyle.

And, you know, as I've said to you many times, Ian, you know, realise we can do with lifestyle. And, you know, as I've said to you many times, Ian, you know, I'm not sure that lifestyle medicine necessarily is the best term in the world, because I think it can be misconstrued as to being, oh, this is a public health issue. You know, there is a public health issue, isn't there, about encouraging the population to be healthier. But these are tools that actually can help doctors get their patients better absolutely right and i think i think you've made a great point there we are going from complex science at one end to the patient in front of us at the other and i i'd argue that in generalism there is no other discipline where that is more important you've got

generalism, there is no other discipline where that is more important. You've got undifferentiated illness that's presenting to you and you suddenly got to get this hat on to work out what's going on in this person's body. So the other thing that you picked up on just there about the science being complex is that the science is out there. And when I used to work at the BBC in the radio science department, we used to get all sorts of articles and papers. So, for example, I remember one about women in South America who paint their babies with vaginal paint. Again, microbiota and going through the birth canal and how important that is. And there would be articles on plastics as endocrine disruptors. Now, this is all out in the public domain and interested members of the public and interested clinicians will read these articles. I think the difficulty is applying all of those things and putting it together when it

comes to the person in front of you and coming up with something that is achievable for them and is simple enough that is going to have a big enough effect on their health that is pretty complex and as you said normally that's the kind of thing that you would ask of from a drug you know a drug company would be delighted if they could get that result and actually what we're seeing is just by thinking a little bit differently engaging the patient involving them in what's happening you can get enormously beneficial results that sometimes are miraculous and some of the testimonials that that you see which I think you know the cynical medic would say well you know where's the proof they could have just got better anyway well actually no they've been struggling for 20 years

and now they're better because of these simple lifestyle interventions. And I think you're right. Lifestyle medicine does sound soft because of the reasons that we said. It doesn't exist in old school textbooks. You know, it's not haematology. It's not general surgery. It's fluffy lifestyle medicine. But actually, it's not fluffy. It's anything but that. It's deeply scientific and it's very, very powerful.

And I would say that every clinician going through their training needs to know something about it and what really excites me but you know in a way I have some trepidation about it is how many medical students are interested in this because they're living through this generation where the patterns of what they do in their life, the patterns of health and illness, their cultural consumption, their consumption of food and all the things that they do nowadays are slightly different to 20 years ago and very different to 40 years ago. And I think it's very exciting. You make the point, Ian, that every clinician going through their training should have some training given to this area.

And we were so delighted, weren't we, that actually on our prescribing lifestyle medicine course, we had a whole variety of different people coming. Yes, we had a lot of GPs, but we also had psychiatrists, we had oncologists, endocrinologists, a rheumatologist gastroenterologists that's right and that was incredibly satisfying because although we are very proud and passionate generalists and you know as i've stated on many occasions i i don't think there's ever been a time where we have needed generalism like we need it today um you know what we just get all these you know we are you know we are it is a specialism in its own right

you know it's it's we see a lot of incredibly complex problems that we have to put together and we can't move off to a different speciality when it's you know we're the ones who when when different specialities can't deal with the problem or say it's not our department you know where does it end up exactly you know back at back at our door so it was great to see that the the breadth of different specialities from you know the medical profession who came but we also had you know quite a few nurses there a few pharmacists um and you know interesting for me over the last few weeks and getting more and more interest from other allied health professionals saying can we come and you know we we're having to think about that now aren't we as a as a group as a team we're trying

to have to figure out what do we do because the goal initially was for the medical profession not because we wanted to exclude anyone else but only because we felt that we've got to start getting doctors educated in this model right and let's really focus on what is relevant for those doctors um but where do you see this going do you think do you think the training is relevant for other allied health professionals yes i mean i think it's it's tricky because there are there are so many different worlds and and you and i both know and we're very non-hierarchical and we don't like labels do we neither of us we we like um i think

that limits people and it limits science and um it limits being able to get people better because that is the business that we're in. We want people to feel better and we want them to live longer and be healthier. And it doesn't really matter what tools are used to achieve that. I remember when I was a GP in Haringey years ago, occasionally I would get letters from a nutritional therapist or a nutritionist. And I wouldn't really understand the contents of it but what I did realize is that the patient their symptoms had sort of had really improved and I was cynical you know I've got to admit this was maybe 15 years ago

and I'd sort of think well have you really got better you know what have they done how is eating more of this and less of that worked um and I'm i'm no nutritionist by as you know but now that i've learned a little bit more about the science behind that and a bit more about the gut and you and i know we had we had a gastroenterologist who came to our first course and he put his hand up you know when i met him before the course and said look to be honest i don't really know much about the gut microbiome. I just tend to scope people. And that's the problem. Medicine has become siloed off.

And I think being more inclusive is a good thing. I have to also say, I think you and I originally thought that there were a lot of people out there that would know a lot of the content of the course and might have thought that it might be a bit thin on, say, for example, we're not teaching anyone nutrition or hard nutrition at all, but it's an element of what we do.

You've got to know a little bit about it. And on that point, I think it's very, very important to clarify, you know, the prescribing lifestyle medicine course that we put on in January and we're running again in April. It's not a nutrition course. No, absolutely.

We're not training people to be a nutritionist. We're looking at mechanisms and systems and how food can impact those systems. Exactly. And there is absolutely a need for us as doctors to have the ability to refer on to people with a more in-depth knowledge. But it's about changing the way that

we think and there's plenty that we can do you know with some basic nutrition recommendations there's plenty we can do in general practice actually but there's plenty of scope also for specialist nutrition experts to to take over when we have to refer on i think that's quite an important point to make absolutely and also health coaches you, they're a burgeoning, it's a burgeoning field, you know, and they're not talked about enough in this country, I think. They could be really useful in actually delivering the kind of plans that a practitioner comes up with. Because one of the problems we have, certainly I have in general practice, is that the availability to see me is very poor. So I can set someone off on the right path.

But if that person needs a bit of guidance or help or someone to touch base with, they need someone with different skills to me. And I think that's the thing. It doesn't really matter what kind of health practitioner you are. Like I said before, we're all trying to do the same thing. We want this person to feel better, whether you're a physiotherapist or a health coach or a doctor or a nurse. And so I think actually, you know, broadening the course is probably the right thing to do. I would agree, you know, as you say, all these allied health care professionals who are now clamoring to be involved.

And I think that just shows that there is a lack of this information out there um people are not feeling as though they've got enough tools to use with their patients whether you are a doctor whether you're a nurse and don't forget practice nurses see a lot of patients first these days so they've got a very important role to play. You mentioned health coaches. Literally last week, I was giving a talk and this lady came up to me and she said, you know, I first heard about you in the first series of Doctor in the House and I found it inspiring and I made these changes and that I'm trying to follow on with your book. And then she said to me, I didn't really have an open-minded GP. So I moved practice.

And I was wondering where this conversation was going. I said, I've moved to a different practice. And the GP was fantastic, very open-minded. And the first thing they did was refer me to a health coach who started working at the practice. And I said, was this on the NHS? She goes, yeah, this is part of the national health service and it was a pilot program and i just thought it was incredible and as you're

saying health coaches are a very much underutilized resource you know it's all very well us starting off the conversation in that 10 minute period but who's continuing on who's going to help those patients sustain that behavioral change long term because ultimately what we're asking a lot of the time is behaviour change absolutely absolutely and that's the key isn't it to lifestyle medicine it is about lighting the fire and making that person make that change you know the whole thing is is really about behaviour change you've hit the nail on the head but I also think when when you know and i don't want to go on and on about the whole the course for the whole the whole of this session because it sounds like it's just an

advert for it but um um you know i i think we wanted it to be very much focused to nhs frontline staff didn't we and um i think a lot a lot of our colleagues work in the private sector which is fine you know and i think you I think people who access private services are absolutely entitled to do so and they pay so through their own money. But I think the focus, the elephant in the room is the fact that the NHS is dying. It's 70 this year and it's in need of some sort of resuscitation.

And I think my passion and your passion is we wanted to train up as many people as we could in those frontline positions to be able to make change and there's a massive multiplier effect there if you think about the number of people you know if you take the 200 people that came to that first course and the number of people they might be helping each week since January that's an enormous amount of prescriptions that have been avoided referrals that have been avoided you know this is something we need to audit except you and i too disorganized to do that but um okay cut that bit no um so um you know and but but

there is good work going on here and i think we need to to really you know i'm so passionate about this i know it works my colleagues can see that it work you know it works people come back patients come back going you know and my colleagues will say what did you do and i go well i didn't really do very much but you know this is how it works so so you know it's time it really is time and i think you're in your sort of true modest fashion you're underplaying what you what you have done because i i've seen you at first and you are a brilliant clinician and you know you say it's simple but you know once you really have a a good grasp and a really detailed grasp of the science it's only then that you can make it simple so on the outside yes it does appear simple but there really is a lot of complexity behind it and you know we spent a lot of time didn't we,

trying to come up with a framework that was simple. And safe as well. Safe, simple, because then it's going to be applied in practice. There's no point us coming up with this program and this new framework if everyone found it too complicated to use. Yeah. I think that's why we're getting such great feedback as people are using this now in real-life consultations you say you know in in our nhs practice we can help 30 40 you know

maybe some on busy days 50 patients in one day but by training up all these uh frontline clinicians who can then help their patients we've got the potential there to transform the health of thousands tens of thousands of people i think that's our drive and look we could literally chat about so many different things um i see you're wearing that um uh iw coffee t-shirt which we got when we were indian wells coffee when we went out a couple years ago to study with Professor Dale Bredesen you know one of the probably one of the globe's leading and neuroscience researchers who's making some really interesting headway into Alzheimer's disease we could have spent the whole time chatting about that I think you know we ended up focusing on that prescribing lifestyle medicine course because that is here that is now it's's running again in april and you know we want to to teach as many clinicians as possible so we'll definitely get you

back on the podcast soon and further on these conversations i guess my my final question which you have not been given a chance to prepare so i'm putting you on the spot a little bit is go on give us your best shot well no really the podcast is literally about you always want to leave people with something to reflect on you know in their own lives or something that they can actually put into practice in their own life immediately and in your vast experience as a practicing clinician as someone who is in the trenches as an NHS GP, are there some top tips that you would leave the listener with that they can think about changing

in their own life because you've seen those same tips change your patients' lives? That's a big question. Yeah. And I think it's really interesting you say that because next week I'm doing a talk at my son's school about how to keep your child healthy. So I've been thinking about top tips already, but that's very focused towards children. I think the main thing is simplifying your life. Literally going back to basics in terms of all the things that you do. So food, for example, all the things that you talk about in your book, for example, about avoiding processed foods,

you know, eating real food, very, very simple thing, but actually amazing how many people don't do it. And I know it's difficult for a lot of people, but, you know, you can buy frozen broccoli for one pound at our local freezer shop. It doesn't have to be expensive and you can just stick it in a pan and boil it up. Most people can do that.

And it's just, you know, the reason I mentioned that is that once you explain what broccoli does to your aryl hydrocarbon receptor in your gut and why it's so good for you, patients buy into that and they think, wait a second, you know, I think I might eat broccoli. It's quite nice, actually. No, and that type of thing. So keeping things simple in terms of eating real food is one. Trying to mimic nature as well.

You know, this thing about artificial light. You know, at the moment we're in sort of an artificially lit room. Dark podcast studio. It's a classic sort of broadcast environment, you know. And all the things about not over stimulating your brain when you're meant to be switching off which means that your sleep will improve you know thinking of yourself really as a machine we spend more time making lists of what we're gonna i don't know do for the next month or you know a shopping list than we do thinking about

our own health and just just sort of you know taking a step back and simplifying everything in your life so eating real food resting when you have to um and taking the opportunity to get things in that are very necessary a bit like brushing your teeth you know everyone does that twice a day so patients of mine for example who say they are i don't get time to go to the gym. Well, you don't have to go to the gym. So I actually got, for example, I got here early today and I thought, what can I do that's sort of useful but also pleasurable? So I walked all the way from St. Pancras because I thought, why not? It's a nice day.

It's not raining. And then I walked quite briskly. So I've got my kind of exercise in. That's great. It's that sort of thing. So simplifying and and going on from going back to basics i think i'm just gonna take one example that's very topical at the moment so diabetes and low carb diets i mean it's everywhere isn't it it's in all the papers and stuff i've got with me actually i thought of you wrong and when i when i brought this in today this book it's called the household doctor so a lot of people a lot of my friends including yourself will know that i collect a lot of

antique medical books or old medical books because i find them fascinating because it tells the story of how medicine has evolved for me really really interesting so this is one of my favorites it's called the household doctor so exactly what you were doing on tv doctor in the house by s king hutton and the first imprint of this was from 1938 so i'm going to actually read from this this is how awesome this is so look this is a little bit it says here some pages on illness and this is the segment on diabetes so it says the treatment is twofold so i'm reading directly from the text in this book now. Dietetic. Since diabetes depends on too great a quantity of sugar in the blood, the rational treatment is to withdraw or reduce the intake of sugar-producing foods.

These are sugar itself and all sweetened things and all starchy foods such as rice, tapioca, sago, bread and cakes. Eggs, salads and green vegetables may be taken also bacon cheese fish meat i mean that is a low carb diet from 1938 isn't it i mean that is that is pretty much the kind of sheet that my patients get if they're pre-diabetic or diabetic because we know low carb diets work and it's obviously a part of the treatment in type 2 diabetes it's not the whole thing and you need to sort of work on stress and exercise and other other factors but how amazing is that yeah incredible to know i mean just just to sort of clarify we're talking here about type 2 diabetes um but just to know that that was written in the 1930s it really just goes to show

that very little of what we're doing is new that's right what what is new i think is the fact that there is now a lot more science to back up you know these old school recommendations and you know i particularly think about you know traditional chinese medicine and ancient sort of ayurvedic medicine and how they always thought that the body worked, different organs worked better at different times of the day. And now we're having a whole load of new science showing us that is absolutely the case. So I think it's quite humbling, isn't it,

to know that actually people were writing about this in the 1930s. And look, Ian, I just want to thank you for your time. We could have gone into a whole host of different things today. And no doubt we will do very soon on the podcast. But you're a busy NHS GP. Today was a morning off where, you know, arguably you should have been resting and recuperating from the stresses of the week.

But you, well, I dragged you into London to have a chat about things. So thank you very much for your time. And I hope we get you back on the podcast very soon. Thanks, Ron. It's been an absolute pleasure. That's the end of this week's Feel Better Live More podcast. Thank you very much for your time and I hope we get you back on the podcast very soon. Thanks Rongan it's been an absolute pleasure. That's the end of this week's Feel Better Live More podcast thank you so much for listening and I really hope you found the conversation useful but also enjoyable. If you're not already I'd highly recommend that you subscribe to this podcast so that you can be notified when the latest episode of my podcast comes out. I'd also be incredibly grateful if you consider going onto

iTunes and giving this a five-star rating so that I can get this information out and reach more people. It really does make a difference. And if you have any suggestions for people you'd like to see me have conversations with on this podcast, I'd encourage you to get in touch with me on social media using the hashtag feelbetter more you can find me on facebook and instagram using the handle at dr chatterjee and on twitter using the handle at dr chatterjee uk