Feel Better, Live More with Dr Rangan Chatterjee - How to Transform Your Health in Eight Weeks with Dr Ayan Panja #324

Episode Date: January 8, 2023

Doctors working in general practice have never faced such challenges as they do today – and yet there’s a perception that they’re just not working hard enough. The reality, says this week’s guest, is there are fewer doctors and resources and soaring patient numbers with increasingly complex needs. But Dr Ayan Panja might just have hit on a solution. Ayan, as regular listeners will know, is a returning guest to the podcast and a good friend of mine. Together we developed the RCGP-accredited Prescribing Lifestyle Medicine course, which we offer to fellow healthcare practitioners. As well as being a very busy NHS GP with almost 25 years of experience, Ayan is an exceptional health communicator. His brand-new book, The Health Fix: Transform Your Health In 8 Weeks, contains life-changing insights about how we can all improve our health and wellbeing using techniques and strategies he has seen work time and time again in over 2 decades of clinical practice. In our conversation, Ayan explains the eight key factors which affect our health the most day to day and shares the simple ways that we can start to improve them. We talk about autoimmune disease and how the underlying mechanisms behind these diseases often start in the body years before we actually get a diagnosis. We also discuss the limitations of evidence-based medicine and why real-world experience often counts as much, if not more than laboratory findings. And of course, we talk about the practical things that we can all implement immediately to improve our health and happiness. One of the things that I love the most about Ayan’s approach is that it really understands that you are unique and it's going to allow you to generate your own targeted lifestyle prescription. And this episode will put you on the right path to discovering your own, individual health story – and the right interventions for you.  Find out about the LIVE, Prescribing Lifestyle Medicine event for healthcare practitioners http://www.prescribinglifestylemedicine.org/ Support the podcast and enjoy Ad-Free episodes. Try FREE for 7 days on Apple Podcasts https://apple.co/feelbetterlivemore. For other podcast platforms go to https://fblm.supercast.com. Thanks to our sponsors: https://www.athleticgreens.com/livemore https://www.vivobarefoot.com/livemore Show notes https://drchatterjee.com/324 DISCLAIMER: The content in the podcast and on this webpage is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your doctor or qualified healthcare provider with any questions you may have. Never disregard professional medical advice or delay in seeking it because of something you have heard on the podcast or on my website.

The Health Loop is a collection of eight factors that give rise to your health right now. Sleep, stress, diet, exercise, your genetics, your environment, historic infections and your exposure to sunlight. So you and I right now, our state of health is based on these eight factors. Hey guys, how you doing? Hope you're having a good week so far. My name is Dr. Rangan Chatterjee and this is my podcast, Feel Better, Live More. So I've decided to release an extra episode this week to celebrate the publication of a fantastic new health book by my friend, Dr. Ayan Panja. Now, Ayan is a really experienced medical doctor. He's worked in the NHS for almost 25 years now, and he really is one of the best

clinicians I know. His brand new book, The Health Fix, Transform Your Health in Eight Weeks, contains life-changing insights about how we can all improve our health and well-being using techniques and strategies he has seen work time and time again in over two decades of clinical practice. In our conversation, we look at the eight key factors which affect our health the most day-to-day and look at simple ways that we can start to improve them. We talk about autoimmune disease and how the underlying mechanisms behind these diseases often start in the body years before we actually get a diagnosis. We talk about the limitations of evidence-based medicine and why real-world experience often counts as much, if not more, than laboratory findings. And of course, we also talk about the practical things that we can all

implement immediately to improve our health and happiness. One of the things that I love the most about AIN's approach is that it really understands that you are unique and it's going to allow you to generate your own targeted lifestyle prescription. Now, AIN really is someone who I have a lot of respect for. Together, we developed the Royal College of GP Accredited Prescribing Lifestyle Medicine course, where we have taught and continue to teach thousands of doctors and other healthcare practitioners how to apply the principles of lifestyle medicine with their patients. And for those of you who are healthcare professionals, we're actually running a brand new face-to-face event in London on Sunday, the 4th of March, 2023.

It's going to be a fabulous in-person event. You can see all details at www.prescribinglifestylemedicine.org or by clicking on the link in your podcast app. It's always fun for me to catch up in person with Ayan. I'm convinced that his approach is going to help so many people take back control of their health and well-being. I hope you enjoy listening. And now, my conversation with Dr. Ayan Panja. with Dr. Ayan Panja.

You've been seeing patients now for almost 25 years. You've seen tens of thousands of patients and I think you're very, very good at helping your patients help themselves. You've got all kinds of techniques to help people with things related to autoimmune disease, type 2 diabetes, depression, anxiety, whatever it might be, you've got tools and techniques to help. So I wanted to start off by asking you, with all that experience, what are some of your top practical tips that you keep coming back to time and time again because you know that they work. Okay, so the first one, which I do myself, and it may seem innocuous, is something called a one-minute recharge. So this is something that combats stress. And it's very simple. all you do is for one minute you literally just do nothing so i do this when i pull into work in my car i i used to put a minute timer on my phone

and i just close my eyes and just sit and breathe slowly and think of something that makes me feel relaxed it's often lying on a beach for me. And if you really heighten the experience, you can sort of feel the heat of the sun on your face. You know, the brain's so powerful. And when the alarm used to go off after that minute, I used to want that minute to just go on and on. But what it does is it means that whatever stresses I have in the day, I'm much better able to handle them,

having done that one minute of just activating my vagus nerve, whatever you want to call it, whatever's going on physiologically. And I do the same when I pull into the drive at home so that I can sort of metaphorically leave the doctor's bag outside the door. Sounds ridiculous, but it works. And the last time I recommended this was on someone who is a hospital doctor, has got a very stressful job. And I got a text from them saying, do you know what, it's ridiculous, but it actually works.

It's two minutes a day. So however busy you are, if you can afford two minutes just to do that and you don't have time for yoga, meditation, all of those things that we know are good for you, but actually require a bit of time. If you don't have that time, just do the one minute recharge twice a day. So you don't do it first thing in the morning, you do this once you've, you know, got your kids off to school, you've done what you need to do at home, you've driven to work, you've done it at that point before you go into work, why do you do it then? Yeah, because, you know, we're always sort of on go. And the natural instinct is when you rock up

to work is to just rush in through the door. But the nature of my work is such that, and like a lot of other people, is that you're just slammed with problems the minute you walk in to the building and if you're on a sort of if you're in a state of you know uh fight or flight or you're rushing around and your heart rates up then that will just you know that stress that you're being hit with will just sort of exacerbate how you're feeling. Whereas if you're calm to start with, your ability to handle those things, mine certainly is better because the days I don't do it, which is rare, but occasionally I forget because I'm just late or something, I really notice it. Things irritate me a little bit more or my patience isn't quite the same.

And it's the same at home you know you you get home at the end of a long day and it's something like the washing machine's broken down again or whatever something else has happened and those things stress you less it's just it's a very simple practice that pays a lot of dividends you know it's it's two minutes a day yeah it's interesting that the hospital consultant who you recommended this to was sceptical. And I think there's probably people listening or watching right now who are,

you know, they share that scepticism. Like, what is that really going to do for me? I think you've explained just how powerful it is for you. For that person who's skeptical, just talk me through or explain it as if you were explaining to a patient, what would they do? Let's say they, like you, are driving to work. What are they doing? You mentioned silence. A lot of people don't know how to sit in silence. You mentioned silence. A lot of people don't know how to sit in silence, right? Their mind starts rushing, you know. So what about music? What about a guided meditation? You know, help us understand

how exactly you do that. Yeah. Yeah. So those things like guided meditation or music, they're absolutely fine. And I think the reason I wanted to do silence is that it it's a total switch off so you're right some people find it very difficult and actually when i go and do talks on well-being or you know kind of companies sometimes ask me to come and talk to their staff um i often start with this and i go i just want you to just sit quietly in in your chairs for a minute and i'm going to do it with you i want you to close your chairs for a minute and I'm going to do it with you. I want you to close your eyes for a minute. And then once we've done the minute, what I do is I go, how many of you found that easy? Not many hands go up. And then I go, how many of you wanted that minute to go on for longer? It's the same sort of number of people.

And I go, how many of you found that difficult to do and then loads of hands go up because invariably wherever I've gone to do the talk you know whether it's like a police force or whatever they work in a very high pressured sector so they're always on go but actually the more you do it the more you get used to sitting with that stillness and if you're finding it difficult and you've got worries coming into your head one of the things i tend to do is i use the breath you know and i go if you've got a worry coming into your head just stop go back to the beginning of a breath and think of something that makes you feel relaxed some people find it hard to find something to

think about that makes them feel relaxed it just shows you the kind of world we we live in and i pick that stereotype one of the beach because that does make me feel relaxed it just shows you the kind of world we we live in and i i pick that stereotype one of the beach because that does make me feel relaxed but you know it's whatever works for you and i think there's a key point there that if you never expose yourself to silence you may well find it hard at first right so it it doesn't mean that the practice is not for you. It just means that you need to bear with it and practice and keep doing it. And what I love about it is that it is so simple. It doesn't take long, time-wise. It doesn't cost any money.

So it's something that pretty much everyone can introduce. I can imagine that as a doctor, doing that before you start seeing your patients is going to make you more present and more attentive and better able to be the doctor that you want to be. I think that applies to all of us in our own lives. I think there's also something really powerful though about what you said. You do it when you're sitting in your drive after your long day at work, before you go into your house, and I know you're married, you've got your kids, I think that's another really important time of the day where if we don't do something, you know, if we carry that stress into our homes,

it affects our relationships, right? It affects all kinds of different things. So maybe talk to me about, you know, why it's so important for you to do it at that time of day and what you found with your patients when you introduced this idea to them as well. Yeah, it's interesting. So for me, it's because, again, the nature of the job that I do means it's very easy to sort of take it into the house with you, you know, mentally. And also, you know, my wife's a doctor, and so she has a similar sort of stress. We don't sort of tend to talk shop, but it's nice to kind of leave it metaphorically outside

so that you can be present and do the things that you would do in family time. It's interesting what you say about patients. One of them actually found that rather than doing that, it sort of worked to a point that what helped them was getting changed into a tracksuit. You know, changing clothes seemed to be the thing for them, whereas it doesn't really make any difference for me. I tend to wear the same things at home and work nowadays. You know, post-COVID, I sort of don't look quite as smart as I used to many years ago at work. But so, so it's whatever works for you, that one really works for me, because it has this calming effect

on me. And it means that, in a way, I guess what I'm doing subconsciously is kind of allowing all the kind of stresses of the day to just sort of stop right there. And then I pick them up again when I sort of head out the house the next morning. You know, that's what's going on at the back of my mind, I guess. Yeah, I love that about the patients changing their clothes. I mean, I call these things transition zones in the day. And I think they're really, really important. And if we, you know, we pay attention to them, just some way to kind of shift your state, right? So as you say,

it could be that mindful minute, or it could be changing your clothes, whatever it might be. For me, changing clothes is a big one when coming in. Okay. So that's one of your kind of tried and tested tips, hacks, if you will, that you found beneficial yourself and with many patients. Any others? Yeah, the next one is a really simple one. And it's hydration, actually, talking of which. And it's one that I've noticed in retrospect, and a lot of the things in the book book you'll notice are just from myself learning from patients and my own experience and also matching it with evidence. And as junior doctors, I remember thinking actively, wait a second, you know, my patients are all on more fluids than I get through in a day. And I'd literally have this like can of fizzy drink in my white coat when you were still allowed to wear them.

And that handbook that all junior doctors have in the other pocket and then i'd just i'd get through one a day and i'd just be exhausted because we worked so many hours but it's the same principle in in kind of grown-up doctor life as well and and for and for many of my patients where you know and the thing that the last time i remember sort of recommending this was someone who had really poor concentration. Actually, it was a guy doing his A-levels and just had come with his mother. And the story was that, you know, you just can't focus, can't concentrate, whatever.

But relatively healthy, very sort of sporty, which in a way meant that, you know, obviously being sporty, you sweat a lot more but drilling down into sort of that that guy's routine you know they just didn't drink and it's like well just I never feel thirsty and I'm like wait a minute but you know then literally he'd have like one drink in the morning and that would be it till the end of the day and the change in him you know just into I didn't sort of follow him up in person, but often we do things by text message or on the phone a lot more these days, was just dramatic. He was just like a new person.

And that is just by making sure that you're drinking enough water in the day. The benefits of hydration, it's one of these ones that's safe to Google, I think, are just ridiculous just in terms of skin, brain function, renal function, just everything about your health, unless you've been advised not to, some people have to fluid restrict, but that's when they've got particular medical conditions. It is just one of the things that I cannot highly recommend enough. So one of the things in the book, actually, in terms of, which we'll probably come on to in terms of morning which we'll probably come on to in terms of morning routine,

is drink a glass of water. And a lot of people looking at that will go, well, where's the science behind that? There's no real science. It just gets you, your hydration process for the day, kick-started, as simple as that. Yeah, completely concur. The amount of people who don't drink enough is huge. And all kinds of things are

often related, aren't they? Low energy. Often, not always, of course, but often, you're just not drinking enough water. And it can be transformative. Headaches sometimes related to dehydration. Stomach ache. It's so common. And as you say, it's one of those things that, you know, it's very safe to recommend and it has potential multiple downstream benefits. Okay. I like those two very, very simple tips that can have, you know, huge implications to people. Before we get into the book, third one, perhaps? Okay. Third one's one I struggle with myself, which is to do with sleep. And my problem is I get to bed too late, which in itself is a problem. So for me, I want to kind of get to bed a bit earlier. But the tip that I would give is to try to get to bed at the same time each night and get up at the same time each morning. And the reason for

that is to do with your circadian rhythm. And the fact that even though you think, and I do this myself, where you think, oh, I'll have a lie in, you know, on a Saturday or a Sunday, you're actually messing up your circadian rhythm, which in a way will, as you know, you know, some people call it the rhythm of life um messes everything else up in terms of blood sugar control your cravings your mood your stress levels and when i can do it well for a few weeks the difference in how i feel you know my energy levels my brain power my stress levels everything improves um and you know as we come on to what's in the book,

you know, as you know, more than anyone else, you know, all of this stuff is interconnected. But sleep, I think, is probably the most underrated function. We take it for granted, don't we? Because it's just something we all do, you know. But it's so important to prioritize it. And I think that's hitting me more and more the older I get. it's so important to prioritize it and i think that's hitting me more and more the older i get yeah what what in your experience is the main obstacle for people in terms of getting good quality sleep um it really varies because insomnia you know if we if we call it that um that we see in practice has lots of root causes and And a lot of, I do find a lot of people have done the basics. So they go, well, I've cut caffeine out, you know, and I'm, I'm trying not to kind

of, and they've done a lot of reading, like I'm trying not to look at blue light and all the, all the sort of things that you would see in terms of simple advice, but they still struggle. And I think my analysis is that people are just wired and tired. They've got too much on their plates. You know, too much on their plates. They can never switch off. We're living through difficult times anyway where people have just got a lot on their minds, whether it's just from what they watch on the news or whether it's what's going on in their own lives.

And often it's just there aren't enough hours in the day for a lot of people I know to do what they've got to do, whether it's work or whatever. So they're not getting that ability to switch off. And again, you know, going back to the first tip, that sort of one minute recharge, you asked me a minute ago, whether I do that first thing in the morning. I don't actually, but some people would benefit from doing it then. Or last thing at night, if you're someone who's a perfectionist, and you just worry all the time about things one of the exercises again i mentioned it in the book one of my patients taught me this is that he actually sort of makes sure that he's very perfectionist

and he's got a perfectionist type of job in engineering and so he sort of has to make sure that everything is sort of at peace you know as in I'm not going to worry about that before he goes to bed. And actually that one minute recharge kind of thing might help there. But so it depends how you're wired in a way. Yeah, certainly for me, what I've seen with people, and I've experienced myself is that, you know, that one hour period before bed is so, so important. You know, what signal are you giving your body and brain? And I always use the analogy about children. You know,

when we've got kids that we want to get to bed, we create a certain environment to assist that. You know, we don't give them a ton of sugar. We don't have the music blaring. We don't have bright lights on. No, we kind of do the opposite, don't we? We calm everything down. We soften. If there's music playing, it will be soft music. We read them stories. And the older I get, the more I realize that adults are just not that different from kids. We also need a signal to us that, oh, it's the end of the workday. It's the end of daytime. It's now nighttime. And I think these lack of boundaries we now have, because you can check your work email on your phone that you might have next to you whilst you're watching TV in the evening. Well, you know, at 9pm, suddenly you are looking at that work email

because it's easy to do that. So I know for me, I have to have, not I have to have, I choose to have a one hour, you know, a routine sounds as though it's kind of really disciplined and droid. It's not. But in that one hour before bed, I pretty much switch the laptop off. I won't look at work emails. I'll try as much as possible that things are relaxed and soft. And I'm pretty good these days at not going and doing work, even if it needs to be done. I appreciate, you know, everyone's got different requirements for their work, and sometimes if it needs to be done. I appreciate, you know, everyone's got different requirements with their work and sometimes they just have to do it. I do get that. But I know for me that having that one hour where I pretty much don't do anything stimulating for my mind,

it makes every hour of the following day better, more productive, more empathy, better food choices, better relationships. Do you know what I mean? So for me, at least, I have stretched my life in such a way that I can have that one hour before bed where I'm not doing work stuff. There's something you find tricky with your job, isn't it? bed where I'm not doing work stuff. There's something you find tricky with your job, isn't it? It is, yeah. And I know it's something I've got to address. And certain days in the week, it's easier than others. But three days a week, it's pretty much impossible, you know, just because of the working week. Well, why don't you paint a picture of that? Because I think a lot of people don't realise what, you know, a kind of full-on NHS GP, what does that day look like?

Yeah, it's just you never stop, you know. And I guess, you know, it starts early. It depends what time you get in. I actually sort of go in, nowadays I go in a little bit later by half eight. But that's unusual. A lot of people, a lot of my colleagues are in at half seven you know but the downside to me going in late means I get away late because I have more work left and so and what's changed while we're on NHS general practice is that you used to sort of ring up

get an appointment after a few days and you know you'd come in with all sorts of things sometimes it's minor illness sometimes it's something complicated nowadays nearly everything is complicated so we've got all the minor illness and i say minor illness because it's only minor in retrospect you know ear infections chest infections urine infections coughs and colds all that stuff and we've got you know brilliant paramedic team at work who cover almost all of that. But the volume of complex stuff, and I'm making these up, but the kind of thing that you'll see, you know, you'll come in in the morning and there'll be 60 names on the list. And the first one might be 11 year old who, you know, has locked themselves in the bathroom and won't come out and the family only want to speak to a particular doctor

because they know them. Really complex problems. You can't just toss this to someone else because there's no resource. Hospitals are slammed, community services are slammed. The second one might be an elderly gentleman who's rung the paramedics and the paramedics aren't quite sure whether to take them into hospital and want the GP to review. Again, not something you can do in 10 minutes very easily

because normally they've got very complex needs. Another one might be someone who's suicidal, you know, again, not something easy to handle. And again, there's no, there's nowhere to sort of, you can't just send these people to places, you know places easily because the resource isn't there. So we end up holding a lot more risk. And of course, the patient is in dire need. And they struggle to get through anyway because there are less GPs nowadays. So there's less of us in the system. So it's a perfect storm.

People are more ill with more complex stuff and there are less of us i mean it's just and you know how the story might end there because it's just you know there'll be there'll be nothing in the end if we don't i don't know what the answer is i'm not going to get political but you know we we just need to be aware that that's going on yeah i i genuinely feel that a lot of the public don't realise what GPs actually end up seeing, and that the clinic times are just one aspect of the work. And I understand that there's huge amounts of frustration that people can't get appointments. I think… Absolutely.

It's, you know, obviously it would be ideal if everyone who wanted an appointment got one when they wanted to. But as I've mentioned many times on the podcast before, I don't know a single GP who works in the NHS who is not overworked, probably close to burnout in some way. And the workload, the stress is impacting their personal life, their relationships, the amount of time they have with their family. And again, I understand that it's not just unique to GPs or doctors. There are loads of professions who are in this boat as well. Teachers, nurses, just to name just a few. How frustrating is it for you when there are negative headlines about GPs and there's that whole narrative, oh, they're just lazy, they're not seeing enough patients? You know, what does that feel like for

you? Yeah, all of us want to do a good job, we are under resourced and it's it's very very disheartening because you're doing your best in in really really difficult circumstances it's interesting actually i went to my mum's gp surgery the other day which is down the road from where i work and i went to pick something up a form. And I was having a chat to the reception team member there. And what's interesting is when you walk into the building, because it's relatively empty, you think, there's no one here. You know, how come it's so busy? How come we can't get through?

And the stress, of course, is what I just told you about the 60 names on that list. Yeah, they're names on a screen, but they're really complex problems you know and if you suddenly sort of put those names on a screen in the context of an a and e department where everyone's got scrubs and there's beeping machines and stuff and and more serious stuff going on behind the curtains like heart attacks and you know stuff that goes on in resus, it suddenly seems more serious because you're in that setting. And because primary care is a bit more close to home, and when you see that the waiting room's not full, you just assume that there's not much going on.

But actually, behind those closed doors, you've got a battered GP who's just just got you know a hundred very complex problems to solve in a day i i've said this before but i was trying to explain to someone the other day that um sometimes you know i've had not not recently but i've had up to a hundred letters to read in a day in terms of stuff that comes back from the hospital each one will have an action for me the ones that don't have an action just get filed into the patient's notes and then then you've got an action like please tell the patient to go and do this or please can you arrange this but also the implication of not doing it of missing something yeah exactly yeah you know that's

that's the thing isn't it you talk about talk about those names and the wide variety of things that can be on that list. Just take one, that person who's suicidal. We all know what that's like when you then have to deal with that and almost everything else becomes secondary because you're trying to deal with an acute problem with some really potentially dire circumstances. And you can't just fit that narrowly into,

oh, I've been allocated five minutes for this call. Exactly. You know, it's suddenly you could still be there 45 minutes later, 50 minutes trying to talk to people, trying to find out what's the right thing. And then, of course, your existing work is still there. I don't want this conversation to be a negative thing about general practice or the state of things at the moment. There is a problem. There's not enough doctors.

We also recognise that patients are very frustrated. They can't get the help that they want. One of the things I think is fantastic about your new book, The Health Fix, is that it's very empowering for people. And I think it's really, really needed, Ian, at the moment, because, as you say, a lot of people can't get help. But I think what they'll find when they read your book is that there is a lot that they can do to help themselves. Do you know what I mean? Yeah, I hope so, yeah.

That's one of the reasons for me writing it. If you can't sort of find tools to maximize your wellbeing in an easy way, you know, then you're not in trouble, but you're going to struggle to sort of find help easily. I think that's the thing, you know, for lots of reasons, as we've just discussed. I think that's the thing, you know, for lots of reasons as we've just discussed. Now, one of the core concepts you talk about in the book at the start is this difference between systems and symptoms. What do you mean by that? What I mean in the book is that symptoms, which can be anything from, you know,

just anything that you feel is wrong as a human being, you know, pain in your hands or bloating after meals or headaches, you know, those are symptoms, aren't they? Symptoms often, but not always, but often come from the fact that one of your biological systems in your, you know, biology has effectively started to malfunction or gone wrong, one or more systems. And those systems are your gut, your immune system, there's a big overlap between the two because a lot of the immune system's in the gut, your musculoskeletal system, your nervous system, your endocrine system, which is your network of hormones, and your cardiovascular system. And if you think about those systems, they're all sort of working at the same time,

but they're all communicating with each other. So a really simple example of this is, you know, I've done this countless times, you know, when I was a student, if you stay up really late, revising for an exam, have 10 cups of coffee, because you've not quite done enough, and then you have no sleep all night, and you go into the exam at nine o'clock in the morning. If you think about what's happening to your gut, your heart rate, your brain, you know, your stomach will be churning, your heart will be going at 100 at least, and you'll have a banging headache. What I've just described there are three systems, you know, which are intercommunicating with each other,

but also slightly malfunctioning because you've done the wrong thing for the last 12 hours or so. And in many ways, that process of your systems malfunctioning, that was an example of, you know, a one-off because you stayed up all night and had too much caffeine and, you know, you're stressed. But that happens in slow motion to us as time goes on your systems can begin to malfunction and in the book i describe it and use an analogy of the water leak so you know imagine your shower leaks you know and so there's lots of options for this you can either sort of see the brown patch on your ceiling and paint over it. Not a good idea. Because if you do that, what's going to happen is that the water keeps leaking.

And then eventually, you know, think of the systems in your house, exactly the same as in the body. You know, you've got your Wi-Fi, your electrical system, your plumbing. You know, you've got carpentry, all sorts of things. You know, that leak will start to sort of leak down into the wall, then mould will set in, then it might leak into the light switch on the ground floor and affect your electrics, you know. So one system going wrong can then start to affect other systems,

just like that example I gave you about staying up all night and what you'd feel in, you know, your heart and your head and, you know, so it's a bit simplistic, but it's a key concept because, and what I don't want is people rushing off to their doctors going, oh, I've got a bit of a pain in my finger. I've heard it can be a problem with my systems. No, that's not it, you know, because there's a difference between things that happen overnight and things that happen in slow motion but if you generally sort of got a persistent symptom um you know like for example migraine headaches is a classic one that you know we know that migraines have an inflammatory component you know and and that is an example where sometimes there is some systemic inflammation and actually if you make

adjustments to your lifestyle essentially your behaviors and your environment which is how i define it in the book you know then your symptom can get better because your systems are working better yeah i think it's a really good analogy because we often and i think we're taught to do this as doctors as well, we overly focus on that symptom, don't we? We see the brown patch on the ceiling, which is what the patient has come in with, the headache. So in the house, as you say, we could just paint over the brown patch. And yeah, temporarily, it appears that there's no problem

especially if water's not leaking right that's a little bit like giving a pharmaceutical medication to take away the pain of that headache right same kind of concept but if we don't do a bit of investigating and figure out well where's that brown patch and the ceiling coming from yeah there's kind of two in the ceiling coming from? There's kind of two things the way I see it. Number one, we're not getting to the root cause of the problem. But number two, as you pointed out, not only are we not getting to the root cause, we're allowing that issue to keep going,

which in turn, as you say, can start to affect other things in the house. So, you know, using the house analogy, your Wi-Fi is not working. You think, what's going on, right? You look at the Wi-Fi box, you phone up the Wi-Fi operator, but actually that's a downstream consequence of the fact that you didn't fix the leak. And it's not overly simplistic at all. I think that's a very, very good analogy for a lot of the common problems that people struggle with and how in medicine, we're often overly focused on the symptom. Of course, it's important what that symptom is, but what's driving it is just as important, isn't it? Yeah. Just taking a quick break to give a shout out to AG1, one of the sponsors of today's show.

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Usually, they offer my listeners a one-year supply of vitamin D and K2 and five free travel packs with their first order. But until the end of January, they are doubling the five free travel packs to 10. And these packs are perfect for keeping in your backpack, office or car. If you want to take advantage of this limited time offer, all you have to do is go to drinkag1.com forward slash live more. That's drinkag1.com forward slash live more. slash live more absolutely right and i think that's the thing you know it you've nailed it really i mean that's that's what this is all about it's about looking upstream you know and actually

you know the what the book is sort of about is it's a toolkit that allows you to improve your health in simple ways by understanding the story of yourself. You know, it's totally tailored to the individual, you know, and that allows you to get to the root cause because come on to the book, maybe in a bit in terms of the structure, but at the end, there's this whole section on the fixes, you know, which are effectively hacks. And I know a lot of people will want to jump straight to that bit thinking, oh, hang on, there's no point in reading the whole thing. It won't work. There's no point. A, because most people don't need all of them. And B, it won't be tailored to you. You've got to lay out your story, you know, and that helps you get to the root cause much more quickly. One of the ways you help people and readers

understand what they need to do, not what their brother needs to do or their sister or their partner or their mate. What they need to do is with something you call the health loop. So explain to us what's the health loop and why is it so effective? Yeah, the health loop is really a collection of eight factors

that give rise to your health right now. So you and I right now, our state of health is based on these eight factors and they are not in any particular order. Sleep, stress, diet, exercise, your genetics, your environment, historic infections, and your exposure to sunlight. That last one is also a euphemism for vitamin D levels. And if you think about those things, you know, when a patient is sort of telling me a story and it's all a bit nebulous, so it's not the story of yeah i had a fall i've broken my elbow i need a sick note that's quite defined no need for the health loop but if it's

kind of like you know i'm just not feeling right i've got all sorts of things going on um you know i'm tired all the time i've got pains in my joints i've got headaches you know how i felt basically when i was when i was about 40 but but the point is that you know that needs slightly different antennae because if you're using the kind of conventional medical model you know and i'm not saying this is alternative in any way but if you're using you know the training that i i had and you had and how i would have approached that 20 years ago, I would have listened very attentively and been very compassionate, but I would have dealt with all of those things individually going, well, why don't you try an anti-inflammatory for your joint

pains? And then I'll give you some, you know, proton pump inhibitor for your gut. And, you know, but actually all of those things might be connected if your systems are kind of not functioning well. And if you look at those factors, everything that I've just laid out, stress, sleep, diet, movement, the easiest way to get that out of someone is by asking them, tell me about your typical day. You know, that's the thing I sort of, and in the book, I get someone to think about their typical day. Because most of those things will drop out of them. Some of them won't, genetics won't, because you need to know what your family history of illnesses are.

And other things are kind of not always that obvious. But, you know, again, when you tell your own story, you kind of think, wait a wait a minute actually I am working like 14 hours a day maybe maybe that's why I'm tired you know you just don't see it do you unless you you think about it yeah I think the health is brilliant actually it's these eight key factors that pretty much are the contributory factors to all chronic illness yeah It's that simple, right? And I think the way you've done it is really, really helpful, especially as you say, for people who've got a variety of different things. It doesn't neatly fit into a particular box that you've got this problem or that problem. It's just

generalized symptoms that are meaning they're not thriving in life. Everyone wants to thrive, don't they? You've got some brilliant cases i wonder if we can talk about amelia because amelia in the book i think beautifully illustrates just how powerful the health loop can be and how quickly it can work yeah yeah i i'd agree yeah so she'd gone from being this really healthy university student who was like a sports champion at hockey, tennis and various other sports. And had gone from being, from thriving, I guess, to being near bed bound, you know, to the point where she just could not function. So she'd get up and then go back to bed, wasn't able to train, wasn't able to continue with her studies for a while. And it was a bit of a mystery.

She'd already seen doctors who'd sort of said, look, don't know what it is. It must be viral. You know, just keep on kind of, you know, doing what you're doing type thing. And what the health loop laid out in her case was that in fact she she you know her dad um um accompanied her to the appointment and basically said look you know she's um never really been ill she's a very very healthy person this is just totally not not like

her and actually to start with nothing was coming out you know her typical day she goes her typical day then was look I just I get up have breakfast you know cereal or toast and I just sort of I feel really tired and then I can you know I kind of go to lectures but I can't really I'm falling asleep by the middle of the afternoon and I can't do any netball training and and all that sort of stuff which she used to do in the evenings. So when I met her, her typical day was terrible, but what we'd call in medicine her pre-morbid, you know, typical day, which means before she got ill, she was super active. She was just full of energy. And then I go, okay, well, and one of the things that we do in the book is also something called

a timeline. So it's really important to look at someone's early life. And there's a whole section in the book about how our early life affects us as adults, you know, both mentally and physically in terms of health. And the example I would give is if you've got someone who is perhaps, you know, know born premature not breastfed has lots of infections when they're young just those three factors will affect this person's health later they're more likely to get gut symptoms or fatigue for because of insults to their gut flora but we can come back to that later but the point was Amelia had none of these nothing and so I remember going through the years going, okay, that's weird.

I go, what about when you were 10 or 11, anything then? And, you know, her and dad are going, nope. Right, okay, 12, 13, 14, don't remember anything from your teenage years. Like, nope, it's like never been in hospital. So I wasn't really getting very much. And then suddenly came this revelation that she'd um split up with her boyfriend fallen out with a friend and had two urine infections all in the space of a few months they sound quite innocuous don't they but so a spike of thinking of the health loop a spike of

stress infections is one of the spokes in that you know loop as well um and two lots of antibiotics and i suddenly thought do you know what that could be enough just to tip you know that thing that you always talk about about tipping points and how everything's at a threshold and she just reached her threshold she'd been sort of managing quite well for 18 and a half years you know with what i'd call a beige diet you know she wasn't particularly you know she got away with just sort of living on non-nutritious food i'm not judging at all but you know a lot of teenagers do that that's fine but but suddenly the stress and the insult to her gut flora tipped the balance

the only other thing was her brother has celiac disease which was at the back of my mind and often you know everyone with celiac disease pretty much 99% of people have these two gene haplotypes particular genetic marker but she'd been tested for celiac disease and it was negative she didn't have antibodies to it so anyway she had sort of big end of year exams coming up and that's why the pressure was so high and i remember saying to her look you know i think i know what's going on here and there was there were a number of interventions that we had to make the first one was changing um what she ate she just loved beige food you know

um like most teenagers nothing wrong with that. But you know, it's not particularly nutritious. She sort of lived on cereal, toast, pasta, you know, that sort of student diet. So I wanted her to improve her diet a little bit by introducing more nutrients, really vegetables and fruit. And you know, she used to eat a bit of fruit, more nutrients really vegetables and fruit and you know she used to eat a bit of fruit but not very much then i noticed that she she's a very quick eater and one of the concepts in the book is how what and when it's not just eat more healthfully you know it's how you eat what you eat when you eat and there were two things that stood out one was that she liked snacking before bedtime which is a bit of a disaster because it disrupts sleep. And, you know, it's

just not good for you for lots of reasons, because you end up with a high spike in blood glucose, and then a high insulin level while you're asleep. But that wasn't the reason for this. It was more to try and help her sleep. So I stopped her snacking at bedtime, and I wanted to eat more slowly. So that was the sort of eating bit. I also detected that she was quite stressed there was a lot of pressure on her in terms of exams and she's obviously a top level sports person so I asked her to do nothing for five minutes a day when I say nothing it's a bit like my one minute recharge where you just zone out and kind of do something to kind of make yourself feel relaxed. So she was quite up for this,

but hadn't really realized that she doesn't get any downtime. You know, she's always on the go. She's quite competitive. And the last thing, because of the story of the antibiotics, I figured her gut flora were shot, you know, and so I put her on a probiotic, something called Lactobacillus GG. It's the one that most of the studies are done on if people, you know, look it up online. And really that was it.

And what was remarkable was that very quickly, within a matter of weeks, she was almost back to normal having been in this state of feeling unwell for six months and i remember thinking about this at the time and she's really a case of evolving autoimmunity you know she was on this march towards autoimmunity and people will sort of say, well, you can't prove that, you know. But the alternative was that she was being labeled as someone that might have chronic fatigue. You know, that was what was going on with the doctors she'd seen already. They were going, well, maybe it's just maybe got chronic fatigue. I don't know. You know, maybe it's post-viral,iral you know all this kind of conjecture and and just thinking about what she did there to help herself you know we we it's all

in the story you know so you've got this very well person who suddenly has a couple of you know of blips in terms of stress, relationship breakups, and then has two urine infections, which people get all the time, two courses of antibiotics. Bear in mind that one course of antibiotics can sometimes wipe out, they can't tell the difference between good and bad bacteria, so they wipe out all the good stuff, all the good bacteria in the gut, which is effectively the food for our immune system. So in a lot of people, it doesn't affect them. But for her, it obviously did. And that triggered a number of things. Her symptoms were fatigue, bloating, lack of energy,

and also some sleep disruption. Everything, a little bit like people who get COVID and then end up with long COVID. They get all of their body systems just seem to be affected. They get this dysautonomia. And actually Amelia had that. She kept sort of, you know, I don't think I talk about it much in the book, but she was feeling faint and kind of dizzy

and all of that sort of stuff as well and what was going on there well there's two things but three things really one is we haven't come to the bit about her brother having celiac disease which we can come back to because that may be relevant so one of the things that her new diet did it it sort of removed, she's a real all or nothing sort of person. So she went all in and kind of removed all the beige stuff. But that also meant she wasn't really eating any gluten. And I do wonder whether she has the gene for celiac disease because there is a group of patients that i see at work who react to gluten but they come up negative when you do a blood test for antibodies to gluten and those antibodies the

ones in the gut you know you know tt anti-ttg antibodies they're called they only really measure whether you're making antibodies at that moment in time but they don't tell you whether you've got the gene that everyone say everyone but 99 of people who have celiac disease have a particular gene variation you know these um called hladq2 or hladq8 and sometimes what i'll say is okay look you know often it's children and the parents are going look why why does she get a bad tummy and why is she sort of so grisly every time she has gluten even though she's negative for celiac disease and i go well she might have the gene if you've got the means get a get a dna test done i don't know with amelia whether she ever did that and i don't know whether she's got that gene but it's definitely something in the background um but so often if you do have

that gene then you've got a choice because you can either think, right, well, we're just going to avoid gluten altogether because that way we guarantee you don't end up with celiac disease. But if you don't, then there's a 10% to 20% risk that you will develop it at some point in your life. But a bit of a side… Well, this is super interesting. And I just want to back up a minute, Ian, because this is a very powerful case, right? So, young lady, 19 years old, comes in to see you with a variety of different symptoms. You know, her life is literally falling apart. Her concerned dad brings her in and says, you know,

what's going on here? Right. She's knackered, struggling with motivation. She's got brain fog. She's fainting. She can't concentrate. She has some sleep disturbance. But modern medicine can't put her in a neat little box, right? We can't say, oh, you have this condition. Now I know from reading it in your book, I think, that you ran some blood tests. Because, of course, fatigue can be many different things. So the first thing you did was just double-check all those medical things first, right?

Which she aced. They were totally normal. She had several sets of bloods. It's important, this, actually, because there are some medical reasons for fatigue. And in fact, doctors, we call it tired all the time, TAT, you know, when we write a blood format, often we'll put that as a shortcut. Things like anemia, or an underactive thyroid, or type two diabetes, or sometimes something a bit more mysterious, like Lyme disease might be the cause, or glandular fever, another very common one.

I mean, they're not exhausted by any means, or vitamin D or vitamin B12 deficiency. And again, relatively, I say common, but often that will come up, but they didn't. So they're all ruled out. They're all ruled out, yeah. So at that point, you know, okay, there's no obvious medical, in inverted commas, cause for this. And I think this is where there's no obvious medical, in inverted commas, cause for this. And I think this is where there's a real knowledge gap in medicine. For all the brilliance of our training, it's clear to both of us that it's good for some things and not so good for others. And I think Amelia's case is one of those classic cases that many people around the country, around the world, these are symptoms they feel.

Yet often they draw a blank when they come and see their medical doctor. And it's not because the medical doctor doesn't want to help them either. It's because the systems v. symptoms framework that you've already outlined is because we often, well, it's because we're trained to look at those symptoms. it's because we often, well, it's because we're trained to look at those symptoms. But those symptoms, although seemingly unrelated, you know, fainting, tiredness, sleep disturbance, brain fog, actually, maybe they're just downstream symptoms of an underlying root cause, like we've already mentioned with the water leak, right? It's the shower that's leaking upstairs that's the problem. That's why you've got a brown mark on your ceiling.

That's why the Wi-Fi is not working. That's why the light isn't working in that room. That kind of pattern. So you've ruled out medically. That's when you brought in the health loop. That's right, yeah. And what I find really interesting about that, because I actually think everyone listening to this,

could do their own health loop. Your books can absolutely guide them on how to do that in detail, but very broadly, you identified, I think, three or four areas, right? Huge amounts of stress, that's one of the eight factors. You identified recent infections, a second one of those eight factors. You identified an average sort of beige diet, third one. And then you also identified, or you were suspicious of genes because of her brother's celiac disease. But what it does, it gives you as a doctor, and it gives people who are doing it on themselves,

it gives them somewhere to go. Instead of being lost, what does all this mean? You go, okay, let's just look at it. These are the eight factors. Oh, there's four that are lighting up here. I can start addressing them or I can start addressing one of them. At its core, mate, it's that simple, right? So let's go back to Amelia because you brought some really interesting things there, right? You changed her diet, you gave her a probiotic to sort out her guts, you helped her manage her stress. Obviously, you didn't do anything for her genes. No.

But you mentioned in the book that she gave up gluten by accident, which I found really interesting, this concept that she gave it up by accident. So let's just hone in there for a second because this concept of evolving autoimmunity, I think is really interesting. I don't think it's something I've spoken about much on the show before, right?

I think listeners to this show are aware now that by the time they get a diagnosis of type 2 diabetes, that process has been going on in the body for at least 10 years. By the time they get a diagnosis of Alzheimer's dementia, that process has been going on for maybe 30 years. So these things don't just happen overnight. But what you're saying with evolving autoimmunity is that autoimmunity also does not happen overnight. It is a process. It's the

end stage on a continuum. And what you're saying is that for some people, these vague symptoms, if we don't get on top of and start to help people with, they are going to keep evolving, this evolving autoimmunity. And as you say with Amelia, with that genetic history in a family as well, it may well have ended up with a diagnosis of autoimmune disease five, ten years down the line, right? Yeah, yeah, absolutely. And you're right. And I think going one step back from that,

if you're lucky, and actually, if you look at the factors in the health loop, if you don't have any genetic predisposition to autoimmunity and you never had very bad glandular fever as an infection because viruses can prime you for autoimmunity, and if you haven't got any of those risk factors and you're relatively lucky and you do all the basics right in terms of sleeping, eating, and exercise, and all those things, you'll probably be okay. But that's not real life, you know, and most of us are primed. You know, I am definitely because I had something called

dengue fever years ago. And, you know, I don't want to go into my own story at this point. But, you know, I talk about it briefly in the book at the beginning but but um so so so you're quite right you can lay out the the story for yourself so that it tells you exactly where to focus and i think that's the point you know rather than this scattergun approach of because there's so much info out there these days, isn't there, in terms of public health messaging. But when it's you yourself with problems that are not being resolved, or you're slightly stuck, then you need a different lens and a different approach. And this is just a very logical, very sort of, you know, easy way to lay it all out for yourself. Yeah. Let's just complete the loop on the triad, the three things that are needed for autoimmune disease, because I think that's going to help make this really, really clear.

Yeah, yeah, absolutely. So my understanding of autoimmunity and why people get it, how it starts and how it evolves, is that you need three things. So one is a genetic predisposition. So if you've got a family history of an autoimmune disease, you're more likely to develop an autoimmune disease. The second one is an environmental trigger. And that can be, and this is real world stuff and also written in the scientific papers. This isn't woo-woo.

The environmental trigger can be anything from very high stress levels to a viral infection to some other form of inflammatory process. trigger can be anything from very high stress levels to a viral infection to you know some other form of inflammatory process it can be it can be lots of things but very commonly viruses and life events very high levels of stress you know we see this time and time again in general practice and the last one is something called increased intestinal permeability this is one that's quite contentious and theorized there's lots of papers on this and it the theory for that one well there's two things firstly that's the only one you can really do anything about because

you can't really change well you can't change your genes apart from gene editing but you can't change what's happened you know in previous generations in terms of family history if you've had the environmental trigger that's in your past that's in your timeline but intestinal permeability um and and just to talk a bit about that what that means is that in the small intestine there are these things called tight junctions a little bit like those sort of gaps on the side of the motorway that sort of you know there's a gap but they're kind of sealed off so that cars can't get through um and when you have increased intestinal permeability molecules that are meant to be within the gut lumen effectively leak through these tight junctions

into the bloodstream and cause inflammatory effects. And so, you know, particularly for medics who are interested in this, but I'm sure other people will be, there's something in medical textbooks called blind loop syndrome. Do you remember this? So blind loop syndrome is in surgical textbooks. And I remember years ago reading about it thinking, and it said, oh, blind loop syndrome is in surgical textbooks. And I remember years ago reading about it thinking, and it said, oh, blind loop syndrome can also be associated with rashes

and joint pains and other systemic symptoms. And I do remember, you know, 30 years ago, whenever it was, thinking, that's a bit weird. Why would something in the gut give you rashes? And actually, if you think about this theory of intestinal permeability it makes total sense because those kind of molecules that then leak into your bloodstream and activate inflammatory mediators give you systemic effects meaning that they affect all your systems you suddenly start to get headaches joint pains you know rashes. And there's a very specific type of condition called SIBO,

or small intestinal bacterial overgrowth, where that process of increased intestinal permeability is at play. And to cut a long story short, it's when you basically have more bad bacteria in your gut than good bacteria, the balance is tipped. And that is sometimes one of the triggers for autoimmunity in the gut, you know, beyond your environmental trigger and beyond the fact that you've got a genetic predisposition. So it's, you know, but the point is that if you catch it sort of early enough and you spot the signs, which is difficult, I have to say, I mean the thing with amelia was she was pretty desperate you know she was really quite you know really not well you know she wasn't functioning and that's why um it was so obvious when she got better that she was better um but but i don't think you know in in defense of her and people who'd seen her before, it probably wasn't

that bad four months before. She was just a bit under the weather. It's just got worse and worse and worse. But, you know, if I was a betting man, I would say she was definitely on that march towards autoimmunity. Yeah, I found the triad. I think it was the immunologist, Aristo Vorjadani, who initially came up with that triad from recollection that you need these three things to get autoimmune disease. You know, the genetic predisposition, environmental trigger, and increased intestinal permeability, also known as leaky gut. I've always found it really helpful when assessing patients. It's a great lens through which to look at it. And then if we look at Amelia for a minute,

she absolutely fits, doesn't she? We don't know her genes. No. But given that her brother is celiac, it's not unreasonable to assume that there may be some genetic predisposition there. But I think that's a key point that the genes you're born with, it's just a predisposition. If you don't have the other two things, the environmental trigger and the leaky gut,

it's not going to happen. You're very unlikely to get that autoimmune disease. I want to just pause on these genes a minute because gluten is something that a lot of people talk about. And again, like many things online these days, things become quite black or white. I would say the current view by most of society and many healthcare professionals is the only reason to exclude gluten from your diet is if you have a confirmed diagnosis of celiac disease. Right? Now, I actually don't agree with that. That doesn't fit with my clinical experience personally. I think there are nuances here. There are people time and time again who, when they exclude gluten from their diets, starts to feel better. And there could be many reasons for that because, you know, is it the gluten? Is it the kind of products that gluten is in? And

therefore, when you exclude that, you're no longer having those things, you know, like FODMAPs, for example. But do you know what I mean? How do you see this? Yeah. Before we get back to this week's episode, I just wanted to let you know that I am doing my very first national UK theatre tour. I am planning a really special evening where I share how you can break free from the habits that are holding you back and make meaningful changes in your life that truly last. It is called the Thrive Tour. Be the architect of your health and happiness. So many people tell me that health feels really complicated, but it really doesn't need to be.

In my live event, I'm going to simplify health and together we're going to learn the skill of happiness, the secrets to optimal health, how to break free from the habits that are holding you back in your life, and I'm going to teach you how to make changes that actually last. Sound good? All you have to do is go to drchatterjee.com forward slash tour. I can't wait to see you there. This episode is also brought to you by the Three Question Journal, the journal that I designed and created in partnership with Intelligent Change. Now, journaling is something that I've been recommending to my patients for years. It can help improve sleep, lead to better decision making

and reduce symptoms of anxiety and depression. It's also been shown to decrease emotional stress, make it easier to turn new behaviours into long-term habits and improve our relationships. There are of course many different ways to journal and as with most things it's important that you find the method that works best for you. One method that you may want to consider is the one that I outline in the three question journal. In it you will find a really simple and structured way of answering the three most impactful questions I believe that we can all ask ourselves every morning and every evening. Answering these questions will take you less than five minutes,

but the practice of answering them regularly will be transformative. Since the journal was published in January, I have received hundreds of messages from people telling me how much it has helped them and how much more in control of their lives they now feel. Now, if you already have a journal or you don't actually want to buy a journal, that is completely fine. I go through in detail all of the questions within the three question journal completely free on episode 413 of this podcast. But if you are keen to check it out, all you have to do is go to drchatterjee.com

forward slash journal or click on the link in your podcast app now i i agree the problem is that there's a sort of perceived wisdom in the scientific community that is quite sort of rigid and concrete um i i do touch on this in the book and there's a whole bit on the importance of evidence-based medicine but also when there's no evidence you know how ridiculous it can seem and um but going back to what you said about is there a reason to exclude it um if you don't have celiac disease? So, for example, patients with Hashimoto's disease, which is a thyroid condition, it's an autoimmune thyroid condition, do very well on a gluten-free diet. Why is that?

The reason is a very well-established scientific concept called molecular mimicry. scientific concept called molecular mimicry and what that means is that the proteins on the thyroid gland resemble gluten in terms of their shape just imagine it's this shape and that means every time so just to clarify Hashimoto's disease is when you make antibodies to your thyroid. So you've got antibodies attacking your thyroid tissue. But the thyroid tissue looks like gluten to the immune system. So every time you eat gluten, guess what? Those thyroid antibodies will be activated and you'll again get this flare-up of thyroid symptoms. And so, you know, it doesn't work for everyone, but certainly that group of patients, if they go on a gluten-free diet,

feel a lot better because they're not getting the antibody response as much. Molecular mimicry is something that's very well established. A really well-known example of this is oral allergy syndrome and allergy to birch pollen. So if you're someone who eats fruits and then your lips swell up, you're probably also allergic to birch pollen because it's exactly the same thing. The actual shape of the molecules are so similar that it tricks your immune system.

It's a case of mistaken identity, effectively. So I don't agree with that. I think there are instances where a gluten-free diet would benefit. The other group I see it in are people who have, you know, I get this a little bit, so I can eat certain types of gluten, but other types really just, honestly, it's like i've been poisoned i've often wondered why it is because i i don't have celiac disease and i don't have the gene actually for celiac disease really yeah because um so i don't have them so why do i react to it who knows but the point is i i do and i think for me it's because my um environment my autoimmune trigger is I had dengue fever in my 20s,

which is quite a nasty virus. I was very, very ill with it. And viruses prime your immune system. Not all viruses, but they can prime your immune system for autoimmunity. So Epstein-Barr virus, which is the one that causes glandular fever, or human herpes virus 6, HHV 6 is another one. Very common virus, but in some people, prime you for autoimmunity. And then all you need is another trigger. So, you know, my own illness, which I describe in the book, was a mixture of that. No sleep, I say no sleep, but almost no sleep for three years,

and then a huge spike in stress. And just those three things in my health loop were enough to just tip the balance for me. So yeah, you know, that's the way I like to look at it. Yeah, there's so many interesting points there, Ian, which I think are really worthy of discussion. a really worthy of discussion. You said something that I think is incredibly powerful, which is, I don't know why I'm sensitive to certain types of glutes, but I am. That's good enough, right? But, you know, when someone then says, well, you don't have a diagnosis of celiac disease, you shouldn't be excluding it. There is no reason to do it, which people say, like really

well-respected scientists say, to me, it just shows a complete lack of real world understanding of what actually goes on in people's lives. It's all very well to study something in the lab or in the scientific journals. But why I think the approach that you've outlined in your book is going to help so many people is because it's based on real world clinical experience. We all know that feeling as a doctor, any healthcare professional, when there's a patient sitting in front of you in pain of some sort, they're struggling with their life, whether it's Amelia, it's a 19 year old or someone older, you know, they can't think properly, they've got joint pain, they've got anxiety, whatever it might be. And often the science doesn't give you the answer of what to do, right? That's the truth. You use the science

to help guide you, but also you go, well, okay, what's relevant for this person? And then there is also something about clinical experience and clinical expertise. You go, what? This patient reminds me of that one I saw last month who this works for. And it's not the science that's not important. Of course it's important. Do you know what I'm getting at? Yeah, yeah. It is. And I think practitioners, you know,

they have their own internal sort of gut feeling and evidence base. And I think the difficulty is that science, you know, is advancing as we know. But with it, there are a lot, you know is is advancing as we know but with it there are a lot you know what this book isn't and is almost the opposite of is is apps and aids that sort of tell us about things like heart rate variability and you know what what you're what you're what what's going on because data is is king isn't it i mean data is just amazing. But it can be quite confusing if you can't put it into context. And I think, if nothing else, this book puts your health into the context

of your life more than anything else that I think is out there. Yeah. We mentioned a health loop. You also mentioned something called a timeline and i just want to reiterate that doing a timeline on a patient is incredibly helpful but do not on yourself yeah it's amazing isn't it it's if someone was just to sit there for 20 minutes and do their own timeline and plot out everything all the big moments in their life from childhoods, I think people will see patterns. And it's just incredible when you, with a patient, sort of go through their story. Now you need a bit of time to do this, for sure.

And you can almost see the realization in them when they go, oh yeah, I used to get ear infections all the time i was on antibiotics every two months when i was a kid for five or six years then this happened when i was 14 and then my parents got divorced at this point and then oh i got sick just after that like it's so obvious sometimes when you see it isn't it yeah sometimes they just burst into tears because it's so kind of um graphic but um yeah it's a great tool you know it's it's no different in a way to to a therapist or a doctor listening to a story or just sort of plotting it out really there's nothing fancy or

wacky about it but it's just it's a great tool because you can see it and then it gives you something to work from um so i'm a real fan of it. I don't do it very often now because we don't get the time, sadly, in the world that I'm in. But it's a great tool and I do think people should do it for themselves and keep adding to it, you know. So, yeah, it's almost like a retrospective vision board

because it's sort of what's happened in your life, you know. Yeah, yeah. And I think life you know but yeah yeah and i think you know i think these tools give the reader and give your patients agency you know they really feel oh man i get it now i get it and and when when a patient is bought in when a patient gets their story that's where the magic starts to happen. Because then they're really, in my experience at least, super motivated to do something about it because they can see it. They go, of course I've ended up like this because of A, B and C. Now I want to take charge and

make some different choices and see if I can change the outcomes. I think the other thing that really helps is there's something in the book like all the drawstring effects and it's um you know it's basically this tightening up that happens once you sort of say with amelia she's a really good example of this you know just changing one or two little things makes everything in your system work better and once you start feeling that it's working better you stick to it more do you know what i mean it's just it's just an it's such a powerful thing um but that you know that requires you know going back to the beginning of the book the first two bits are on biology and behaviors and and the reason i do that i call it the foundations that section because if you don't really if i don't

you know i'm not a particularly structured person and I'm not very linear, but I realize that people want some substance. And if you don't kind of get those two things, if you don't understand your behaviors and how to change them, you won't be able to kind of help yourself. And if you don't quite get that symptoms come from systems, which is the whole first bit is about systems biology you know just a kind of 101 and i think that works really well and then then you see you know once you lay it all out in the health loop you think about your typical day how what when and then you can sort of almost write out your own lifestyle prescription you know it's really simple yeah it really is. I thought Amelia's a great example. Let's go to a different example, because as you're making the case, every single one of us can use that health loop to identify what's going on in their own life. So, you know, there's so many examples in the book.

I quite like Janine. Janine, yeah. So really interesting case. And one of the things I should say is that how I picked these cases is they're based on the things I hear most commonly as a GP. You know, so over the last 20 or so years, people's health wishes, I flipped them in a GP, you know, so over the last 20 or so years, people's health wishes, I flipped them in a way, so tired all the time, you know,

the health wish that that person wants, like Amelia is, they want more energy, you know. And Janine's case is one where her wish was that her memory was better. So she was struggling with her memory. She's like in her late 40s, lovely lady, three kids. Background was that one of her, her son had basically had leukemia a few years ago, and that had left her sort of on high alert. She works really hard in a hospital and came to see me with fatigue and brain fog. Her memory was failing her, so she'd forgotten to do certain key tasks at work, which is really unlike her because she's very reliable.

And the background is that her dad has Alzheimer's, and so she was very worried that this was the start of that. Someone who also, for lots of reasons, had never exercised. She had a bad experience at school with a teacher a PE teacher which had sort of shamed her somehow about sports and so never done any physical exercise ever since then and had a really sweet tooth and that was also quite interesting her sweet sweet tooth arose from a family funeral. And she remembers, you know, her uncle dying

and a lot of her extended family coming round to her family home and her and her cousins kind of snacking on sweets. And it was a source of comfort for her. And as a result, as we know, a lot of childhood kind of behaviours carry into adulthood. She was someone who was just trying to kind of cope as best as she could with, you know, sweet milky cups of coffee to keep her going all day. And had just run out of resources. She'd even had a brain scan because she was so worried about her memory.

And she works in a hospital environment anyway, so had managed to arrange that. Nothing on the brain scan to worry about she was a bit broken because she you know single parent three kids her mum helps out a little bit really nice lady and what was interesting was um what laid out in her health loop were those things that the genetics bit was her dad has alzheimer's her diet high sugar you know um and a little bit of stress around her son because she worries about him a lot you know and actually if you've ever had any kind of experience like that you know a child with leukemia who suddenly gets a fever it's a you know you rush straight into hospital pretty much you know so she's always on high alert about him and never never done any exercise um at all you know so those are the main things in in her health loop

where do we start with that well you know she's busy her typical day means that she gets home has to make dinner for the kids help them them with homework, all that sort of stuff. And, you know, part of me was thinking, you know, she's sort of in her mid-40s. Could she also be perimenopausal? Possibly. Did a load of bloods. And actually it showed that she was pre-diabetic, which didn't surprise me. But it really sort of slightly scared her I think you know because you know especially you know she wanted to be around for her kids and once you sort of realize that you might be on on the journey to a particular

disease you you want to take steps to stop that so the first thing we we sort of agreed was changing the how what and whenever eating that was definitely going to be quite a big part of this and also the fact that she's you know exercise tell me a bit about that you know why could you imagine yourself ever doing any exercise and she's like well i just it's just not i don't want to join a gym i I don't want to, you know, and, and actually the thing that absolutely worked brilliantly for her was something called Couch to 5K, which is an NHS app. It's absolutely brilliant. It starts really gently with walking and builds up to a five kilometre run.

So there were all these things going, you know, in tandem with each other. And she found it hard. I mean, she wasn't massively, she was motivated because she knew she had to do something, but she found it very difficult, particularly if you've got a very sweet tooth. Anyone with a sweet tooth will know it's really not easy to suddenly go from having a coffee with two sugars to a coffee with no sugar. It just doesn't taste right to that person because your taste buds are used to the sweetness so for her you know something called the ideal framework which i mentioned at the beginning of the book is is what she used so you know literally sort of identifying what she wants to do that's i

d is defining what it is that she needs to do e is engaging a is activating and l is looking back and patting yourself on the back saying well done and you know what she managed it she did the couch to 5k she struggled a little bit with the sugary foods but the more she did it the better she felt and bit by bit her brain function got better. And her fear, which was actually, look, you know, does this mean I've got Alzheimer's? What's amazing about systems and symptoms is that all of the interventions that she's taking to bring her blood glucose level down also work to prevent Alzheimer's, you know. And, you know, I don't know whether she's going to develop Alzheimer's in her lifetime, but if she does, hopefully it will be 10 years later than she would have done, you know.

And it's the same with diabetes. You know, we're all going to get old and die at some point. But, you know, when your quality of life and when your symptom is meaning that, you know, in her case, you know, the brain fog the the memory issues were so bad that it's affecting your work and you know you can't function you know you've got to do something but it just worked a treat with her you know and just laying those things out was was the key it strikes me that these approaches i mean you've shared two cases so far. I know there's a ton of cases

in the book, which, you know, people are going to be able to see themselves in at least one of those cases. I think that's what's so clever about it. People are going to go, that's me. Wait a minute. That's exactly what I've got. This is not the typical approach. It's certainly not the approach that we're taught at medical school. And it's still not the typical approach that most doctors will use with their patients. And again, it comes down to this symptoms versus systems. We in medicine typically will practice symptom-based medicine. What's the symptom? What's the name for it? What's the disease label? What's the treatment?

And again, as we mentioned, that has value, but certainly in my experience, and I want your view on this, the vast majority of what we now see, it doesn't, you know, that conventional approach just doesn't work that well. You know, what's your experience with that? And I guess following up from that, when did you realize you had to do something differently if you were going to truly help your patients? Yeah, I think I realized that

we had to do something differently many years ago because, you know, the model of, you know, trying something where you don't really know what's going on, hoping that it sticks because you know the model of you know trying something where you don't really know what's going on hoping that it sticks you know i i knew that it may or may not work and you use that sort of bayesian thinking of it might be this but i don't really know um so that realization was many years ago and and actually what you say in a way is nowadays only partly true because I think the awareness is there. So whatever we want to call it, the lifestyle medicine movement is quite big. But even within that, my issue is that it's not really focused enough on the individual.

It's very much this kind of tick box approach as in like well you know um hey you know exercising for x number of minutes a week's meant to be good for you yeah and yeah we know that but is that going to work for you and if it doesn't work for you know someone like janine who's never exercised just that isn't going to be very helpful for her you know it's got it's much more nuanced and i think you you've got to sort of start with the person which is why i think this book's going to help people because it's about them it's about their story it's not about what's out there because there's lots of that stuff we kind of you know if you've got you know resources are quite easy in a way. But actually knowing what's going to work for you is the hard bit, for the practitioner as well, you know.

Do you know what I mean? Yeah, I think just following up from that, I kind of feel that a lot of the time, we as humans are drawn to our kind of favourite area, you know. So, you know, some people are foodies right some people um you know very careful about their diet they'd like to try and eat well yeah so if they're gonna have any health complaints and they feel that the way that they're living their life is contributing they may feel you know i'm gonna go straight to my diet and actually i found that

a lot of the time hey your diet's already really good you know that I'm going to go straight to my diet. And actually, I found that a lot of the time, hey, your diet's already really good. You know, that 5% improvement in your diet, which you're trying to make with all that effort, I don't think it's going to do much for you because you're neglecting the chronic stress in your life with the fact that you're sleeping five hours a night. And I think that's what your health loop does really nicely is that it just shines a light on, oh, these are the areas I need to work on. It doesn't matter what the influencer on Instagram said or what my friends said. Actually, no, these are the two or three key areas in my life

that if I put a bit of attention there, they're going to work. So I think that's worth highlighting. The other thing I like about the health loop and the way you've written about it is that this is an iterative process. It's not just a one hit, is it? It's something you can do, make some changes, and you redo your health loop. So maybe can you speak to that a little bit? Yeah, that's a really good point. And it is iterative. The first thing I would say is that, you know, anyone who's been through this process, and I know I'd say maybe 100 people have done this kind of process,

either through myself or themselves, and anyone who's made changes to their health by analysing their routine and laying things out will know how great it feels to feel better. The problem is twofold, really. it feels to feel better the problem is twofold really one is that we're all getting older you know and that means that the expectation bar gets raised so high by the by often the person themselves thinking yeah you know i you know i feel fantastic but i want to feel even better you know and then it's like well hang on compared to how you were feeling six months ago you are doing amazingly well but some people want to go to that next level. And I think at that point, it then is a case of really drilling down,

you know, the type of apple that you eat rather than just eating an apple, you know. But hey, that's fine, you know, horses for courses. But you can do the health loop again and again and again and keep refining it. And you'll just find, you know, other things that just pop up Do the health loop again and again and again and keep refining it. And you'll just find, you know, other things that just pop up where you think, oh, you know what, actually, the way I was doing press-ups, you know, was making my shoulders ache. And I've just modified it a little bit by splaying my hands. Or just little micro, I call them tweaks in the book, you know,

and they're quite important um sometimes you know things starting to kind of fade yeah so yeah it is iterative you can just do it again and again and again and again hopefully just feel better and better i want to talk about the concept of balance and why this has come up for me is there's a little story in the book where you talk about one of your mates who lives in Asia and you talk about his wonderful morning routine, but the fact that he finishes it off with a cigarette. So perhaps you can share that story and share your conclusion from that, because I think it really speaks to balance. Yeah. It's so funny this this because he was telling me what he does every day.

It wasn't a consultation, it was just a normal conversation about whatever. And it was like, in the morning I get up at five o'clock in the morning, I stretch, and then I go for a run. I come back and I drink a load of like, you know, fresh filtered water. And then I either do some yoga or some meditation. And then I sit on my balcony and I have a smoke. And I'm like smoking a cigarette, you know, nothing else. But I'm like, what? You know, it was like this record scratch thing. I wasn't expecting it.

I was like, oh, I thought you were going to say you have like a fresh fruit platter or something you know which he does anyway but but it just didn't fit and and and i go and he goes and he even said to me he goes look it's therapeutic i'm literally just sort of sitting there just looking out into the desert and i'm like right i go i wouldn't say it's therapeutic but the point was it's to do with context, this, because, you know, if you think about your average smoker, they're kind of rushing out in the rain, you know, because you don't like smoking indoors, certainly in the UK, and you're going outside and sort of like struggling to light it up and kind of like having a couple of puffs thinking, oh, no, I've had my've got to get back up oh the lighter doesn't work whatever and and that you know i'm not i'm you know i would never encourage anyone to smoke but the point is that the context of him smoking even though he's only smoking one cigarette a day which is mechanically and physically probably doing him some harm is you know in terms of the rest of his habits you know the effect is likely to be fairly minimal you know as in i guess the what it boils down to a real hardcore scientist would go

oh we want to study the effect of having one cigarette a day is how a scientist would look at it but um and that that is totally different depending on your genes and how you react to cigarette smoke and toxins and stuff like that so in itself is is slightly flawed because you just don't know with anything what the effect of something's going to be on the individual but i guess the point being that you don't have to be perfect and no one is i mean i myself probably do about 60 of what's in my own book, which isn't that high. And why that doesn't matter so much is that if we go back to the very beginning

of this conversation and you asked me about my tips, just doing hydration better will make you feel X percent better. So that's one out of about maybe 10 things that come up from your health loop do you know what i mean so actually it's that whole drawstring effect the more you can do the better you feel and there is a threshold and you know you might say to me well hang on what's in your health loop now and what are you doing well at the moment touch would not not very much sleep actually is definitely not, but as in I need to address

it. It's not that I don't sleep well, I'm just getting to bed late and that's having an effect on me craving certain foods and all that sort of stuff the next day. So I do need to do some work, but the time I'll really pay attention is when things slip a little bit more and I think, hang on a sec, I really need to kind of you know think about my environment you know environment's a massive piece you know and a lot of people don't realize that they've got a load of mold in their bathroom which is making them cough or whatever you know there are things that will just pop out so so yeah balance is really key yeah you can't do everything perfectly and you know i i it's not it's not possible because none of us are perfect.

Yeah, I think that's a really important message, actually. I think it's very empowering for people because all of us are bombarded with more and more things that we could do. And I'm very, very aware of this. Having a health podcast, posting regularly health tips on social media. I'm aware of this, that there's a lot of information out there. You don't have to do it all. Coming back to the health loop again, just to reiterate, I think what's great about it is it will help you identify which area

do you need work in. So for example, if you're already moving your body well for you in the context of your goals and the context of your life, yeah, you can see a new Instagram post from someone about the benefits of this latest exercise or this machine or that and go, yeah, okay, great, but I'm okay in that part of my health. I don't need to worry about that. I can read it. I can enjoy it. I can absorb it. But that's not for me right now. What is for me are these two things that I've identified, which I think is really powerful. And in that example that you mentioned a few friends who lives overseas. You know, it reminds me of a couple of patients who I saw in the past who would have a sugar

in the coffee on a Sunday morning. But I remember thinking, hey, you know what? You are thriving. You've made all these phenomenal changes. Your diet is absolutely incredible now. You move made all these phenomenal changes. Your diet is absolutely incredible now. You move regularly, you're sleeping well, but your vice, if you will, is this cappuccino on a Sunday morning with one sugar in it. And again, like you said, I'm not encouraging people to do this, but I do think sometimes we need to take

a step back and go, well, in the context of everything else in that person's lifestyle, is this really a problem? And for this particular individual, it really wasn't. Do you know what I mean? It was almost, potentially, it was the vice that allowed everything else to work. And that's real life medicine. That's kind of getting away from the textbooks and the ideal stuff and the scientific research papers. It's like, well, this combination is working for this person. And I think this is a pretty good place to sort of start finishing off this conversation because I feel that's what your book does so brilliantly, I think, is it helps people personalize the changes that they need to make, that they want to make.

They're empowered to kind of do it for themselves, right? It's not like, oh, follow this because I've told you to do this. It's a very different approach, which I think is going to be much more effective for people. Yeah, I think, you know, I really do hope it does that, you know. I mean, in essence, what the book does is it takes you and your life, you know, not anyone else's, you as an individual, all the elements of it. And this is why it's all about understanding yourself, you know, not anyone else's, you as an individual, all the elements of it. And this is why it's all about understanding yourself, you know, and it lays out anything that might need

addressing through the health loop. You think about your typical day, you lay out your timeline, which looks at your past medical history and your life to date. And then you look at the bits that jump out from the health loop and apply how, what and when, if that needs doing. There are other tools in the book called Drill Down and Diary Up. You may need those, you may not. And what that all enables you to do is write yourself a lifestyle prescription. you to do is write yourself a lifestyle prescription. And that is just a very simple list of things that will change your health for the better, given what you've already done with

all this info that you've got. And that's it. Really simple. Simple, but very, very effective. I think you did a fantastic job with the book. I think it's going to help so many people. People want to follow you online. Where would you direct them to? Instagram, Twitter, LinkedIn, and Facebook. I've got a Facebook page as well. Okay, fantastic. And you've also got a podcast. You want to tell anyone about your podcast? Oh, definitely. Well, the podcast really is what this book does, think and the podcast is called saving lives in slow motion and it's a bite-sized podcast which is just me there's no guests and it's like 10 to 15 minutes on various topics that kind of affect us in our lives and i think will be interesting and uh final question um a lot people, as you've hinted at

throughout this conversation, are really struggling. People are struggling with stress, the state of the world, the state of their own lives. We've covered so many tips today. There's a ton of tips in your book. But if you were going to leave people with one final tip, one thing to think about what would it be i would say just be in the moment live in the moment in the now and savor everything that you're doing

because life's short and you just don't know what's going to happen tomorrow hey that's coming on the show. Thanks for having me. Really hope you enjoyed that conversation. As always, do think about one thing that you can take away and start applying into your own life. And I'd also highly recommend that you check out Ayan's brand new book, The Health Fix, Transform Your Health in 8 Weeks.

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