Feel Better, Live More with Dr Rangan Chatterjee - The Truth About Sugar, Alcohol, Caffeine, Protein & Exercise with Neuroscientist Dr Tommy Wood #404

Episode Date: November 22, 2023

This extra special – and slightly different – episode of the podcast is for anyone who’s ever felt confused about best practice for good health. If you’ve wondered which diet is the best one for your health, or if you are confused about how much protein you should be consuming - or whether a little bit of alcohol has any health benefit at all - then I have just the guest for you.  Dr Tommy Wood is Assistant Professor of Paediatrics and Neuroscience at the University of Washington, US. He holds a degree in biochemistry from Cambridge, a medical degree from Oxford, achieved his PhD in physiology and neuroscience in Oslo, and has published papers and lectured across the globe. It’s fair to say that when it comes to health and longevity, Tommy knows what he’s talking about. And that’s exactly why I invited him back onto my podcast for the third time.  He, like myself, is passionate about empowering individuals to take control of their health by simplifying the wealth of information that exists and giving people practical, realistic recommendations. In today’s conversation, Tommy and I work through a list of common areas of confusion when it comes to our wellbeing. And together we try to put the received wisdom in context, summarise the evidence, and then give nuanced, practical advice. We begin with alcohol, and Tommy explains that while there are no proven health benefits to drinking it, there are caveats. And that becomes a theme for this conversation. Nothing is all good, or all bad - context is always key. Next, we cover caffeine and its effect on performance, cognitive function, gut health, stress and, again, sleep. Then we dive deep into the hot topic of sugar, ultra-processed foods, continuous glucose monitors (CGMs) and other trackers. We go on to tackle protein, the minimum effective dose for exercise, the importance of building muscle, and the supplements we might want to consider taking. And for every subject we cover, Tommy exposes the common pitfalls in research methods and tells us what the science can show, but also what it can’t.    There are so many mixed messages out there when it comes to our health. Our hope is that this conversation offers a valuable lesson in critical thinking and context, and highlights the importance of taking a personalised approach to your health.  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://exhalecoffee.com/livemore https://drinkag1.com/livemore Show notes https://drchatterjee.com/404 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. Never disregard professional medical advice or delay in seeking it because of something you have heard on the podcast or on my website.

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. This week's episode is a little bit different to normal. If you've ever felt confused about the best practices for your health, for example, if you've ever wondered which diet is the best one for your health, or if you're confused about how much protein you should be consuming or whether a little bit of alcohol has any health benefits at all, then I have just the guess for you. Dr. Tommy Wood is Assistant Professor of Pediatrics and Neuroscience

at the University of Washington. He holds a degree in biochemistry from Cambridge, a medical degree from Oxford, achieved his PhD in physiology and neuroscience in Oslo, has published multiple scientific papers, and has lectured all across the globe. It's fair to say that when it comes to health and longevity, Tommy is someone who knows what he's talking about. And that's exactly why I invited him back onto my podcast for his third appearance. Tommy, like myself, is passionate about empowering individuals to take control of their health by simplifying the wealth of information that exists

and giving people practical, realistic recommendations. Now in today's conversation, Tommy and I work through a list of common areas of confusion when it comes to our well-being, and together we try to put the received wisdom in context, summarize the evidence, and then give nuanced practical advice. We begin with alcohol and Tommy explains that whilst there are no proven health benefits to drinking it, there are of course caveats and that becomes a theme for this entire conversation. Nothing is all good, nothing is all bad. Context is always key. We also talk about caffeine and its effect on performance, cognitive function, gut health, stress and sleep. We dive deep into the hot topics of sugar,

ultra-processed foods, continuous glucose monitors and other health trackers. We tackle optimal protein intakes, the minimum effective dose for exercise, the importance of building muscle, and the supplements we might want to consider taking. And for every subject we cover, Tommy exposes the common pitfalls in research methods and tells us what the science can show, but also what it can't. There are so many mixed messages out there when it comes to our health. Our hope is that this conversation offers a valuable lesson in critical thinking and context and highlights the importance of taking a personalized approach to your health. There's a lot of confusion out there around health. One minute we hear something's great

for us and next week we hear something's bad for us. And I don't think it needs to be as complicated as it sometimes might appear to be. So my hope today is that we can help people cut through the confusion. Sounds fantastic. Yeah? Yeah. Alcohol. I thought we start with alcohol. Okay. Is there any benefits for our health when we drink alcohol? No. But as with everything, and I imagine most of the topics we'll talk about today, there are always caveats. So if you look at hard health outcomes, there's some mixed results and mixed research and what previously we thought was that moderate alcohol consumption so within say the alcohol guidelines um was associated with with better health outcomes overall so not drinking alcohol

is less good for your health than drinking some. When you then sort of break out the different health conditions, you might see that a small amount of alcohol intake or regular alcohol intake is associated with lower risk of cardiovascular disease, but then that's balanced by a slightly higher risk of certain cancers. So overall, if your main outcome is say, how long do you live? There doesn't really seem to be any effects of alcohol, either beneficial or negative

in terms of moderate consumption. If you try and then figure out, well, what's a safe amount to consume? There are several studies, and me, I'm particularly interested in the brain, so there was a recent study that looked at brain volume, so the size of people's brains, which decreases over time.

That's associated with risk of cognitive decline and dementia. And a drink once a week seemed to be just fine, but beyond that, you maybe start to see some detrimental effects. Are you saying there, Tommy, that our brain volume will decrease over time as we get older, but that more than one drink a week, potentially one alcoholic drink a week, increases that? So when you look at these kinds of data, they're generally not longitudinal, as in they don't look at the same person over time what they do is they look at people across ages and across levels of drinking and at one snapshot in time they say how much do you drink and what does your brain look like oh so it's not the same person it's not the same person so we kind of so we cannot say that um alcohol is the driver here

when you do this kind of epidemiological research we call it an association right this amount of So we cannot say that alcohol is the driver here. When you do this kind of epidemiological research, we call it an association, right? This amount of alcohol is associated with these changes in the brain, but we don't know if it's truly causal. We can adjust for a whole, but that's what we do with statistics. We adjust for other things

that may be accounting for that. And then we think whatever's left is a signal. So I think that there are a few studies that basically suggest that drinking one or two drinks one or two times a week is probably fine. But anything above that, there's certainly no benefit and then it may be detrimental to our brain health and our other health.

The other side of that though is that often people drink alcohol in social situations and that if it's helping to facilitate social connection and it means that you're going down the pub with your mates and you get to spend time and talk with them, that probably offsets some of those effects. So it's not always black and white, good or bad. But higher levels of drinking than that

don't seem to be associated with improved health and maybe associated with worse health. But drinking some amount is probably just fine, but then context and other things are going to be important as well. Yeah, I think you've brought up some really interesting points. And it's kind of one of the reasons I wanted to have this conversation with you is to try and bring that context and nuance that I think is often lost in the conversation around health these days. You know, everything's either good or bad, which diet is best, you know, is alcohol all good or all bad? It's like, well, hold on a minute. It kind of depends. And I agree that it's pretty hard to make a case that there's a physiological benefit to consuming alcohol but I think we also have to acknowledge that many cultures have managed to drink small

amounts of alcohol now and again in the community absolutely and they seem to have high rates of longevity and minimal disease so it's like everything everything is balanced, right? And you can look at the blue zones, for example, which are front and center of everyone's mind at the moment, because of the Netflix show. And I know there can be some debates on various things in the blue zones, but I think one thing we can say is that many of these populations, they do drink alcohol, but they're also doing a lot of other things do drink alcohol, but they're also doing a lot of other things very well that may counterbalance that, like low stress, nutritious foods, strong sense of community, and all these things. So, yeah, if we say, though, what are the negatives, if we're really trying to address,

okay, for someone who does drink, let's say, more than that one drink a week and goes, well, I feel okay, right? You know, I think I'm eating well, I'm moving my body well, you know, but you're saying more than one drink a week may be problematic. How would you have them think about that? You know, are there some key things, for example, you say, well, just watch out for these three things because this is what alcohol consumption can do if you're not careful. It's really difficult to tease that out at those very moderate levels, you know, within, say, government alcohol guidelines, right? Because it's going to be very subtle, and you may not, there may not even be something that you can, you know, put your finger on and say, that's

definitely something that you need to watch out for um when you talk about the blue zones they may you know some of them they may drink red wine every day but in general portion sizes are much smaller than we would consider a glass of wine say uh in the uk so it's probably even more moderate than we might think and of course all the other things that you mentioned uh come into play so one one thing that i see very frequently is people really don't want to give up alcohol and and i and i'm not here sitting saying that you should of course you know i i do i do drink uh occasionally and socially But you might think about what is it that alcohol is facilitating for you? Why has it become a habit if it is a habit? And so if it's the social aspect,

then actually now it's much easier to get non-alcoholic cocktails, non-alcoholic beers. You can still go out and you can have that that same kind of ritual with your friends or with yourself that gives you that feeling of relaxation even though there's no alcohol involved so you can get all of those benefits you can still feel like you're getting that de-stressing the end of the day with like a beer in front of the tv or something like that um all of that is still is still possible um and so you can think about maybe replacing those things in occasionally. And then it's also worth thinking about often when people

sort of fight against the idea that maybe they may be drinking too much. Often we hear about that it's like they're bargaining. Oh, but I do all these other things. So isn't it okay that I drink alcohol? And I'm not here to judge one way or the other, but it's just worth thinking about. Are you trying to find ways to justify it? And if you are, then that maybe signifies that it's worth thinking about even deeper and maybe considering some alternatives. Yeah, I really like that approach. One thing I think about with my patients who are in this conundrum is I always talk to them about their sleep because I think alcohol for many people

disrupts their sleep and often they're not aware of it. You know, if they get this sleep fragmentation, they're waking up multiple times in the night, they don't always know that. They just know they feel tired the next day. And I found that some people don't always put that together with alcohol the night before. So I know with certain patients I've said,

why don't we try a week without? Just see how you feel. And sometimes I go, wow, I've got so much energy and I'm sleeping better. And then that's empowerment because I'm very much like you, Tommy. I don't really want to tell people what to do with their lives.

I don't think it's my place to. And I think alcohol now is becoming, again, a big thing that we're talking about in the public health arena for good reason, because many people do have a problematic relationship with alcohol. But I think we've got to be very careful it doesn't go to nobody should be drinking ever. I personally don't really drink much anymore. I don't think I've had an alcoholic drink in maybe four or five years now. I have no ethical or moral problem with people who do at all. It's just in my own life, I found I got to a point where I just don't need this anymore. Like it's not doing anything for me. And I prefer the way I feel without it. So yeah, I don't know anything

else you want to add on alcohol perhaps? my own personal experience i noticed that it affect negatively affects my sleep that's one of the reasons why i don't drink very regularly you know maybe once a month or something because i certainly feel less well rested the next day it affects your temperature regulation so you like like hot during the night or other things you just don't feel as rested. So that's certainly a nice in, because I think that's something that people will appreciate, that that's going to be important, and they'll notice the difference. And may I ask, given that you know it affects you negatively, because this is the funny thing about alcohol, I think,

we all know, I know when I was drinking, that you're going to not feel good the next day, or you're not going to be your best self the next day, yet we still do it. So I guess it's a bit of a personal question, but given that you know all that, and I kind of, I'm asking this just for the purpose of asking it rather than, you know, trying to highlight anything because, you know, we're all human. Given that you know, it's going to negatively affect your next day, what goes through your mind before you actually consume it?

So I've, historically, I've struggled with a lot of these things around alcohol. I had what some people might have considered disordered eating a long time ago and being very hyper-focused about the quality of the food that I ate and what I ate. And so it's taken me a long time to work on some of those things. And in reality, I've gotten to a point where I'm, where if I have decided to do it, then I lean into enjoying it. So if I'm going to eat this cake, I'm going to enjoy this cake. Like this is, you know, all and all the reasons why, why I'm eating it. Just like, if I'm going to have a nice cocktail, I'm going to make sure it's a it's a nice cocktail i'm really going to enjoy it i'm with my

friends i'm having a nice dinner so i really lean into um the enjoyment factor because the the alternative is spending hours then worrying about the thing that i ate or the thing that i drank and how that's going to affect my health and that worrying is probably worse than the eating and drinking itself so i embrace embrace the positive sides of it because it's usually a social aspect or some other thing. And then I think that's how I approach it. Yeah, love it, Tommy.

Thank you for sharing that. Okay, let's move on to caffeine. Okay, there's plenty more I could do on alcohol, but I think I'm going to try and discipline myself to keep moving through topics today. Caffeine, good or bad for our health? Yes. As ever, I think this is going to happen several times.

The answer is it depends. There's certainly, if we go back to the epidemiological observational evidence where you ask people how much coffee they drink, and then you look at their health outcomes, it seems like drinking up to, you know, three or four, maybe more small cups of coffee. So probably like one or two of my cups of coffee per day is associated with improved health outcomes. And that's liver disease, Alzheimer's disease, then there's certainly no signal of harm, right? So it doesn't seem to be harmful up to those levels and maybe some benefit. Of course, there's no randomized controlled trials of coffee drinking that show that definitively.

But there does seem to be some potential benefit there. And there's lots of polyphenols and other things in in say coffee for instance or tea could you just explain what a polyphenol is for someone who doesn't know yeah so these are the compounds often they're colorful that make up these beans or berries and it's the same they're in the same class of compounds that make like blueberries blue but they have coffee has its own compounds like that that seem to affect our gut microbiome uh they affect our vascular health and there are randomized controlled trials actually on some of that they extract those polyphenols out and they give them to people and look at their cardiovascular function or their you know their uh the health of their

blood vessels or their cognitive function and they seem to be beneficial so um those are the health of their blood vessels or their cognitive function, and they seem to be beneficial. So those are the kinds of things that are coming along for the ride with caffeine. But sometimes when you look at the research, like decaf coffee, for instance, has some of the benefits, but maybe not all of the benefits of caffeinated coffee. But again, you have to think about, well, what kind of person drinks decaf versus regular coffee? And it's probably the differences in those people that's driving that rather than the caffeine itself. So I think there's definitely a signal that some caffeinated beverages may be associated with improved health outcomes. And that's probably because some of the compounds that come along for the ride in those, both tea and coffee separately. But then you have to think about the other side. So what are the things that caffeine can

potentially negatively affect the most obvious one is sleep and different people have different abilities to metabolize caffeine so there's a gene that that affects how fast you metabolize caffeine and anybody who's done a genetic test will have probably gotten that on there and know if they're a fast or slow metabolizer. And there's some early evidence that suggests that people who are slow metabolizers that drink a bunch of caffeine may be getting some negative effects of that just because it's hanging around in their system for much longer. But you probably know that a little bit about yourself anyway, or a lot of people do. So I know some people who are very sensitive to caffeine, right? They have any at all and they're awake for 24 hours. They can't sleep. Whereas others, and then again, it becomes, you know, you don't know what's habit versus real, but some people who say,

I can drink caffeine late at night and it doesn't affect my sleep at all. We don't really know if that's necessarily true, but it's certainly, there's some good evidence from randomized controlled trials. There's a meta-analysis that came out in the last year or two that looked at caffeine intake and it can affect sleep architecture and how much sleep you're getting. Negatively. Negatively, yes. So then it's just a case of making sure that you're timing your caffeine relative to your sleep so it doesn't negatively affect your sleep um so for me i try not to drink caffeine after midday because there was this period of time where i was having coffee

you know every night and you know we're in the lab or and everybody's drinking coffee in the late afternoon this is very i did my phd in in norway and it's very normal to have a cup of coffee at four o'clock in the afternoon or something. I couldn't figure out why I couldn't sleep. And then sort of tinkering with caffeine timing, that made a really big difference. But that's going to be very personal from person to person, like how much it affects them. The other thing that I think is very interesting about caffeine is how it affects cognitive function. And if you're doing very simple tasks or you're very sleep deprived, caffeine does seem to be beneficial. But if you consume a lot of caffeine, it can actually negatively affect your cognitive function, particularly on complex tasks. So it might

improve your action time. But if you had to think through some complex task, and they do this in the lab with like, complex executive function, like how fast can you interpret this diagram? Or how fast can you like reel off these different things? Having a bunch of caffeine in your system can actually make you perform worse. And it's interesting, because people think they're performing better, but they're actually performing worse. So caffeine, like improves your mood, which we know it does, but it doesn't necessarily improve your performance. Yeah, it's so interesting.

There's quite a few things to pick up on there. First of all, genetic testing. I like the theory behind the genetic testing of fast metabolizers and slow metabolizers. But what I've seen with certain people and experienced myself, I think I am a fast metabolizer genetically, but I'm exquisitely sensitive. So I'm like, wait a minute,

the genes are saying this, but I can be, I've got to be very careful with my caffeine intake, both in terms of dose and timing. For many years, I won't touch caffeine after 12 o'clock midday, won't touch caffeine after 12 o'clock midday, unless there's some, you know, I'm tired and I'm driving, right? Or I really need to get through, knowing there may be a consequence that evening as well. But for whatever reason, I need to get through something. So that was the first thing to comment on.

And I'll just quickly respond to that by saying that whenever you think about any part of a biological system it's not just one thing that's important right so um your caffeine metabolism will tell you how far like which should tell you on average how fast you'll clear it but caffeine attaches to a receptor so it's an adenosine receptor antagonist so there's going to be polymorphisms in the receptors. There's going to be differences in how you then respond to caffeine binding to that receptor and what happens in the cell. And that's going to be different from person to person as well.

So yeah, you're right. Just that one thing isn't going to be enough to tell you exactly how you're going to respond to caffeine. Yeah, and I think also something I'm quite passionate about, whether it be alcohol or caffeine, is I've noticed with patients and myself that the kind of stress load in your life also can play a role here. For example, I remember when I did used to drink, not to excess, but if I'd have a glass of red wine or a beer in midweek, let's say after work, sometimes I wouldn't sleep so well. And you'd

feel it the next day, maybe one or two units of alcohol. But the same amount when I was on holiday, I wouldn't feel a thing. It could be different alcohol, but it was kind of similar. And I really thought about this. I thought, well, my stress load is right down. I feel I've got a lot of headroom psychologically and mentally as well. And I think, you know, I really think about this idea that I don't think we can completely separate biology and psychology. Like, I do feel there's something about that. So if you're really, really stressed and you're using caffeine to get you through, I don't know, I really sort of believe there'll be

a different impact if you're very relaxed and drinking it. Yeah, and caffeine partly activates the sympathetic nervous system, which, you know, the stress fight or flight side of your nervous system. So if you're adding, if you're pouring that on top of a whole bunch of other psychological stress, of course, there's the potential for greater negative effects. Like the context is important as well, absolutely. Did you ever see the study, I think it was in 2011 from the University of Bristol,

where they looked at caffeine drinkers and they tried to really answer the question from recollection, does caffeine really enhance performance and enhance our cognition? And the conclusion of that study was, if you are a habitual caffeine drinker, then yes, consuming your caffeine in the morning does raise your mood and cognition,

but only to the level of where non-caffeinated drinkers are all the time. And I find that really interesting because it kind of makes sense to me that for a lot of us, that would be the case if we, because in the past I have quit and I haven't had it for a few months. And I'm like, I feel great all the time. Even I don't need a morning cup of tea or coffee, but I do enjoy it. So what is your perspective on that? And then how does that fit alongside the fact that athletes, for example, or I know you working for me, the one, for example, so I don't know if you encourage your drivers to maybe have caffeine or not. So that's a very well cited study, the one that you mentioned. I think that's probably right, is that a lot of that first

caffeine boost is just making up the caffeine deficiency that you've generated because you're so habituated to it. That takes you up to sort of like your normal baseline um and then you can you can wean yourself off within a couple of weeks and that that effect goes away um the i think the formula one drivers it's very different from from driver to driver but something that i've noticed over the years actually fits very well with what i was saying earlier. So there are multiple components to performing well in that environment. But if you think about the beginning of a Formula One race, there are two things you want to do. You want to get off the line as fast as you can, and you want to navigate the first corner while 19 other cars are trying to do the same thing.

while 19 other cars are trying to do the same thing. So caffeine, and this is based on the work of Yerkes and Dodson, which looks at how your arousal level and your performance of tasks. And there's this classic arousal curve, which basically says that the more aroused you are, the better you perform up to a point where greater arousal is basically more anxiety and more stress and then your performance goes down. And every sport has its own sweet spot for arousal. So if you're a sprinter in the blocks,

your optimal arousal level is very different from a snooker player, right? Or an archer, even in the even in the olympics right so that's why um they banned beta blockers which sort of calm down your nervous system in those sports where you want to be like very calm like like archery say or or some kind of shooting or snooker um i think used to in the 80s i think even they drink whilst playing snooker because it would calm them down. Exactly. For that reason.

So they're adjusting their arousal curve. But something like caffeine will improve your performance in a simple cognitive task or a simple task. So particularly, the thing that they measure is reaction time. It's often called a psychomotor vigilance task. So if you want to get off the line fast in a Formula One car, caffeine is great. But what happens is that you can get to a point where your caffeine dose is so high,

it will then affect your ability to navigate the first corner, which is a much more complex cognitive task because you're trying to figure out the direction you're going plus where all the other cars are. And so you can caffeinate, you want to caffeinate yourself to the point and not all drivers use caffeine. This is like some find some benefit

from small doses at the right time. But you want to improve your reaction time off the line, but you don't want to negatively affect your ability to then navigate the first few corners of the race. So there's a really fine line in terms of that arousal curve and i've seen that in action in formula one drivers so i just think it's really interesting yeah absolutely fascinating even that idea that different sports have got different times where you want to peak yeah and i guess then taking it back to a non-sportsman well we've all got different things in our lives that are important to us and

different times in the day when we want to peak, right? So, you know, again, what's the right dose for you? What's the right time for it? Which I guess comes with experimentation and just trying to bring alcohol and caffeine together and sort of close them off. I guess what you're saying, and I would agree with Tommy, is that there's pros and cons and we need to figure out what works for us. And if, for example, you really enjoy your caffeine and it has no seemingly negative effects on your mood, your anxiety levels or your sleep, and even if you accept that drinking it might just bring you back up to the level that if you didn't drink it, but you get so much enjoyment out of it, you know, I love a good cup of black coffee in the morning for sure. Then it's probably worth it. But if you enjoy it and love it, and it's giving you palpitations and anxiety, and

it's trashing your sleep and you're moody and reactive with the people around you, you might want to rethink about your relationship with it, basically. So it's not black or white. When you sort of bring them together, I think if you think about our collective modern lifestyles, that's a phrase that you use, what often happens is that you'll drink at the end of the day then you'll need to you won't sleep very well you'll have to drink coffee all day

because you're sleep deprived and then to wind down you're going to need alcohol at the end of the night so they they often reinforce one another and so again it's just worth thinking about how is it affecting you is is there is it possible that there's this sort of perpetuating a cycle of one another that you can somehow try and break? And if it's not negatively affecting you, you're still performing well, you feel good, great. Neither of us would recommend that you change anything. But it's possible that they can go hand in hand in that way as well. Yeah. And the whole point of this conversation, Tommy, and I think for me, you're the perfect person

to have this conversation with, is there's too much of, in my view at least, is it good or bad? Yeah. You know, you can't really answer that question. And hopefully,

certainly for alcohol and caffeine, hopefully we've given people a few things to think about. What about sugar? Just taking a quick break to give a shout out to AG1, one of the sponsors of today's show. Now, if you're looking for something at this time of year to kickstart your health, I'd highly recommend that you consider AG1. AG1 has been in my own life for over five years now. It's a science-driven daily health drink with over 70 essential nutrients to support your overall health. It contains vitamin C and zinc, which helps support a healthy immune system, something that is really important, especially at this time of year.

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is sugar intrinsically problematic for us or is it more the volumes that we're consuming? Of course, I think it's the latter. It's both the quantity and the context of it. And there's been a lot of interest in terms of, so basic sugar, sucrose, which is 50-50 glucose, and fructose. It's a disaccharide, which just means two sugars bound together. Fructose has really come under the microscope recently because it can affect our uric acid levels, which is often used as a risk factor for gout, but it's often used as like a sort of marker of our metabolic health. And fructose can affect cellular energy levels if it's, you know, in the way that it's metabolized and it can be quite intensive on the cell, particularly in the liver. What does that mean? Cellular energy level?

Yeah. So inside the cell, we have this energy currency called ATP. And in order to metabolize fructose, we end up using all of that within the cell. And you can get to this point where it's almost a stressor on the cell in order to metabolize it. And that's maybe one of the reasons why fructose is an issue for some people. And it's certainly high amounts of fructose consumption and or sugar, which is 50% fructose, can increase the risk of things like fatty liver. Fatty liver disease, which is 50% fructose, can increase the risk of things like fatty liver, fatty liver disease, which is increasingly common. Although the other side of that is that there are potentially other nutritional deficiencies that are affecting your risk of that as well, particularly choline, which is important for packaging fat out of the liver. And if you don't have enough of that, then the liver can accumulate fat with high amounts of sugar. But in reality, when I think about individual food components,

and there are several other things that we could talk about that are controversial in addition to sugar, but it's really the context of the sugar that we're currently consuming. And like you said, the quantities of it. I like to think that the majority of our diet should be minimally processed and nutrient-dense foods, so they support the function of our bodies. And other than just being a source of energy, there's nothing else in sugar that's really beneficial. So if you're consuming a large proportion of your calories from sugar, So if you're consuming a large proportion of calories from sugar, you're not consuming foods that have nutrients in that are then important for doing everything else. And that's really the same with all ultra-processed foods or highly processed packaged foods.

They're generally nutrient-poor, calorie-dense. They negatively affect our ability to understand our hunger and satiety signals. And we know that we over consume them because they're hyper palatable. We much more of them, we would have something else that's less processed and people get into the issue of what processing actually is or what processing means. And so like the definition of ultra processed foods basically means that it's highly refined and they've usually added additives fillers and things like that in order to keep it shelf stable so you can just like stick it in a packet and it can stay there for for months or years on end yes yeah um and so i don't particularly ever focus on sugar individually uh because it would be very easy to remove sugar but you just replace it with

some other highly processed food that is is you know is going to have the same effects because it's out competing more more nutritious foods so in general i would think about the entire dietary pattern because there's there's no evidence that some sugar is detrimental to our health, really. What do you mean by that? Because some people are going to go, what do you mean? Wait a minute, I thought sugar was bad for me. So when you say there's no evidence that some sugar is detrimental, just expand on that a little bit. Yeah. So in general, if you are eating within your caloric requirements and you're otherwise healthy then consuming some sugar doesn't really seem to have a negative effect right it's a source of energy um there's no real reason to assume that you know a large part of our metabolism runs on

glucose when we metabolize fructose which is the other half of sugar it gets turned into glucose it gets used as an energy source so if you're in otherwise good health and you're eating you're consuming enough of the nutrients in general from your diet there's no reason why sugar should be detrimental it's when it then becomes the major source of energy and you're not getting all these other things that we might need from our diets so when usually when people cut out sugar what they've done is they've dramatically improved the quality of their diet because they're eating other things now um so i'm not i'm not uh exonerating sugar in itself but i think that focusing purely on that doesn't really tell us the greater story of what's the overall quality of your diet and what's the overall sort of balance of nutrients

you're taking in and fiber and and and other things and i think again it's that point of context and what else is going on in your life kind of influences whether sugar is a problem for you or not. And it's interesting, you know, Mark Sisson, would you call him a paleo guy or, you know, primal, primal, primal. Yes. And Mark, for people who don't know Mark, I think he's just gone 70 years old. He's in fantastic shape, fantastic shape, Eats a very primal, ancestral way of eating for a number of years. He's been talking about it, promoting it. But if he ever tweets about the fact that he will,

I think he enjoys sugar in his coffee each morning, like one spoon of sugar. Oh my God, people go nuts on it. And I would imagine that that really speaks to exactly what you're saying, that 90% of his diet is really good. Whole foods, nutrient dense. He's fit and active. He moves his body every day. He looks after himself. In that context, one small spoon of sugar and a coffee each day is probably not an issue, right? In that context, someone else Yeah, absolutely. Someone else who, let's say,

has a highly processed food diet, eating to excess, not because they're lazy or gluttonous, because they struggle. We all struggle, right? In that context, they may find that sugar or the amount of sugar in their diet is problematic.

Is that another way we can look at this? Yeah, I think so. And some of it can also be you know there's a big debate in the scientific world as to whether sugar is addictive or not and you'll have people who have some uh some evidence on both sides and sounds like most things like most things and i would say that i'm i'm not really sure i can in some people who consistently overeat they do you know get a large activation of reward centers in the brain when they eat sweet things. Whether that's the same as addiction is very difficult to

really pass out, although some people certainly have very problematic eating behaviors, and that's its own psychological disorder that requires specialist intervention. but you're right that when we think about how we respond to certain foods uh part of the problem and with the processing is that and so when you're taking refined sugar um you've extracted it from sugar cane or sugar beets you've taken it or you know we're as a species we very regularly have consumed sugar either from honey or from fruit right and nobody would tell you that eating an apple is going to be bad for you even though you know there's a few grams of sugar in there well some people would these days actually but generally that i that i

think we can say is i'm confident saying that's not correct. But when you process foods with industrial modern methods, you divest the calories from their context. And so... Divest is a big word, Tommy. Sorry, what's another word for that? You separate them out, right? So say we're historically evolutionarily if you did eat some fruit you eat some sugar and that it comes in this context of

water and fiber and all these other things and there's the body expects some context for that sugar um in terms of and then how it affects your physiology and your hunger signals and stuff like that afterwards when we process those foods and strip them out the response that you get physiologically is no longer the same from the same amount of of that food so they've done this with um various grains right if you take a whole grain grain, you could cook and eat a handful of pearl barley, say. You know, it's minimally processed. That's how it looked on the stem. It's still got all the fiber, all the context. And then you look at how that affects your blood sugar. It probably has quite a small effect on your blood sugar. If you then take that same thing and you cook it and you grind

it, or you grind it and you cook it and you turn it into a paste or you turn it into bread, it has a much bigger effect on your blood sugar. It's exactly the same thing. But what you've done is you've changed the context of the food and then that affects how your body responds to it. So you're no longer getting macronutrients, like things like carbs and fats or protein in the context that our bodies are used to getting them. And so that's where it starts to become problematic. So when you create processed foods, you might add sugar to something

that doesn't normally have sugar in it. And then that makes you want to eat more of it because you've started to create, and that's the idea of creating hyperpalatable foods. So even savory foods have some sugar in because you start to activate different receptors. You start to then drive a greater likelihood of overeating them. So that's where it starts to become problematic. So let's say the population we were looking at was all healthy. Everyone was of a, you know, a healthy weight in inverted commas. They were metabolically healthy. Then in that context, of course, which isn't the context we're living in today, certainly

not in most countries around the world these days. If that was the situation, then sugar here or there in our tea or coffee or whatever, you know, a sweet treat if you want. And I'm not convinced, I love the word treat, but I think people know what we mean when we say that, you know, a sweet treat if you want. And I'm not convinced I love the word treat, but I think people know what we mean when we say that, you know, maybe once a week or once a fortnight or whatever, you know, or whatever you choose to do may be okay. How does that though sit in the context of what we have today? So we know in the US, for example, what is it now? Is it 90% of US adults may have some degree of metabolic dysfunction? And actually the UK and Europe and most of the world are catching up. So

we can't even single out the US anymore. So if we're saying the bulk of the adult population, and it's not just adults, I know, but the bulk of the population, unfortunately, these days have a degree of metabolic dysfunction. So the way they're processing energy in the body is not as efficient as it could be. And that's leading to an increased risk of all kinds of diseases. In that context, is sugar now becoming even more problematic? It's absolutely contributing due to the way that we're using it. But again, I think it comes down to the entire context of the diet. Because you could certainly get to a point where,

say we dramatically reduce sugar in foods, if that then comes with a parallel decrease in overall caloric intake, say, there will absolutely be benefit. But when other people are in charge of creating these foods, you know, these ultra processed foods, those sugar calories are just going to be replaced by something else. And you're going to, you're going to overeat it just as much. And it's not really going to change anything. So I think that if by reducing your sugar intake you decrease your overall caloric intake and you improve your um the overall quality of your diet that's absolutely

going to be beneficial but if that doesn't happen and this this often happens with the way that we engineer foods nowadays is just it'll be replaced by something else and it may not make the same difference so i think it really depends on how that gets enacted if people so if you say that i want to reduce my you know i'm going to focus on sugar and you focus on reducing sugar intake and then with that comes you know you're not eating cakes or biscuits and with that you've dramatically both decreased your you know overall energy intake and improved your diet quality that's going to come with him with health benefits but it's if you then say well i'm not going to have cake but i'm going to have you know an extra serving of

fries instead right there's no sugar in that but i'm not convinced you're not going to get any healthier so it really depends on how those changes then what the knock-on effect is. When we think about sugar, do we need to think beyond just actual table sugar that we might put in stuff or might be added to biscuits and cakes and pastries? Do we also need to be thinking in your view about blood sugar spikes. So for example, one teaspoon of sugar in let's say a hot drink, that probably is not going to have as detrimental an impact or as significant an impact I should say on our blood sugar than let's say a modern healthy cereal or a cereal that's marketed as healthy. When we know that you have a bowl of those, you can have the equivalent of far more

than just one spoon of sugar in. So I think sometimes when we think of sugar, we're not really, and maybe it's the way we communicate as healthcare professionals sometimes, it's not just sugar is it it's also foods that are turned to sugar in your blood so any or the vast majority of carbohydrates will get converted to either are or get converted into glucose which then will at least temporarily increase your blood sugar in response and i think in general that can be normal right we don't want to pathologize that's another fancy word we don't want to like create a disease out of spikes in blood sugar necessarily of course there's lots of evidence that suggests that having better control of your blood sugar is associated with better health outcomes um particularly as you you know if

people go into say pre-diabetes or type 2 diabetes, that's associated with a whole host of long-term chronic health conditions and earlier mortality. So if you can have better blood sugar control, that's in general is associated with better health. And particularly in those populations, if you're somebody who's otherwise very healthy and very active and you once in a while eat something that causes a big big spike in your blood sugar i'm not convinced that's going to have a big impact right it's all about the context like you talked about earlier but you're right that anything that we eat that has carbohydrates in will

will increase your blood sugar um to to some degree and there are there's some evidence to suggest that if you can make that spike lower and you can do that either by the timing of your foods i know you've had episodes on this previously uh maybe eating protein with your foods there are other things you can do to decrease the size of that blood sugar spike and for some people that that that may be beneficial. The problem is that it's really difficult to predict what foods will do that. 10 years ago, you would have talked about the glycemic index, right? So this is a food that has a high glycemic index. That means when you eat it, you're going to get big spike in blood sugar. What we've learned in the last five years is that that just doesn't hold from person to person, right? You can have two people eat the identical foods and one person will get a big blood sugar spike and the

other person won't get any spike at all and then there was there's a recent study it came out it's um it's a pre-print so it's not formally published yet it will come out as soon as by by kevin hall who's done all these very complex metabolic ward studies in the US. And they had these trials where they gave people a fixed menu. And they had a plant-based one. They had a low-fat one, a low-carb one. And the menu would cycle over a couple of weeks. So they would have... And then some of the people in these trials

wore continuous glucose monitors. And then because the menu rotated, they would get a blood sugar response to the same meal in the same person, but a week or two apart. And what they found was that eating the same meal in the same person resulted in completely different blood sugar responses

from one week to the next which just tells us that we don't we we have like right now we cannot predict what foods will uh spike our blood sugar so even if we we have our own i see you're wearing a continuous glucose monitor um that you you can you have to test something out a lot again and again in yourself to see an effect. And even then, there's going to be a lot of variability. So then is that even meaningful or feasible for some people? It becomes really difficult. So I think managing blood sugar is obviously incredibly important.

But right now, it's just really tricky to navigate. And Tim Spector has done some studies uh where they show that a whole bunch of things affect how you respond so it's how did you sleep what meal of the day is it like what's your genetics like have you exercised recently there's a whole bunch of things that affect how we respond to foods and and even in the same person the same meal has has different effects from one week to the next so but i think that speaks to what you said, maybe when we were talking about alcohol or caffeine, that in a biological system, it's very rarely just one thing, right? Because you're assuming that everything else in that system is identical when it isn't.

And we're not the same person day to day. and that system is identical when it isn't. And we're not the same person day to day. Anyone who has worn a continuous sugar monitor, and I think for some people that can be tricky to figure out, well, what does this actually mean for me? I feel I'm quite in tune with my body and I guess it's what I do and I think about this and sort of pay attention a lot.

And I certainly found for me that you can see correlations quite well where, you know, depending on if you haven't slept well, your sugar's higher and the same meal can give you a bigger response. Or if I feel high levels of stress, I guess with everything we're talking about, we've done alcohol, caffeine, sugar, but on ultra processed foods so far as well. about we've done alcohol caffeine sugar but on ultra processed food so far as well are we not more and more moving into an n equals one era whereby we can use science to give us good starting points and ideas but ultimately we're going to have to test these things out on ourselves and go well is this working for me?

I think so. And that's, you know, even going back, say 50 years, this is in a slightly different arena, but looking at elimination diets were once the gold standard for people with autoimmune, certain autoimmune conditions before we invented monoclonal antibodies for these things. And the only way to know if they worked was to change your diet and see how the patient responded. And you would do that individually. And I think that's where we really are at this point. The problem is that, so say if we go back to blood sugar or we stay on blood sugar,

I'm not convinced that the data is necessarily helpful for people. So say, I don't generally recommend that people go out and get a blood sugar monitor. And one of the reasons is that it becomes and i've seen this several times when working with people it becomes incredibly stressful so i'm gonna eat a piece of cake i know that cake is gonna spike my blood sugar i'm now stressed about the blood sugar spike that i'm gonna see because of the cake that i'm that i And we've had people who've come back and just, we didn't really appreciate how much stress,

like the idea of eating and how that was going to affect the data that they see was incredibly stressful to them. So like, is that, at what point does that become harmful? And there are actually studies that show that the expectation of a blood

sugar spike drives a bigger blood sugar spike. So there was a study by Ellen Langer at Harvard where they took diabetics and they gave them a milkshake and they showed them how much sugar was in this milkshake. It was a high sugar milkshake and they saw a big blood sugar spike. And then later on, they came back and they gave them a different milkshake. It was a low sugar milkshake and they showed them that and they had a lower blood sugar spike. And then later on, they came back and they gave them a different milkshake. It was a low sugar milkshake and they showed them that and they had a lower blood sugar spike. It was the same milkshake both times, but they had a bigger blood sugar spike

when they thought that it had more sugar in it. Biology and psychology. Yeah, biology and psychology coming together. So it just, I think that, yes, the N equals one experiment is really important, but I think that rather than like being hyper-focused

on this one thing, which is blood sugar, can you move yourself closer to a less processed diet, right? Increased vegetable consumption. Do I make vegetables a bigger part of your plate or start with a bigger portion of protein on your plate. Both of those are going to come with a whole bunch of nutrients and these other things. And then maybe decrease the portion of whatever it is, whatever refined carbohydrates or something. So I think that overall shifting your dietary pattern is much more important.

And that doesn't need necessarily, unless there are different foods that you enjoy, as much N equals one experimentation. So I think we're at a point where you can, particularly with diet, you can give pretty good advice that's going to work for a lot of people and they don't need fancy tools and they don't need fancy data and they can still make a big impact on their health.

Yeah, I appreciate your perspective on that. And I've always had a real caution with trackers. I guess the argument you're making around CGMs, continuous glucose monitors, I guess we could also make about, let's say, scales, for example, and weights. And I kind of feel a lot of this becomes personality dependent, whereby for some people, scales and their weight becomes incredibly obsessive and becomes problematic. And then for others, it's like, yeah, they can check once a week and, yeah, I'm going in the right direction. I've mentioned, I think, before with you that I saw the same thing with blood

pressure monitors, which aren't like modern tech necessarily, but for half the patients, it was great. For the other half, it was anxiety inducing. I guess where I see CGMs as being different is I kind of feel that they give a real, and I totally agree, they can be overdone. I think if you've got a history of eating disorders, you've got to be very cautious. Probably not the right approach for you. But in the context of a population, as we say, maybe 60, 70% of the UK, maybe 90% in the US of the population having a degree of metabolic dysfunction. I think in that context, I personally believe we have to be open to tools that are going to help people

because we've been asking people to make these choices for years. And I feel that we're still struggling. And a lot of that's because of our food environment, I know. But I don't think I've seen a better tool, Tommy, in over two decades of practice now, where I don't think I've seen a better tool that helps people start to change their diet in a meaningful way than a cgm i don't think everyone needs them but i would say from my own experience with people and also myself i found them to also to be very very helpful so that would be what i would say in response so i think we have maybe a slightly different perspective on this which is okay as well yeah absolutely and there are studies in type 2 diabetics that

and again early small studies suggesting that having a cgm improves their adherence to um say a dietary intervention or dietary recommendations so so absolutely sometimes that can you know give people some accountability and help drive some behavior change um and it's with like let's say a step count on your watch or your phone. For some people, it works great. And it motivates them. I didn't get my 7,000 today. 7,000 is my target. So I'm going to go for, I'm only at 5,000. After dinner, I'm going to go for a walk around the block. But for other people, it becomes an obsession and problematic. So I think, again, you know, relaying this to alcohol and caffeine and sugar, I think it depends a lot. I do think we

can overdo these things. As I think I mentioned last time, I did wear an Oura ring a few years ago, but I haven't worn one in years now because I learned what I needed. I get it. If I eat near bedtime, sleep quality goes down. Okay, great. If I saw a few other things and I don't really feel I need it anymore, I learned what I did. And I kind of feel for some people, like you wear a CGM once for two weeks and you have your regular foods and you were like, I had no idea that that does that to me. I had no idea. I think for some people, that's all they ever need. So yeah, this will be continued, I'm sure, as we see this evolve over the coming years. Protein. I think there's a lot

of confusion about protein. And there's a lot of talk in the longevity space about the optimal amount of protein that you need for your muscle mass, which is important for longevity. And I don't disagree that muscle mass is important for longevity. There's also advocates for low protein diets. And I think this is one of those areas where there's a lot of debate about, and I think it leaves people feeling confused. So how do you view protein and what kind of recommendations do you make to the people that you see? 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? teach you how to make changes that actually last. Sound good? All you have to do is go to drchatterjee.com forward slash tour and 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 this 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. I generally think that people under-eat protein

at the population level. And part of that is driven by the types of foods that they eat, which tend to be low protein. Could you just explain population level? Yeah, so if you're going to look at how people eat in the US or the UK on average, so that's the population level. How much protein are they eating? And in general, I think people eat too little, particularly as they get older.

When you look at some of the evidence around protein intake and longevity, there's two broad streams of evidence. One is animal data. a lot of it's from mice and i mentioned this last time i was on the podcast i do animal research for a living that's what pays the bills and most animal research is not useful for humans at all i think most of it's a complete waste of time um And I would include most dietary studies in rodents, if I'm honest, because rodents are not small humans. And we have seen again and

again how these kinds of studies fail to translate to humans. So if you feed a mouse, which doesn't normally eat a high protein diet a high protein diet you may see some negative effects on their health that doesn't necessarily that tells you that you shouldn't feed mice a bunch of protein it doesn't tell you whether you should feed humans more protein and humans evolutionarily consumed a lot more protein like in addition to being gatherers we were hunters and it made up like animal protein made up a large proportion of our diet and our we are our digestive system and our metabolism is in tune with that and you know that i think that that's an important consideration like what are we what are we looking

at to try and tell us some of this the other type of information or studies that we get are usually epidemiological studies. So we ask people how they eat, and then we look at how long they live or what diseases they get later on. There are two problems with that. One is that people are really bad at telling us how they eat. So there's one classic study on protein and cancer and longevity that came out in Cell Metabolism nearly 10 years ago. And they talked about how low protein was beneficial early in life and then higher protein was beneficial later in life. And there was some mouse data and then there was some human data

and they used a study called NHANES, the National Health and Nutrition Examination Survey in the US, where they call up a few thousand people every year and they say, what did you eat in the last 24 hours? And then they say, you know, so you tell them. And then they're like, are you sure you didn't have any ice cream? Are you sure you didn't have a beer? Right.

So like things that people just tend to under report. And then that's it. That is then assumed to be their diet every day and well they also ask them how typical it was right um for their diet and then they look at how long they live 20 years later and there have been some studies on nhanes data in particular um there's there's a nice paper that came out that said that the majority of dietary responses in NHANES were not physiologically plausible. As in, these people, based on how tall they are, how much they weigh, their physical activity levels, what they've told us they eat cannot physically be correct. It is physiologically implausible that they're eating

this amount. And we're using that, we're using the protein intake from that study to say, this is how protein affects your health. In reality, we have no idea what these people are eating. So a lot of the data that comes from, that is being used to make recommendations, particularly to eat low protein, is just so highly flawed that I just wouldn't even look at it. It's not even worth considering so then you might think

about what about some interventional data right we have um people and we change the amount of protein that they eat and then we look at some outcomes can you just explain interventional data as well so interventional means that there's some people who come in for a study and we physically change something and then we track responses over time rather than just asking somebody what they eat and then assuming that it's correct and looking at the long-term outcomes.

And particularly as individuals get older, we know from interventional studies where we have looked at them and we've fixed the amount of protein that they eat or increase the amount of protein they eat and we look at their outcomes that as you get older in order to maintain muscle mass and strength which particularly strength which is a critical component of long-term health older people need more protein and in general as we get older we tend to eat less protein we tend like often hunger decreases and the protein is very satiating and so the protein intake decreases

over time so not only do we eat less we also need more relatively um and so in general i think particularly as people get older um they have a relative protein deficiency. And that affects a whole bunch of things, right? That affects gut function because you have a high turnover of cells in your gut. You need protein to replenish those. It affects muscle function, probably cognitive function. The amino acids are really important for neurotransmitters and all these other things. So in general, I think most people under-eat protein.

And there have been studies where they give people vast amounts of protein and see almost no negative effects on their health, like four grams per kilo. So it'd be me eating 400 grams of protein. That's a heroic amount. That's a huge amount of protein. I would never eat that much protein. Heroic. But in these studies, they're eating that for a year or two. It has no negative effects on on any blood markers or or

what about these rumors that high protein diets are problematic for our kidneys where does that come from so one of the things is that if you if you overeat protein above your requirements you will your kidneys will have to work harder to excrete the extra nitrogen which is which is from that but that's that's part of what the kidneys do. That's part of their job. In people who have normal kidney function, so if you have chronic kidney disease and or you're on the way to or need dialysis, it's a completely different question, right?

Yeah, for sure. Absolutely, you speak to your renal team. That's the important thing you need to do. But for people with normal healthy kidneys, eating, there's no negative effect of protein intake or kidney function. I'm not actually entirely sure where that originally came from,

but there's really no evidence to support that. I really appreciate that. Whenever I come across conflicting bits of information or let's say different health experts giving advice on the same topic but completely different bits of advice which again is one of the reasons I wanted to have this conversation because I think there is a lot of confusion where people go wait a minute this expert who I really like and respect said this this other expert who's also a medical doctor also a scientist or a researcher,

has had the complete opposite. I don't know what to do anymore. The way I look at that often is I go and trust what I've seen time and time again with patients. Because as you said before, you can actually find a lot of science to support both sides of an argument, which gets really, really confusing. But what I know is that I have seen tens of thousands of patients and I've been applying these lifestyle principles for many, many years. And whilst I would always say there's very rarely one approach that works for everyone, there are some common principles that I've seen work time and time again. One of them being in this modern food

environment. I think that also comes into it, right? When and where are we studying people? In the context of a food environment, which is highly problematic and full of ultra processed foods everywhere we go, encouraging us to eat too much and for too long a period over 24 hours, I found honestly that increasing our protein intake for many people really helps them get back on track. It helps them feel fuller. It helps them eat less overall. And so I guess my bias would be that I've seen that work over and over again. So for me, it's a helpful recommendation. I think most people benefit from a bit more, but then what does that mean? Because you will hear things like,

some people say 1.8 grams of protein per kilo. That's more, I think that's more than you need. I do, because if I apply that to myself, right? I'm almost six foot seven. I weigh, I don't know, I really don't weigh myself, but I'm probably somewhere between 95 and 100 kilos. Let's call it 100 kilos for simple maths. That's like 180 grams of protein a day. I think that feels pretty heroic as well, right? That's a lot of protein.

Now you may say actually for your height and frame that's fine but you know i never really like giving getting into you know grams per kilo but i do i do accept for some people it's helpful do you have a recommendation about that so i think the the general recommendation and there's been lots of different meta-analyses and these other things that look at how well do you respond in terms of muscle mass and strength. I think those are a nice hard outcome that we know are associated with long-term health outcomes, at the same time not seeing any negative effects. seeing any negative effects and in general it is probably somewhere around 1.2 to 1.5 grams per kilo say there was a meta-analysis that looked at strength responses in younger and older individuals and the the optimal amount of protein intake from an interventional study seems about 1.5 but there have been other studies that compared like 1.3 to 1.7 and they

see similar responses so it's somewhere in that in that kind of range um and in in general what that means is that if you have three or four meals a day or you know three or more periods of where you intake some calories that each of those contains something like 20 to or 30 to 40 grams of grams of protein and you can figure out what that looks like in terms of a cut of steak or salmon or or eggs or tofu or yogurt um you know there's some strained greek yogurts that have a high protein content and that that and i think that's how you should in the way that i would work with people is that's that's the basis of the meal that comes first and then things come around because that's the most probably going to be the most critical single component that you want to

consistently make sure you're you're consuming because the the fats and the carbs and things they can kind of go up and down and around but i think the protein i would recommend be relatively consistent and in that range and relative to what you mentioned earlier as i say there was another study by kevin hall that i mentioned earlier where they had people consume uh either an ultra processed versus a minimally processed diet and they they have them in the lab and they they can eat as much as they want and they could you know they measure all uh everything that they eat and they can follow them you know for several weeks at a time and even though they matched for like fiber and these other things in the diets those who are eating ultra processed foods so and it was if you look at it it's just like tip it's just like uh cereal uh, bread, right? Just typical.

That's a standard diet for many people. Standard diet. Those individuals on that diet ate about 500 calories more on average per day, four to 500 calories more per day. But the protein was consistent in the two diets. So the idea is, it comes to this idea of something called

the protein leverage hypothesis, which is that you continue eating until you reach a certain protein threshold that your body needs and so most like i said ultra processed foods are low in protein and part of what's driving you to eat more of them is to get up to some protein requirement so an easy way to get around that is to make protein the focus of a meal, and then you will be more satiated and you're less likely to overeat in response. There are some proponents, I think, of having a minimum of 30 grams of protein, particularly after, let's say, an overnight fast. I think someone like Gabrielle Lyon, for example, or Don Lehman would promote a minimum of 30 grams to make sure

you're getting the minimum requirement of leucine that's needed to build muscle. You mentioned before, I think 20 to 40 grams. And the 20 being, there are some people who are a lot smaller than you or I, so 20 would be just fine. So that's where that range starts to come into play. So 20 to 40 grams, basically, you're saying should be the mainstay of most people's meals. And that will depend whether you're slight or whether, you know, if you're very tall and large, well, if you're very tall like me, it's probably going to be more towards 40 grams. Yes. Okay. So helpful. And I also love what you said before that there really isn't that much evidence that high protein diets, if you have too much, you're not really causing harm. Your

kidneys will just have to get rid of it. Yeah. Fine. Well, let's just talk about exercise and movement. I think there is a lot of confusion about exercise. What's the state at play? Okay. We have a sedentary population, right? Who are not moving enough. what's the state of play? Okay, we have a sedentary population, right, who are not moving enough. There's a lot of talk these days about different types of exercise, different zones of exercise. There's talk of HIIT training, high intensity training, walking. And then, you know, I talk about it as different gears of movement. So gear one might be walking around a lot. Gear two, very much equating to your car. You're going a little bit faster, perhaps. And there's a lot of talk about the unique benefits of what is being called Zone 2 training.

And some of the advice around that, I think is going to be very unachievable for many people. So let's try and break it down. What's your current perspective on movement and what we all should be doing? I think I said something like this last time and I still feel the same, which is that whatever you can do that's more than what you're currently doing is great. that's more than what you're currently doing is great. Until you get to the very, and then I remember some comments of people going in like,

oh no, people shouldn't lift weights because they're going to get injured. Well, actually lifting weights in like a bodybuilding style is one of the safest forms of exercise you can do in terms of injury risk. And then some people said, oh yes, but you can get to a point where you're doing so much exercise that it's detrimental. And yes, of course that's the case,

but like I'm not worried about, I'm not talking about people exercising 30 hours a week, right? I'm talking about somebody going for a walk for 20 minutes a day. And so whatever you can do sustainably above what you're currently doing or previously have done will benefit your health. And I think, you know, that could be steps per day. It could be, you know, amount of time you spend going for a jog or cycling or lifting weights or any kind of resistance training

or anything like that. So if you look at, say, the amount of physical activity that significantly improves certain health outcomes. So, you know, me, I often think about the brain. So the amount of physical activity that significantly improves certain health outcomes so you know me i often think about the brain um so the amount of physical activity that significantly improves cognitive function

been large meta-analyses have looked at this is basically it doesn't um matter exactly what type you do but if you're achieving say government physical activity or guidelines which is 150 minutes per week of moderate to vigorous physical activity that is associated with a statistically significant improvement in cognitive function. And you can break that up however you like. You could do 30 minutes of brisk walking a day. You could do 20 minutes of Pilates a day. You could do 30 minutes of resistance training a day. You could do five minutes of sprinting per day.

The way that it works in general, at the simplest is intensity times time so the more intense the less time you need the less intense the more the more time you need so you can like one day you can go do a little bit sprinting in the park if you want or you can go for a brisk walk or you could do an hour of gardening right that's even less intense but even that's going to have some benefits so incrementally improving this sort of intensity times time this volume that you're doing in any of those activities is going to be beneficial and like that that's honestly where i start and if you want to then dig into resistance training versus endurance training those other things we can do that but the most important thing is that you do some movement every day and And if you're sedentary right now, literally anything that

you can get up and do is going to be beneficial. Okay, that's really useful and really empowering, I think, for people. What you said about intensity there is really, really interesting. So by what measurements or through what lens are you saying that one hour's gardening might be equivalent to five minutes of sprinting? Because we could probably measure that in a multitude of different ways or look at various aspects of that to try and compare them. How are you comparing them when you say that they're the same? pairing them when you said that they're the same so in general when that's done they use something called the metabolic equivalent or met and you can you can google uh there's there's a pdf of mets for different activities and it's very long like literally um every intensity of pretty much any activity you could think of it gives you an average average MET. And of course, that's if I go sprinting, it's a very different number of METs than if you go sprinting,

but it just gives you an idea of the overall intensity of that activity. And so then, if I think about the cognitive function study, what they looked at was how many MET minutes per week. So again, that's intensity times time, what do you need to do per week to see a significant improvement in cognitive function? And it was about 700, which then, you know, with a little bit of back of the envelope calculation is about the physical activity, general government physical activity guidelines. So that's how, and when you look at that, that kind of says that, you know, overall, those are going to have equivalent benefits.

And then when you look at say harder outcomes like vo2 max which is a measure of how efficient your cardiovascular system is that's sort of the gold standard then yes there's probably some protocols that improve vo2 max a little bit better than others but if you look across all the studies that have been done in general you see the same trend that it's intensity times time. So if you do very intense work for a short period of time, that has a similar benefit to a less intense period of exercise for a longer period of time. And again, this is, you know, if we're just thinking about normal people trying to move and improve their health, I think that's really the

main important principle that it would boil down to. Could we take that to an extreme? Let's say there's someone listening who, for whatever reason, doesn't move much at all. They get to work, do their desk job all day, come home, sat down at home and struggles with motivation to move their bodies or time or whatever it might be. If they every day did five minutes of sprinting as hard as they could, let's say, let's say a few intervals, maybe, I don't know, 20 seconds of sprinting, 40 seconds recovery walking, 20 seconds of sprinting, and they do that for five minutes. So that's a pretty intense workout. Whereas someone else says, you know what, I'm going to

go for an hour's walk every day, a nice gentle walk every day. And I know there's other benefits, nature, stress reduction, time away from your work. It gets really complex if we're trying to look at all those different things. But from a pure movement perspective on the body, are we saying through one lens, they're pretty similar? Essentially, yes. Assuming that you find some way to match the total amount of work that those two people are doing, which you can through like an intensity times time lens. In general, I think they're both going to improve their health, and it's going to be really difficult to separate out one versus the other. Yeah, it's really, really interesting and empowering for people.

So that's a sedentary population, right? Where you're going, okay, anything is better than nothing. And you're going to get a huge improvement if you go from nothing to something. What about for people who, I guess, have a bit more time or already active? Let's say they're already able to go for a 30 minute walk seven days a week. They're like, Tommy, look, I can do that. That's no problem. My life and my work allows me to do that. What else should I be doing as I get older to look after my health, body, brain, mind, everything? Where would you go next? Resistance training of some kind, but there's some kind of weightlifting or something where you're applying resistance

to the muscles. There's lots of different ways that you can think about this. In general, I think there's a movement pyramid. It's my own movement pyramid. And I think at the bottom is just spending less time sitting, right? So there's even benefits to getting a standing desk, if you can. Also, say you're in a job where you're sitting all day. Is there some way to make it so that you're just sitting less? And that could even be this idea of movement snacks, where once an hour you go for a quick walk

or you go up and down some stairs or whatever you can do near you. So just less time sitting. And then the next would be spend more time walking. And there's a whole bunch of studies, again, suggesting that risk walking, particularly in those who are otherwise sedentary, can dramatically improve your health. can dramatically improve your health. And there's this linear benefit of number of steps you can get per day in terms of mortality risk

and various disease risk up to maybe somewhere between eight and 14,000 steps per day or something. But the more you can do in that zero to 10 or 12,000, the better, really. And a lot of that, particularly if you're doing quite brisk walking,

so say you're doing your 30 minutes and it's quite brisk, then that, for many people, may be getting them up into that area that you mentioned, briefly mentioned earlier, that zone two. So you're getting some of those cardiovascular benefits, and that's probably where a lot of that benefit comes from. So then the next level, I think, is resistance training. And particularly as you get older, we know there's a decrease in muscle mass, but

more importantly, and probably faster and earlier, there's a decrease in strength. And as you get older, you lose in particular type two muscle fibers. These are fast switch muscle fibers. And those are important for a number of reasons because they're an important glucose sink. So they're important for metabolic health right so if you're talking we talked earlier about all these things that affect your blood sugar having healthy active muscles and having a lot of these types of fibers is really important for our blood sugar control and a whole host of other things and it's also really important for our stability and mobility and function so if you lose those fast twitch fibers those are the ones that are important

for like reactions and like if you uh if you like are going to fall like grabbing onto a handrail or stopping yourself from falling and you know particularly as you get older you know falls risks and broken hips and all that kind of stuff you're going to be protected against that if you have more of those types of muscle fibers and those are the ones that you get through resistance training, the ones you develop in particular. You know, it affects all of your muscle tissue, but those are the ones that you protect when you do that kind of resistance training. I wonder if we could just spend a bit of time trying to define resistance training. And the reason I'm asking this question is some people don't want to go to the gym. And given that gyms are a relatively modern phenomenon and that humans have lived to pretty decent ages for a long period

of time, I think when we say resistance training or strength training, we have to broaden it out beyond lifting weights in a gym. Because for the people who love that, they love hearing it and go, yeah, I knew I was on it with strength training, right? But for people who don't like it, it can be a bit confusing. So, indoor climbing, running up hills, right? You know, that's resistance against gravity. In your view, what counts as resistance training? view what counts as resistance training? So it can be, it's literally any movement where you're moving your body in space against, so against something that makes it harder

than it normally would be for that movement, if that makes sense, right? So carrying your shopping bags to your car or even to your home, or is that resistance training? Because instead of walking, you're carrying, right? Yeah, and we've talked previously about, so you mentioned the blue zones. And in the Nicoyan Peninsula, they're not all down the gym all day, right?

But they are doing physical activity every day that includes things like carrying and lifting um and so and you can translate that to your own activities of daily living as we call it right so if you want to be able to carry your shopping um then heavy shopping bags are resistance training um and any time that you're moving your body and so it could be squats just with your body weight. That's resistance training. Or you could do push-ups, and it can be against the wall rather than against the floor.

That's resistance training. And it can just be these daily activities like lifting things into cupboards and carrying things around. All of that counts. And particularly as you get older, you want to maintain those functions. So anywhere you can find an opportunity to move your body against some kind of resistance, that counts. The problem does become, at some point you need to progress things.

So in order for it to create, again, anything is better than nothing. But to create an ongoing stimulus, it has to be, I think it has to be a little bit challenging. So, you know, if you're just going to, so maybe you do a few calf raises, squats, pushups against the wall, a few bicep curls in the kitchen, like all of that stuff is great. But at some point you have to make sure

that you're, you would like to progress. It would like to be, you would like to get stronger such that that is no longer enough. And then you have to find some way to make it a little bit harder. So I think there has to be a challenge component to it. So the push up against the wall then has to be the push up against the table and then the push up against the chair. And then a few months later, maybe push up on the actual floor exactly Um, and also I think I just want to highlight let's say yoga and Pilates for example Yeah, because sometimes I feel that gets left out of strength training and I think

Participants and teachers of those disciplines will often say hold on a lot lot of what we do is hard on the muscles. And there are plenty of yoga moves, for example, or Pilates moves, which I think do count as resistance training. I think they absolutely should be included, particularly for this kind of discussion. There's a lot of yoga stuff. I'm relatively strong.

There's a lot of yoga poses and things I can't do. It's different, but it definitely counts as as as resistance absolutely is there a next rung on your pyramids yes then the the next rung um is high is sort of high is high intensity interval training or hit and the reason why it's next is because I think that, and again, this is not for elite sports performances, this is just for average people who want to try and figure out how to separate out their time in terms of movement. And so you will get some cardiovascular benefit from your risk walking, or it could be cycling or something, right?

It doesn't have to be walking, but I like walking because anybody or most people can do it um but then you do get some slightly you know if you then want to get into the physiological biochemical nitty-gritty you do get different adaptations to high intensity training versus lower intensity training right i think in general that idea of intensity times time is what's most important. But of course, different things happen at the cellular level when you do one versus the other. And so you can, you know, that's a beneficial add-on on top of say resistance training, if you're already doing some low level intensity movement. And then on top of that, if you really enjoy it, I think you can do very long periods of endurance training. But I don't

think most people need that if they're just trying to move as much as they as they can or to improve their health. So that's kind of the that's the progression that I use. Yeah, so I really like that. If someone's hearing that and says, Okay, Tommy, look, I don't move much. I like that pyramid. But do I have to sequentially go up it? Or for example, if someone goes, you know what? I used to do some strength training while I was at school, but I haven't done it in ages. And I quite fancy that. There's no reason why they can't start there right on your pyramid. They don't have to progress up. Yeah. And what's quite good about, say, if you're going to the gym,

is there's a lot of, you start doing the other stuff as well. So when you're at the gym, you're usually not sitting like you would in a chair at a desk or on the couch or on the sofa. And you're probably walking around quite a bit, right? You're getting some of that additional movement. And there are some nice papers that talk about how, particularly if you do weight training to what they call voluntary muscular failure, right? So you do a number of repetitions

to the point where you can't do any more with good form. Even that has some cardiovascular benefits, right? So you're similar to maybe some lower intensity aerobic training. So yeah, I think anywhere in that, there's a good entry point for you, I think is great. And that's always where I would want people to start. The reason why I have like very long, hard endurance exercise at the top is because that's often where people start because that's where they assume they need to be in order to improve

their health, right? If I'm going to, I need to go for a run, I need to be in order to improve their health right if i'm gonna i need to go for a run i need to be hard i need to do it for an hour or else there's no point in doing it but actually that's that's quite taxing on the body and you don't necessarily get all the the other benefits that you would from those other different types of types of training so that's why i put it at the top but there's other there's lots of other places that people can enter and again anything that you can do that you enjoy and is sustainable, that's the place to start. And the other thing I guess I'd want to add there is, we forget sometimes that exercise and high-intensity exercise

can be a stressor on the body. And what I've often seen with certain patients is they have very high-stress lives, go, go, go. And then the workout is also, you know, high intensity at a fast one hour run. That is very hard on the body. And I've, I think, again, this is a much broader conversation, so we'll have to save this for another time. But I do think we also need to think about how much is this exercise now taxing us? And I certainly have

found over the last couple of years, I've really been leaning more into a lot of low intensity, you know, walks or bikes or swimming where, you know, it's just nice and relaxed, but I'm going for 30, 40 minutes, maybe an hour. I'm like, wow, I feel like I need no recovery. It doesn't stress me out. And I kind of measure it sometimes with HRV and heart rate variability and things like that and I'm like wow I do feel that we sometimes forget about the stress components so that's if people really want to dive into it but I agree with the message which is anything's better than nothing and it's probably not that much for most people right that's going to give them some benefits. Yeah. The main thing that I try and get across is

that the dose needed, or the amount you do needed to see some benefit, again, for most people is really quite low. And that, because often what you see, and that's kind of what I alluded to earlier, is that people assume that they need some vast amount, several hours a week, in order to see benefit. And if they can't do that, then they just don't bother doing anything.

So the most important thing is to do more than you're currently doing. Again, if you're relatively sedentary or you're trying to improve your health through physical activity. And then, you know, once you get beyond that point, you have several hours a week to train. Of course, there's lots of different protocols and different things that you can follow. But up until that point, you know,

anything that you can do and is sustainable and you enjoy is going to be great. You've touched on muscle mass through the lens of resistance training and how important that is as we get older. We have spoken about it before. One thing I wanted to cover though is, like if I look at you, you're a muscly guy,

you like to, you compete I think, don't you? Yeah, in strongman. In strongman, right? So that's a passion for you and you eat a certain way, you work out a certain way, so you can compete in this sport. One thing I've been thinking a lot about over the last few months is, what's the cost of muscle? Because I don't feel that we see often in these longevity hotspots,

really muscly people, right? I haven't gone out there and studied this in depth. So I, you know, I can't say I know that for everyone or, you know, we often don't hear about them being really muscly in their forties and fifties. And I often think about a place I spent a lot of time in, which is Chamonix in France, where it's in the mountains in the French Alps. And many people there, if not most people are active, They are, but very functionally active. So a lot of the time you'll see that people have got quite lean, they're strong physiques, but not necessarily bodybuilding strong. You see this with mountain

guides. And I think a lot about, okay, there's a big movement now to say, guys, you got to work on your muscle mass as you get older, because you're going to lose muscle mass as you get older. And it's very important for longevity, it's important for brain health, as you've covered before on the podcast. But we're not necessarily talking about big muscles, I don't think. I'd love you to expand on that. And also know I guess broader broadly you know what is the cost of muscle mass because the more muscle you have I guess the more protein and calories you need to feed that muscle so how do you think about that there's several moving parts that I'll try and I'll try and cover the first is is an important one, which you didn't ask about, but I will mention,

which is that whenever I talk about muscle, everybody's like, well, I don't want to look like you. I don't want to eat like you. I don't want to train like you. And that is not what I'm saying. Absolutely not. And when I say that the people should build muscle mass and strength, I'm absolutely not talking about what I do or other, you know, other people do in terms of bodybuilding or strength training. Um, that's completely separate. I don't think that that's detrimental to health and we'll cover that as well, but that's not what I'm recommending to people. Um, and it's funny because I actually mentioned Gabrielle Lyon and, um, I heard, uh, like an anecdote, which is that somebody was telling me that they've been telling their,

or suggesting to their wife that they should maybe do some strength training, you know, for all the reasons that we talked about. And it was sort of like in one ear and out the other. But as soon as she heard another woman like her talk about the importance of strength training, immediately that message went in. So the message is important, but the messenger is important as well so sometimes it's not good for me to talk about muscle because people are like well i don't want you know

that i don't want to look like that and that's that's definitely not what i'm suggesting um when you look at again so at the population, we're going to use that word again. So we do these large studies of people who sort of represent the population, and they've done it in the UK with the UK Biobank. They do it in the US with NHANES. And I mentioned earlier how terrible the NHANES dietary data is. The other data they collect in NHANES is actually very good. And what you see is that those who are in the top 50% of muscle mass, so just above average, they tend to live longer and have an overall lower risk of most diseases and mortality.

But there's not like a dose response. It's not like more is better. It's just don't, so really what you see from those studies is that low muscle mass being, and we might use the phrase sarcopenia, that's the technical term for just having low muscle mass. Dynopenia is related to low strength or loss of strength. So low muscle mass is problematic rather than more muscle being better, if that makes sense. So you really

just don't want to have not very much muscle. That's where the real signal of benefit comes from, again, at the population level. When studies that I've done, and there's one we published just recently, and there's some other stuff that we're working on, what we've found is that more muscle is not better, um, above a, you know, above that low level. But if you do have more muscle, it needs to be functional. So you need to have strength proportional to that amount of muscle mass. Um, and that's the kind of muscle mass that you generate through resistance training. So if I have more muscle, but I'm stronger with it, I think that that is just fine, right?

But there's another scenario where you can gain a lot of muscle. And this is muscle measured on a, like a DEXA scan, which is a type of x-ray scan. You look at how much muscle people have. And when they do that at the population level, those who have the most muscle particularly in men there's a study that came out um from the uk biobank recently those who had the

men who had the most muscle the top it was either 20 or 25 they had a higher risk of mortality and a higher risk of cardiovascular disease but the men who were the strongest had the lowest risk so there's this dissociation, that's another fancy word, like the separation of strength and muscle. So strength is what's important relative to muscle mass. And when I've looked at some of these data myself, muscle does not correlate with physical activity. So these people are not gaining muscle

because they're in the gym all the time. They're gaining muscle because they're eating beyond their caloric needs and gaining more total mass. And with that, they tend to have worse metabolic health, more high blood pressure, worse blood sugar. So it's not muscle that's gained through lifting weights right it's muscle gain just through gaining more mass and some of that is muscle tissue so as people put on excess weight there's an assumption that will always be fat no some of it is muscle so you still put on extra muscle as well wow and actually that relationship between strength and muscle reminds me of conversations i used to have with a really good mate of mine who I was at uni with who was a um a very keen indoor climber and he

used to talk about the perfect you know they'd measure the perfect ratio between strength and muscle for climbers because you don't want too much because then you're too heavy yeah particularly in the legs yeah exactly and I was like so it reminds me of those conversations and i think the so there are there are two parts to this one is that there are there are these studies and you talked about the cost of muscle there is these studies that suggest that more muscle is is detrimental but that's because muscle you know muscle is coming along for the ride with um you know gaining excess weight and worse metabolic health and all that stuff that comes with it, that muscle has not been gained with a proportional improvement

in strength or function. But if you look at having a high level of strength or function relative to your muscle mass, that's incredibly predicted of cognitive function and mortality risk. So you want enough muscle. You don't want to have very little and you want that muscle to be strong and functional that's the most important thing and that's that's what you're talking about in terms of those those individuals that you see um in the french alps in in terms of the the individuals you see in in longevity centers or you know you know a place around the world where people live a long time it's functional it's functional um so whatever muscle that you have has to be functional i think that's the main that's the main takeaway now related to that tommy

again whenever we talk about anything we have to think about in what population are we talking about it for sometimes when i think about some of the protein research and the encouragement to high protein diets i know we've covered that there's no real detrimental effects and you believe, as I do, that many people are under eating protein. And we think about it in terms of our muscle mass. Like if you're not eating enough protein, let's say you should be eating 30 grams for your size at a meal. Now, let's say you get really, really active and do loads of strength training. If you do that, yes, I know you need protein to support the muscle growth, but is there a case to say, and I kind of think that maybe this happens in some longevity

hotspots, that they are really, really active active maybe not eating high protein but because they're so active and they're so functionally active they're still maintaining muscle yeah when you i think the best way to understand it in terms of the say the research that we have is if you have individuals who are calorie restricted. And when you restrict calories, one of the things, right, you lose weight. And that comes from fat and muscle and other tissue as well. But in that scenario, if you add in physical activity,

you preferentially keep that muscle tissue and you preferentially get your energy elsewhere. So even if you have a period of time where you're either dramatically under eating or you have a high energy expenditure, then you will preferentially keep your muscle mass and strength as long as you maintain activity levels so that becomes important if people decide to do long periods of fasting maintaining activity is important so that you preferentially keep you don't use your muscle tissue for energy um and so that's that's partly what a part of what comes in there but i think there's there's also been a big debate in terms

of so again we go back go back to the blue zones. There's been some pretty reasoned debate in terms of how much protein those groups are actually eating. And it is probably more than the typical Western diet. You know, they're not eating low protein diets, but then they're also physically active and all these other things are important as well. I do remember a conversation a few years ago i was i was speaking at a longevity conference and

michelle poulin was there who was one of the original researchers who went to study in the blue zones and he shared with me that essentially that in some blue zones they're eating more animal products than maybe than we've been led to believe yeah i love a lot of the stuff on blue zones for sure i think they're really really interesting but what their diet is i i'm not sure we're fully sure yet or certainly i've heard conflicting things let's put it like that yeah And when you step outside of those small pockets and you look at more, say, higher income or westernized, for want of a better word, societies,

there are lots of populations around the world that eat a very high protein intake relatively and have some of the longest lived people on average. So like Hong Kong and Iceland eat a lot of animal products, a lot of meat, a lot of protein, and they are some of the longest lived nations on earth. So I think that using, you know, the blue zones are informative, but if you try and look at an overall population that's closer to ours in terms of overall technological, you know, development or, you know, an access to foods, then those I think are worth considering as well. And in general, you know, there are several that have a high protein diet and live a long time.

Yeah, I think also the nature of science often is to be reductive so we can measure one thing. Yeah. But our human experience isn't that reductive, right? We have all different kinds of inputs into our lives. And so I often feel that it gets hard because science is very useful to inform us. But then, and I guess I'm biased from my experiences with patients where I kind of feel, yeah, that's one factor, but it kind of depends what are the other factors that are going on as well. That influences how much that factor is important. So thinking about food intake without also thinking about physical activity and stress and sleep yes can be useful but potentially limited as well so i feel i feel

like we over focus on diet most of the time that's that's where everybody wants to go when all the other things that you mentioned probably for the vast majority of people are going to be at least if not more important yeah i totally agree i mean you've covered quite a lot tommy i mean maybe just one more topic um supplements um you're a fan of creatine aren't you yeah why um because it does everything no it's it's probably the one supplement that I would routinely recommend to pretty much everybody. Um, there was, uh, there was a recent study that came out in, uh, postmenopausal women where they took creatine, um, for two years and it, it was associated with some improvements in bone strength. Obviously,

that's important for postmenopausal women. I'm a big fan of it because of its effect on the brain. So there are several studies showing that creatine supplementation acutely improves cognitive performance. That's in athletes and young healthy people. And there have been large meta-analyses looking at creatine supplementation on cognitive function and the benefits are greater as you get older so in those who are older they have they seem to have a greater they have a greater benefit there are studies where they've used creatine as an add-on to antidepressant therapy in those with major depressive disorder and seen a significant improvement above what they got in terms of the response from the antidepressant.

And there are some studies suggesting that, you know, the population level epidemiology, the amount of creatine that people get from their diets is associated with their mood or risk of mood disorders. Then there's the effect on strength that in the majority of people, creatine intake is associated with improved strength and muscle function. So a wide variety of systems and organs

in the body seem to benefit from adequate creatine intake. And the amount that you would take is maybe around something like five to 10 grams per day. And that's not a heroic dose, we'll go back to that term, relative to what you could get from the diet. So a tin of sardines is somewhere around three to five grams of creatine. is somewhere around three to five grams of creatine. So, and five grams of creatine is probably, you know, it's like a kilo or two of salmon or beef.

And like, not a lot of people eat that much salmon or beef, but it's possible to eat that much from the diet, but just most people don't. What is it? So, it's made out of three amino acids and it's essentially what it does does a number of things but its main uh role is as uh an energy buffer so earlier we talked about atp adenosine triphosphate and when you move energy around the cell and you use it to do different functions with proteins and things like that, you do this with what we call high energy phosphates. So you break this bond with this phosphate molecule, and then that provides the energy for the process when you um take atp

and you use up a phosphate you create energy adp adenosine diphosphate has gone from tri which means three to die which means two and then that needs to be recycled and that's essentially what your mitochondria do they're they're recycling atp or generating atp creatine creates a buffer for that system so creating you put a phosphor a phosphate onto it's called phosphocreatine and it's used to recycle atp so it's kind of like this short-term energy buffer and that's why it improves physical performance but some of the things that it improves in terms of cognitive performance, we're probably less sure about. It seems to have some effect on mitochondrial function and some other things. It integrates with the methylation system because producing

creatine, and we make our own, is one of the most methylation-intensive processes in the body. By some accounts, the majority of methylation is used in order to generate and regenerate creatine in the body. So, you know, and then when you do that, if you supplement with it so you don't need to make it yourself, then you're offsetting the need for B vitamins and all these other nutrient requirements as part of the system. So there's a number of different ways that it, and to be honest,

we don't really know all of them. We know it has these beneficial effects that we've tested in randomized controlled trials, but the exact mechanism by which that happens is still kind of up for debate. Quite cheap and accessible for people, is it? Very cheap. If people are going to buy it, they should buy something called creatine monohydrate. That's the cheap form that's been well-studied in all kinds of populations for decades and decades. It's very safe. Most of it is made in Germany.

It's a product called CreaPure, and then they do what they call white labeling. So a sports supplement company just like buys it in bulk and then puts their own label on it. It's the same thing. So just like a scoop of one of those. And it can also be useful if you're going to buy supplements. In general, there's some due diligence

that I would always recommend that people do. So there are third party testing companies or groups that test for impurities. And that can be important if you're a drug tested athlete, but also for other things that you don't necessarily want to be in your supplements. So things like informed sport, you can see that as a stamp on your supplements. And then often companies will say that they're batch tested or third party tested, that means that they're making sure they're not full of heavy metals and these other things. Because, you know, some supplements, you know, particularly cheaper ones, or you don't know where they where they came from, they're

made in some anonymous factory somewhere, and who knows what's in them, and, you know, wouldn't recommend that people take those. So you can you can often ask for certificates of analysis so you know where people have tested for impurities and stuff like that and i think that if people are going to take supplements it's worth doing that little bit of due diligence but in general if you see informed sport or something else and like you can go to hollander barrett and you can buy an informed sport certified creatine monohydrate uh it's very cheap you know anybody can do that you don't need to spend a whole bunch of time doing research on it and i think that brings up a wider point on supplements and i think one of the reasons why the medical profession for many years has been quite anti-supplements is because of the lack of regulation so there are

poor quality supplements out there for sure but there were also high quality ones. And I kind of feel the whole thing, supplements, good or bad, is a ridiculous question in and of itself. It's like a pharmaceutical drug is good or bad. Well, kind of depends for who, in what dose, for how long for. And I personally have seen the right supplements be very beneficial for patients over a number of years um so I have a slight I don't really share that view that's been there in medicine for a number of years which is you know you know stay away from supplements because we routinely give them like b12 is a supplement or vitamin d is a supplement and we you know so I don't kind of yeah that but there's a bit of nuance there. And as you say,

if you're going to get one, get a high quality one. Yeah. And in terms of other supplements, in general, the vitamins, like come very, like in those who need them, come very high on a list of things

that I would recommend. So vitamin D, very important. Some of the B vitamins, very important. So I think we talked previously about measuring something like a homocysteine, if you can, particularly if you're thinking about both brain health, but then also cardiovascular health.

And B vitamins that are relevant for that are B12, folate, B6, B2, which is riboflavin. And you can get these from a, right, if you're eating some green leafy vegetables and some eggs and meat, you'll get a lot of those. But equally, we know that being deficient in those is associated with a whole host of chronic health conditions. So, you know, I think we should, you know, in terms of within the NHS, we should probably be doing a little bit more testing for those things so that they can be supplemented if needed. Yeah, homocysteine I still think isn't routinely available in the NHS. It's still a serum B12. And, you know, this whole thing about promoting diet and lifestyle first, yes, of course. But we also acknowledge in this conversation how tricky it can be for people to eat well. And that's why, yeah, I'm all for a food first approach. But at the same time,

I recognize that many, most people are finding it hard to get the nutrition they need. I don't know if you've seen this research on soil quality and how that's poorer now. And so are we getting the same level of nutrients that we were getting 50 years ago from the same foods? That's really interesting. Also, I've tested B12 a number of ways over a period of years. And I've been really quite surprised by how many people have suboptimal B12 levels,

even animal food eaters. And I think a lot of that may also come down to the chronic stress in society because we need good stomach acid to absorb B12 if it's going through our gut and into our stomach. And one of the things that chronic stress will do is alter levels of stomach acid, alter how your digestive function is.

And so I'm thinking, well, I think more people than we currently think, I think would probably benefit from improving their B vitamins. For B12 also, if you're taking a proton pump inhibitor for reflux, or if you're taking metformin for types of diabetes, like both of those can also, particularly for B12 precipitate, B12 deficiency. So there's a lot of other things that we're doing. We're managing these other health conditions where we could then be making a B12 deficiency

or insufficiency worse. So that's a critical one. But then all the B vitamins, I think we've become focused on B12 and folate, but these other ones become important as well, yeah. And I will say that if you are low, the amount of patients I've seen who've had vague symptoms,

really low energy, and then, you know, in one patient, I remember I particularly checked their homocysteine, it was through the roof, you correct it, they just feel like a different person. And they can go for years not getting properly treated and having a substandard quality of life. And so, yeah, a lot more we could talk about. Hey, Tommy, I think we've covered, I think we've done pretty well. You've done great on a whole host of different topics. Anything on those topics that you feel you didn't say

that you want to get out there? No, I don't think so. I mean, for each of them, you could spend an hour and do a lot more homework to really delve into all the nuances but the important thing i think to remember is that none of these things are good or bad and context is always important and you know just understanding how these things might be important uh for you but then but then hopefully also when people have gotten conflicting messages we've we've kind of helped them navigate maybe where they need to enter into something

or whether something is worthwhile for them. Yeah. Well, Tommy, I really enjoyed that. I really hope the audience like what was a very different format to these normal conversations. And if they do, we can perhaps do another one and cover another eight to 10 topics. But thanks for coming back on the show. I appreciate it. Thanks so much for having me. This is a lot of fun. Really hope you enjoyed that conversation.

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