The Food Medic - S1 E6 - Lifestyle medicine and the NHS

Episode Date: July 16, 2018

This week Hazel is joined by Dr Zoe Williams and Dr John Sykes. Zoe and John are both GP’s who are passionate about lifestyle medicine. They discuss lifestyle medicine within the NHS, girls in sport, Public Health England guidelines and reversing type 2 diabetes. Zoe can be found under @drzoewilliams on instagram and twitter and John can be found under @healthandfitnessdoctor on instagram and @Johnsykes_6 on twitter. Hosted on Acast. See acast.com/privacy for more information. Learn more about your ad choices. Visit podcastchoices.com/adchoices

Hello and welcome to the Food Medic podcast. I'm Dr. Hazel Wallace, founder of the Food Medic. I'm a qualified doctor, personal trainer, blogger, and best-selling author of the books of Food Medic and the Food Medic for Life. I'm passionate about maximizing our health through how we live our lives, including the food that we eat, physical activity, and stress management. We will hear from leading experts in their field who will be sharing evidence-based advice on how we can live healthier lives and we will cut through the confusing information that we find online. I like to think of myself as one of the first of a new generation of doctors. Hello and welcome back to the Food Medic podcast. Today I'm joined by not just one but two guests,

Dr Zoe Williams and Dr John Sykes. Zoe and John are both GPs who are passionate about lifestyle medicine. Zoe is a portfolio GP with multiple roles, including Public Health England Lead Clinical Champion for Physical Activity, the RCGP Clinical Champion, Physical Activity and Lifestyle, and CCG Clinical Associate, Obesity and Lifestyle. Zoe is also a resident doctor on ITV This Morning and co-presents on the BBC series Trust Me, I'm a Doctor. In addition to many other TV shows and documentaries and you might have recognised her from a couple of years back on Gladiator. I know, I mentioned it. John is a GP based in Bath who has a keen interest in lifestyle medicine and is a director of the British Society of Lifestyle Medicine. John has also organised and run several conferences, including the RCGP Lifestyle

Medicine Conference in June 2017, winning the local Vibrant Faculty Award 2017 in the Severn Deanery, and also hosts many teaching sessions on lifestyle medicine for students and healthcare practitioners. Guys, welcome to the podcast. Thank you for having us. Gosh, that was a mouthful, wasn't it? I know, I know. And that was me condensing your bios because you both do so much, which is absolutely amazing and one of the reasons I wanted to bring you on here. And for a bit of background, I actually know Zoe and John outside of this kind of podcast space because we really, how did we meet? Through Lifestyle Medicine, through really a shared passion.

Yeah, I think so. We're sort of three parts of a larger group of lifestyle medics. And I guess we're an emerging force in the medical world. Yeah, absolutely. And we all have like this, we're part of this WhatsApp group as well. So shout out to our WhatsApp crew. shout out to the lifestyle medic crew oh my god so i think we should explain to everyone what lifestyle medicine actually is because it's a bit of a new term zoe i'm gonna let you take this first question yeah okay so i guess it is a new term

and that we're talking about lifestyle medicine but it it's not a new thing. In fact, it's been around since the beginning of medicine. Really, to simplify it, it's looking at the upstream causes of illness and disease. So rather than, for example, focusing on the type 2 diabetes or the depression and treating that, it's focusing on the person and not just the person's physical health, but their emotional health, their social surroundings, their environment and thinking about what came before to cause that illness. So if you go one step back, you might think about diet and physical activity and sleep, but we're trying to think even before that is it that person's social circumstances so really taking that full holistic view of the person and thinking how in addition to drugs and interventions can we help them address that and you know it's not a new thing and every

GP practices some element of lifestyle medicine but I think in some respects, it's become the norm and possibly easier to prescribe a pill for every ill than to really dig deeper. And I think sometimes patients actually expect for their problem to be addressed by the doctor or treated by the doctor as well. So it's not new. It's almost in some ways going back to how medicine used to be done before we had all the amazing drugs and interventions that we have today and that's not to say that we won't give the drugs and do the interventions of course without those we would really struggle as GPs and I actually remember John saying in a lifestyle medicine meeting one time if my patient has a cholesterol

of eight he's getting a statin so it's not that we're anti-drugs or anti-interventions, but it's about if a patient has, for example, depression, we tend to as GPs be very good at talking about antidepressants and talking about talking therapies. We might be less good at informing the patient about how much physical activity may improve their illness or how much changes in their diet or actually looking at addressing their stress or sleep might improve their condition. Yeah absolutely and I think the reason it's a little bit I guess an unfamiliar term for a lot of listeners and maybe even doctors is because it's not something that we really learn at medical school and just touching on what you said when it comes to lifestyle intervention what

we mean is the things that we can do in our lives and that that's not just diet it's not just exercise it's sleep it's stress management it's also our social lives yeah and actually rob lawson who's the director of the british society of lifestyle medicine he's got a neat little soundbite actually and he says if nutrition and physical activity are the penicillin of lifestyle medicine then the surgery is sort of the psychology the behavior change because it's really about behavior change and you could say that the community and the community assets and you know whatever you have churches job centers or all those people who are trying to help you that could be the hospital when it comes to lifestyle medicine yeah that's a really really nice way of putting it both of you are still practicing gps despite

doing lots of other things. And I know, John, you probably practice more than all of us. How do you feasibly fit in lifestyle advice into a 10 minute consultation? Because this is something GPs ask me all the time. And I'd love to know what have been, I guess, your solutions to getting around this problem. Yeah, I think it's really tricky. I think we, you know, touching on what Zoe said, we know that 70 to 80% of kind of things that we see in general practice are rooted in lifestyle choices. And I think that's really important to touch on because when so much of it is rooted in lifestyle, it means it has to be a part of our management plan. And we know that so many medical conditions

that we deal with on a day-to-day basis, the first step is lifestyle management. I think one key thing about this is making lifestyle changes easy and simple, but also kind of specific to our patients and enjoying the benefits that we get from that, from seeing the results. Because ultimately, when we see patients make lifestyle changes and that benefits their health, then we kind of get to see the results that we really want to see. Because ultimately, I mean, one of the reasons why I'm so passionate about lifestyle medicine is it's exciting, because you get to see patients change their lives. You get to see patients go from, you know, being maybe quite socially isolated, maybe quite physically inactive, to changing their lives around. Because ultimately, we have become GPs, or we've become

medical professionals, because we've become medical professionals because we've wanted to make people healthier and happier and live more fulfilling lives and that's a great thing about lifestyle medicine it has potential to do so much of that so your question about how do you fit it into 10 minutes I think it's really tricky yeah I think it's about having evidence based messages which you can deliver in a short period of time which you've kind of just got as a little reserve bank yeah kind of having a an open discussion with the patient about which aspects of the kind of five lifestyle areas which i think you highlighted really well at the start of this chat so physical activity diet sleep stress management and community highlighting and checking

with the patient what kind of things they feel they could change making smart goals around that so specific measurable achievable realistic and also got a bit of a time frame to it so that people have got something which they can aim towards which they can then check in with you next time they see you and it can be a very small part of your consultation but actually the impact it could have could be massive and it's exciting to see those changes happen. Yeah. And I think if we had more robust guidelines in place that GPs could put their hand to when it comes to advice on diet, advice on exercise, sleep, like simple hacks would be really helpful. Because I know that we talk about it quite a bit and have our own tips and tricks that are helpful. But it really comes down to information sharing. And also, I know there's a real call for what's evidence-based but if it's a

small tip that can help a patient I think that could make a big difference as well. Definitely I think a lot of these small tips aren't that hard to give either because actually when we think about some small simple changes that a lot of people can make which make a big difference to their overall health these aren't complicated messages and then as zoe's correctly said like directing to the right professionals off the back of that i know in previous podcasts you've talked about health coaches yeah and then health trainers and also directing to exercise referral schemes and that's just kind of maybe from a physical activity point of view but knowing those community things that we can refer on to and utilizing the whole team

is actually going to be a way in which we can really help patients to learn more about lifestyle medicine and just use the resources we've got available yeah and i think i always like to talk about positive things but actually you know if we look at the bigger picture yeah of the nhs which has now been around for 70 years we have to accept the nhs's demands have changed so much 70 years ago we were treating people if anything for undernourishment and infections mostly we were in the post-war era food was still rationed and most people who needed treatment needed it for a short period of time then they either died or they got better whereas now we have people being diagnosed with multiple chronic diseases that they will live with for 50 60 60, 70 years. And during that time, they'll need a lot of support

from healthcare professionals. So I feel that the NHS in order to survive has to sort of move from a model of treating disease and sickness towards encouraging health and wellbeing. And if we don't do that, then we're going to run out of resources. And I dread to think what will happen then. We all have a role to play in that. GPs are just one part of it. Everyone working in the healthcare system, but also patients as well. Yeah, absolutely.

And I think I like that kind of that phrase of moving away from sick care to healthcare or health gain. And that's something that I guess we can all focus on, which is quite positive. And just moving away from sick care to health care or health gain. And that's something that I guess we can all focus on, which is quite positive. And just moving away from that, Zoe, I know that you are super into fitness and also you're an ex-Gladier and we've trained together quite a few times. And you're also really passionate about getting girls into sport,

which I think is incredible. But what are the biggest challenges you find in encouraging teenage girls to actually take part in physical activity? And how can we overcome this? OK, I think if I had the simple answer as to how we overcome it, I'd be really happy working on it. Yeah, no, it's an area that I'm passionate about because, first of all, the statistic that girls who are aged five to seven, only 23% of those girls are physically active enough for good health.

By the time we get to 13 to 15 year olds, only 9% are. So 9% of teenage girls are doing enough physical activity to be healthy, which is 60 minutes a day. And that to me is crushing for several reasons. One, it's crushing because that is impacting on their health. But two, because there's so much to be gained from sport and physical activity. And I feel that as somebody who has benefited from sport and physical activity firsthand, I want to share my story with these young girls

as much as possible. Often I'm going out to girls who are coming from backgrounds that might be quite similar to my own background. I came from quite a deprived background, single-parent family on benefits, had severe asthma was very very shy but I believe that physical activity sport and the friends that I've made through that have actually helped me overcome all those barriers so that I've gone on to achieve the

things I've achieved so I think I almost feel like I have a responsibility to share my story with girls in a similar situation to help them believe that they should never feel held back by circumstances that they can't control and that they can achieve anything they want to and I think physical activity and sport is a great vehicle for doing that but I think the biggest challenge that they face is an absolute lack of confidence and self-esteem and 90% of these girls despite only a small number of them being active enough 90% of them want to be more physically active but it's confidence self-esteem feeling paranoid about what other people think that's the biggest factor that holds them back so with fit for life what we try and do is empower them to change their environment and co-create physical activity programs that they

want to be a part of. A very interesting activity that we do with the girls on the Fit for Life programme is we get them to work in small groups and list all of the barriers, all of the reasons why they are not being physically active and also why they're not progressing and succeeding as much in life as they would want to. And they come up with a long list. And when we ask them to then try and write down the solutions to those barriers, they really struggle.

But if we take the page off them and give them the page of the next table and then say, can you come up with the solutions? They're brilliant and they come up with the solutions. Then we go around the room and we share and they realise that actually we all have the same barriers. We've managed to come up with solutions, not just to other people's problems, but our own. And there's this real feeling of empowerment in the room

that, oh, we're girls together. We can do this. Actually, the school gym, if the PE teacher will ban the boys on a Wednesday afternoon after school, we'll go to the gym. So it's tricky. And that's one of the things we're doing with Fit for Life

is trying to work through what are those barriers and how can we help young girls and young men as well overcome some of those issues yeah recently I did a documentary with BBC inside at London and one of the obstacles that we came up against with the kind of younger or the teenage girl was her um using a mobile phone device a lot more than I guess we used to see teenagers using that and that's almost become an obstacle and a block in itself for all of us for all of us because you kind of go down this war pole of of social media yeah and I think we need to almost not ban it but restrict it within school so that kids are engaging in in social activities at least you

know and then we deal with physical activity it was hard enough being a teenager i can't imagine what it must be like to be a teenager now yeah i can't imagine at all as someone told me the other day that the the first word that babies are saying now is ipad really used to be book now it's ipad oh my god it's terrifying anyway that's me just taking you guys off on attention. But John, you're also a big fan of exercise and I've heard you speak lots of times and you've written a couple of articles for the Food Medic website. Can you explain the difference between physical activity or physical inactivity and sedentary behaviour? Yeah, definitely. So there's this new kind of aspect, it's not even

new, but something that's been coming into the research a lot more is this idea of sitting disease. Now, you can be physically active and hit your 150 minutes of activity for the week and your two muscle strengthening activities. But if you are sedentary, which is sitting for long periods of time during the day, whether it be at work, whether it be commuting or watching TV, then actually you are still at an increased risk of many diseases, including cardiovascular disease, diabetes, and a range of other things as well. The research is quite clear that the kind of markers for these conditions is increased if we do sit for long periods of time.

And in fact, sadly, even our risk of dying of heart disease has increased dramatically from commuting for longer periods in the week and also from watching TV for longer periods. And the stats actually around sitting in the UK are terrifying. So 70% of our day when we're awake is spent sitting. 64 days a year are spent sitting. And it just kind of brings home how much we are kind of spending sitting these days yeah yeah i think the physical activity that we used to do 70 years ago kind of walking every day was about 15 000 step 20 000 steps on average compare that to now when we're trying to aim for 10 000 steps a day it's interesting and if we do have sedentary jobs and lots of us do we just you know that is

the modern lifestyle, can we offset our risk? Can we overcome it by being physically active or spreading it out throughout the day? Yeah, it's a really good question. So the research shows that if we are active for a certain period of that day, then yes, we can. But the amount we have to do is quite a lot. In fact, we have to do 60 to 75 minutes of moderate intensity activity in that day in order to offset maybe seven to eight hours of sitting. And for most people in the busy schedules that we have,

that's unrealistic and not really very manageable. But if we are able to stand for periods of the day when we could be sitting, if we're able to go for a walk or maybe get up every hour, even just to stretch the legs a little bit, we can massively offset that risk of sitting for long periods, which is quite encouraging because we can make those small changes to our day, whether it be having a standing desk, setting an alarm so that we do get up every hour or so to, you know, stand up and stretch our legs a bit. But it is very important that we don't kind of succumb to the chair really and just spend most of the day just easily sitting and not doing very much. Yeah, we all know that 10,000 steps a day is kind of the target that we should be aiming for, or so we're told. But what we're seeing is that actually 10 minutes of vigorous exercise might be

better. Yeah, not even vigorous, just brisk walking. The 10,000 steps, I think it's been a great thing because it's encouraged lots of people to move more. However, it's not based on science or research. It actually was dreamt up by a Japanese chap who wanted to sell pedometers. So it was a very clever marketing ploy and he called his pedometers 10,000 steps in Japanese. So this 10,000 steps has been adopted and I think has been a good thing but even if you do 20,000 steps every day if you're doing that at a slow pace moving around not being sedentary you haven't necessarily done any physical activity because you haven't increased your heart rate you haven't increased your breathing rate so you

haven't kicked off all those metabolic things that happen when we do exercise. So Public Health England would say that actually don't stop doing 10,000 steps a day. If you're doing it, that's great, but make sure at least 10 minutes of that is at a pace that gets you a little bit out of breath. So your heart's beating faster and you feel warmer, but you can still have a conversation. And for people really who just think that 10,000 steps is too much, that's unachievable the great news is well okay if you're going to do something at a brisk pace it's got to be a 10 minutes of brisk continuous walking if you do 10 minutes every day that reduces your risk of early death by 14 and gets you sort of halfway towards that recommendation of 150 minutes i think it's

also a bit more i guess feasible for a lot of people to be able to fit that in and if you can do more again the more the better we know that your risk of chronic disease actually reduces the more that you can do up to a certain point obviously but yeah there's a dose response curve to physical activity which kind of explains why the government recommendations are 150 minutes per week i think for the three of us sat here now in this booth every week we would do more than 150 minutes and there are additional health benefits to doing more than 150 minutes but actually from just a health perspective you get the majority of the benefits from 150 minutes

as long as you're doing that at moderate intensity and in blocks of 10 minutes or more and you actually get two-thirds of that benefit for the first 30 minutes per week that you do so you know as doctors and healthcare professionals and particularly from a public health standpoint we really need to encourage the significant numbers of people who do less than 30 minutes per week to do more than that it's about a quarter of the population yeah they do less than 30 minutes of moderate intensity per week and that is what's really really dangerous yeah absolutely and i think that's something we all need to start shedding about because we do get very vocal about nutrition but when it comes to physical activity we are less vocal and i think that's almost sometimes where we're falling down but it's good to see that we're talking about a bit more

i mean just to touch on that a little bit more, I mean, what's really encouraging is that we know that when we talk about physical activity with our patients, the research actually shows that if we have kind of 12 chats with patients about physical activity, one of them will actually change and become physically active. Now, if we compare that with smoking, say, where in order to get maybe one person to change their smoking habits we'd have to get 80 to 150 conversations around smoking just shows you the impact physical activity can have i mean i see maybe nearly 40 patients in a day and if i cheat to every single one of them about physical activity two of them maybe three of them are going to become physically

active i love that and actually the the fact that we get so much benefit from going from being inactive and not doing anything to just doing a little bit shows how important that message is. Just coming on for that, something that means I spoke about last summer, Zoe told me that you leave a cycling helmet on your desk, even though you haven't cycled to work. Okay, so it's all about nudges um you know people sometimes require multiple nudges in order to change their behaviors to positive ones and smoking is a good example because people often you know the more they're told by healthcare professionals and the more times they attempt to quit smoking the more successful they're likely to be so with lifestyle medicine we already said it's it can be quite time consuming to encourage our patients to make

behavior change so for a quick win I leave my cycle helmet on my desk because even if we don't get around to talking about their physical activity them seeing my cycle helmet I'm being a positive role model because they think I'm cycling even if I'm not so that's my instead of having flowers on my desk or a photograph I have a cycle helmet I think that's great and, you know, maybe we'll see GPs now, like bringing their trainers and leaving them in work or something to inspire the patients. And I think we do lead by example.

Can I tell you my little nudge? So my little nudge is at the GP surgery I work, there's a tallow system for calling in the patient. And I just don't use it. I always go out and get my patient, which prompts every single patient to, oh, is the tallow broken? No, no, no. I just, I out and get my patient which prompts every single patient to oh is the is the tallow broken no no i just i i decided to get my few more steps in by trying to walking in

and coming getting you guys i'm like oh that's good oh oh so you like being active automatically you get a conversation about physical activity with most patients and some people just go oh you're trying to get more steps in and yeah it's not doesn't go any further than that but just that little nudge i like that term that little nudge yeah make a really big difference just to start that conversation yeah absolutely and I think it also like your colleagues as well kind of click onto it and one thing that we did at in the hospital is pedometer step challenge and it was a challenge between all the teams and people got really competitive because we're like we're gonna beat them we're gonna get really like high step count and although my team didn't win despite my

encouragement it got the whole team taking the stairs for a week and I think they realized at the end they didn't die yeah and they actually enjoyed walking a bit more so and you don't run later because actually you know those moments in which you greet your patient in the waiting room and guide them to your room, you learn so much about the patient and you build the rapport with them. I think healthcare professionals sometimes don't realize just what an impact their own behaviors can have on the patients. There's such role models. And actually what I often say when I'm talking about physical activity, and this is true for any lifestyle change, just giving permission, just saying to the patient simply, you would really benefit from being more active or you benefit from eating more vegetables.

Just saying that one sentence coming from a healthcare professional can be really impactful for patients. Yeah, I think that's really good. Okay, so recently, Public Health England have released their latest strategy to tackle childhood and adult obesity. And I know that we all have our own views and opinions on this. But before I jump into that, just to refresh your mind on the Public Health England strategy, essentially, they challenge the food industry to reduce calories and products by 20% through three methods, either by changing the recipe, encouraging consumers to purchase lower calorie products and reducing the portion size. However,

they're not just targeting the food industry as their One You campaign advises that we follow a 400-600-600 rule, which means 400 calories at breakfast, 600 calories at lunch and 600 calories at dinner. Now, i know you both have your views on this and i would love if you could share them and why you think this is a good or a bad idea and john do you want to go first yeah so i think um it's had a lot of negative press the 400 600 600 campaign but i think there are a couple yeah it's a math i get it wrong every time um but i think there are some positives to take from it and i'd like to just touch are a couple yeah this is a math one get it wrong every time but I think there are some positives to take from it I'd like to just touch on a couple of those really if that's okay

so I suppose the first one is I think it's appreciating that a lot of people who I certainly see in in clinic are having a diet which actually isn't as healthy as 400 600 600 now that's not to say that calories are equivocal to a healthy diet. But if we're being honest, we know that two thirds of the adult population is overweight or obese. And I'd say that actually, the majority of my patients are probably in that category as well. And when we know that being overweight or obese does actually contribute a significant risk to a number of health conditions, then actually, it's important that we do address that. i think one of the things that public health england are trying to do is look at the calorie consumption and trying to increase calorie awareness in people so that they could actually

maybe make more um suitable choices in terms of maintaining a calorie balance or maybe even getting to a deficit and losing a bit of weight, we know that will have some benefit. Now, that doesn't mean that, as I said, low calorie means healthy. And I think that's something that it's got a lot of criticism for this message. But healthier for some of my patients, 400, 600, 600, actually it might be. And I can think of a number of patients where this would be applicable, where if they were able to lose a little bit of weight, then actually it would confer a benefit. The other side of it that I think is good is, and it's actually something that Zoe mentioned

in the conversation that we had, was around pushing suppliers to change their methods of advertising, but also to change what's in their food. So I think Starbucks, McDonald's, Gregg's and Subway have all taken on themselves to come up with meals which are these kind of lower calorie options, which does mean that people will hopefully be having a healthier version because it will be lowering calories, debatable healthy anyway if it's from those kind of places, but a healthier option and it will be lower calories therefore not as high calories during the day and potentially lead to some weight loss or at least weight maintenance which we know is such a big issue that we're kind of chasing i mean public health england talk about the fact that

they hope that with this campaign they'll i think it's saved 35 000 premature deaths and save the nhs about 9 billion um showing that this, you know, potential for reducing the calories will have a massive impact. And we see it in so many health conditions which are related to obesity and overweight. So I suppose my underlying message are there are a few benefits from this message. It's not perfect. And I'm never going to say that lower calorie means better health, because ultimately, I'd love all my patients to go away, have a whole meal food diet, you know, lots of vegetables, plant-based, high fibre, colourful food. But if I think of a lot of my patients, I don't know if that's actually something that's very realistic or achievable for them. So maybe this lower calorie option or at least some

calorie awareness might be a healthier option for them. Yeah. And I think we need to remember that Public Health England are trying to do the best for the majority of patients or the majority of people, actually. Do you want to expand a little bit on that? Yeah, I mean, I think the main point I want to get across to everybody listening on this podcast is to remember who this is for. This is not for most of our friends who are on Instagram who are

talking about macronutrients and plant-based. And this is for people who've never heard of the word macronutrient. This is for people whose diets are going to be improved because of this. I've just been doing some filming this morning for the NHS at 70. And we were on a street called Parade Street in Paddington and I was walking along the street and within about 20 meters you have McDonald's, Burger King, KFC, Subway and Chicken Cottage and there was one sandwich shop and they were all full. All those people are buying this type of food not just as a treat once a month like we might but on a daily basis they come

out of their offices, they go into the fast food takeaway, and this is what they eat. So if that person is actually thinking, well, I need to try and limit my lunch to 600 calories. And that's another thing about this campaign. It's targeting people and meals outside of the home. It's not saying to start calorie counting when you're cooking. So if I'm somebody who goes to McDonald's every day for my lunch and I start thinking, okay, my lunch is about 1500 calories, I might choose to go somewhere else. I might choose to go to Boots, for example, and get a meal deal. And instead of choosing a triple deco BLT, a packet of crisps and a Coke, I might think, okay, I need to choose the chicken and avocado sandwich, a packet of snacker jacks and a water or a diet Coke. Now that is still not a very nutritious meal,

but if that person is going to have that meal five days a week for 50 years of their life, it's better for them to be having the guidance of the 600 calories than going for double that. So I think that's the important thing is these public health messages are not for the people who are well informed about nutrition. They're not from people from middle class affluent backgrounds. They're for the people that John and I see in clinic day in, day out, who have obesity, who have type two diabetes, who have depression, have hypertension and high cholesterol, who this message is really going to hit home. And the other thing about a public health message is it has to be one short, snappy sentence.

And 400, 600, 600, you know, that's pretty short, succinct and understandable by most people. When you start talking about even things like eating the rainbow, a lot of people don't recognise or understand what that is. So public health messages have to be simple and they're targeting those with the worst health to get them to be healthier. And I think just to reflect back on something that John said at the time, we're not aiming for optimal, we're aiming for better. Yeah, and I think that's such a really important message. And when I originally read these guidelines, I wasn't 100% happy with them. And I think looking at them with, say, when you have that nutritionist-dietitian approach, and I guess it was the nutritionists and dietitians that were

a bit unsure about whether this was the right guideline and the right move to go for because it's not perfect and I still believe that it's not perfect and I think we can all agree but will it do better and will it improve some people's health and I think on reflection it probably will but it's only one piece of the puzzle and like you said John calories are not everything and low calorie doesn't always mean healthy. And I think the people who are well educated and can afford to cook from home and buy fresh fruits and vegetables, they should take these things with a pinch of salt. You know, you do not need to go home and start counting your calories and sticking to these guidelines. And I would hope that most people know that. But like you said, Zoe. I think people need to be reminded though,

because we live in a world where, you know, we have those choices. We can choose to go low carb or to, you know, go plant-based and we have the time and the resources to build that into our lives. But a lot of people don't and this is for them. Yeah. So Zoe, you're part of a new program the FAST clinic and in the first series we see five type 2 diabetics undergo a very restrictive diet in a bid to reverse their disease and normalize their blood sugars so can you tell

us a bit about this diet and what results you had? So this diet was based on some work that came out of Newcastle and Glasgow universities. Two very clever professors, Mike Lean and Roy Taylor, did a study, an intervention, where they took people with type 2 diabetes and just with the support of their GP, they did a very low calorie liquid diet, which meant they only had 800 calories per day. And that was four shakes that were made up with water and that's it they didn't chew for eight weeks some of them a bit longer some of them 12 weeks and and the results were amazing yeah at 12 months 50 percent of those who participated

their type 2 diabetes was still in remission. So 50% at 12 months. Now, the only intervention we have for type 2 diabetes that can do that is bariatric surgery. No drugs that we have can do that. And what's great about it is it's low cost, it's low risk, it's available to huge numbers, it can be managed in the community by a GP, and it has the potential to save lives and save the NHS a lot of money so so this program was really ITV entertained it up a little bit by taking these five very brave amazing people and we put them in a house under slightly unusual

conditions and we subjected them for eight weeks to this diet. What's really important and what people didn't see so much on the programme was the reintroduction phase, the sustainability phase. So food was reintroduced gradually. So after the eight weeks, one shake of their choice was removed and they had a meal that was around 200 calories instead. And gradually they replaced the shakes. Now all five of them have done amazingly well three of them are now in remission one is on her way there she's just on the cusp of and and one of the guys is struggling a little bit in a much better position than when he started so it kind of reflects the study really just over 50 of our guys are in remission and and that's six months on nearly so it's it's been a really incredible experience now remember there were certain points

on their journey but there were a couple of points that i was in tears and it was so emotional and there were certain points i was literally flabbergasted i couldn't speak i was looking at the results thinking in four weeks this person has gone from having 27% of their liver fat cells to having 4%. In four weeks. That was, for me, the results were quite astonishing. But we cannot deny the fact that it is quite a restrictive diet that would have to be done under the guidance of a healthcare professional. And these guys did have a lot of people around them so in terms of practicality do you think that we will be kind of incorporating this in the future

whether it's a local diet for type 2 diabetics i do absolutely and actually we're looking in my practice now about how we do a small pilot with some patients but you know it's not going to be for everybody no um it's going to be for people who have type 2 who feel very motivated to do this very difficult challenge in the first eight weeks they need support from either their gp or a dietician and anyone who has type 2 diabetes who is taking medication for their type 2 diabetes mustn't try this without support because that can actually be very very dangerous yeah and I guess the sustainability and beyond that is probably more important because it's one thing going into remission but to remain there you have to be very motivated to change your diet and change your behaviors in the

long run so I think if this is to be something that we're going to start prescribing as doctors, we're going to need like a full team of healthcare practitioners around us. and then you know they slip back into their old ways that's two years that their body hasn't been under the insult of high glucose that's two extra years of life without disability or life without heart attack or you know life that they don't die young so for an intervention that's so cheap if they even just sustain it for a year it's still something we should look to do yeah i think it's a really interesting point actually in terms of the reduced time when we have got high sugar levels will confer a benefit. Yeah. But also, I think one thing that's worth noting is these diets, they are hard. They're really hard.

But actually, patients seeing the benefits and seeing those sorts of results is so motivating and so encouraging. You know, we've been in a time where we've really struggled with diabetes. 10% of the NHS budget. We've now found something which you know isn't easy but when it's got the potential to change disease to the point of being in remission and giving so much quality of life back I mean the guys on the show were incredible in terms of the way that they were just super motivated but also just to see the effects that the changes had on them yes they were on a really restrictive diet,

but actually they ended up feeling better for it and feeling more energy. And despite being on a very low calorie, miserable diet, if we're being honest. I'll share with you some of the things you didn't see in the programme. So Tracy, and she was very happy for me to share this, Tracy has fibromyalgia. When I first met her, we talked a lot about her levels of activity because she wasn't able to do anything she needed to hold on to two stair rails to get up the stairs and she messaged me

a couple of weeks ago telling me she'd just done her 5k she has no pain anymore her symptoms have gone she loves the gym she's re-established her relationship with her daughter and she's found her flair again she's an artist and so she's written a book. She's painting again. She's embroidering again. So she's got her life back. And it's not just the weight that she's lost. She's actually got her life back. Yeah. It's really inspiring to hear those stories.

And I think all of us can relate to a lifestyle change, a positive lifestyle change when it comes to exercise and diet and sleep and all of these things that we talk about all the time. And I think we're so passionate about it because on some level we've experienced it ourselves and then you want to share that with everyone and and following on from that because i need to wrap it up even though i'd love to speak to you all day and can you each leave us with three healthy habits which you think we can all incorporate into our day john go first okay so i'm not going to include in my three two things which i think are vital which is being active every day you're adding on to my actual three then

uh um obviously off the back of what i've been talking about trying to reduce how much time we spend sitting so trying to make sure we do get up every certain amount of time and reduce this potential for sitting disease my second thing is uh prioritizing sleep i've been reading that matthew walker book around we spoke about that yesterday just amazing the impact sleep has on our health our well-being our performance everything including our dietary choices our insulin sensitivity all this kind of stuff's just incredible so i've really been challenged by that so getting more sleep and bettering my sleep as best I can and then also the third one is something that I've actually got off one of our friends which is

at Dr's Kitchen, Rupi which is just sharing to Rupi yeah just that idea of having three things every day that you kind of talk to yourself or write down or share with your partner or share with a friend about things that you're grateful about because I think it's really important to reflect on those things because you know we have got healthy bodies and we're lucky that we're able to enjoy that and there's always some good stuff to reflect on the day and I think actually for a positive mental well-being reflecting on those things is really important yeah lovely really good I'm gonna listen to that and take them on board for me when it comes to habits I think they're so specific to the person so instead of giving you three habits I was going to give you three tips if that's okay so um so my tips would be choose a habit that will make you healthier

also choose a habit that will make you happier and work on two at a time and make sure that whatever those habits are that they're sustainable long term wow like that that was powerful yeah amazing okay so thank you guys so much for joining me today that was a really amazing podcast before you leave can you tell us where to find you sure i'm on instagram and twitter at dr zoe williams and i'm on instagram on at the health and fitness doctor and I'm on Instagram and Twitter at DrZoeWilliams. And I'm on Instagram on at the health and fitness doctor. And I'm on Twitter as well at John Sykes underscore six. Amazing. Well, thank you everyone for listening and tuning in. Make sure to leave a review and let us know what you thought of the podcast.

And also, please leave a rating. I'll see you next time. Thank you so much for tuning into the Food Medic podcast. Please do subscribe so that you are the first to hear about any new episodes. And if you are enjoying them, please leave us a five star rating and a review so that we can reach as many people as possible. Check out my website, thefoodmedic.co.uk where you can find tons of recipes and articles. Follow me on social media, Instagram, Twitter and Facebook at The Food Medic and my new book The Food Medic for Life is out now which is packed full of loads of recipes, nutritional advice, myth busting and feature pages on topics such as sleep and mindfulness. You can grab both my books on Amazon or in any good bookstore.

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