The Food Medic - S5 E8: Overheard on Social Media: Nutrition Edition

Episode Date: February 22, 2021

On this week's episode Dr Hazel is joined by Danny Lennon and Alan Flanagan. Danny is perhaps most well-known for being the host of the top-ranked podcast, Sigma Nutrition Radio, where he discusses nutrition science with academic researchers and dietitians. Alan is currently pursuing his PhD in nutrition at the University of Surrey and is the founder of Alinea Nutrition and also a Research Communication Officer for Sigma Nutrition. The topic of this podcast is a bit of a mixed bag of everything to do with nutrition. Topics covered include:* ”Diets don’t work” * HAES/Health-at-every-size* Nutrition and Supplements for PCOS* Turmeric and cancer claims* Intermittent fasting / Time restricted feeding* Metabolism “boosting” foods * Soy and gynecomastia (a.k.a. man boobs.)If you loved this episode make sure to give it a review, rating (hopefully 5 stars) and share it with your friends and family. @thefoodmedic/www.thefoodmedic.co.uk Hosted on Acast. See acast.com/privacy for more information. Learn more about your ad choices. Visit podcastchoices.com/adchoices

What's better than a well-marbled ribeye sizzling on the barbecue? A well-marbled ribeye sizzling on the barbecue that was carefully selected by an Instacart shopper and delivered to your door. A well-marbled ribeye you ordered without even leaving the kiddie pool. Whatever groceries your summer calls for, Instacart has you covered. Download the Instacart app and enjoy $0 delivery fees on your first three orders. Service fees, exclusions, and terms apply. Instacart. Grocer $0 delivery fees on your first three orders. Service fees, exclusions and terms apply. Instacart, groceries that over-deliver. Hello and a very big welcome back to another episode of the Food Medic Podcast. I'm your host as always, Dr. Hazel Wallace. This podcast episode is sponsored by Murad. Murad is the dermatologist developed skincare

brand that approaches skin differently. How? Through founder Dr. Howard Murad's four main pillars of wellness for total skin health. Eat your water, awaken your body, be kind to your mind and of course nourish your skin with their high performance formulas. For more than 30 years Murad has been committed to developing clinically proven cruelty-free products that meet the meticulous standards for safety, efficacy and care you'd expect from a doctor. My personal favourite product is their best-selling Retinol Youth Renewal Eye Serum. Retinol is a derivative of vitamin A which helps improve skin cell turnover and reduce the breakdown of collagen.

I find this product is great for reducing the appearance of fine lines and improving skin texture. It's suitable for all skin types, even sensitive skin, and you can use it all over your eye area, including the lids. Thank you to Murad for supporting the Food Medic podcast. Now today I'm joined by two guests, Danny Lennon and Alan Flanagan. Danny is founder of Sigma Nutrition, a company providing educational media content on evidence-based nutrition. Danny has a master's degree in nutritional sciences from the University College Cork, in addition to an undergraduate degree in biology and physics. Danny is perhaps most well known for being the host of the top-ranked podcast Sigma Nutrition

Radio where he discusses nutrition science with academic researchers and dietitians. And Alan who has been on the podcast twice already is currently pursuing his phd in nutrition at the university of surrey after having completed his master's degree in nutrition science at the same institution alan is founder of alinea nutrition an online educational hub dedicated to providing impartial science-based nutrition analysis and is also a research communication officer for Sigma Nutrition, creating educational resources for nutrition science. So these guys are very qualified. The topic of this podcast is a bit of a mixed bag of everything to do with nutrition and the idea came from one of the regular pieces that you see in circular magazines around the city one of which is overheard in London or

overheard in the tube and basically I wanted to do something similar and do an overheard on social media nutrition edition so we bounce from dissecting claims such as diets don't work to PCOS to fasting to turmeric and a few things that you guys basically wanted to get fact-checked. And so sit back, strap in, get your journals out if you want to take notes, because I know I learned a lot from this podcast, and I'm sure you're going to also. Dani Allen, welcome to the podcast. So what sparked this topic suggestion was your post, Danny, on the meme with the statement to avoid root veg in the week due to the fact that they store sugar. And I think, like, I hope that most people listening to this know that that doesn't really make any sense. But why is it important that we address these absurd claims and not just simply ignore them?

So I think the reason why for that post and why I don't think it's necessarily just calling something out for the sake of it is it's not benign advice. It's not that it's just ineffective or incorrect, but it actually has negative impacts on people in the real world. So I think there's probably two separate aspects to it in my mind. One is that that specific statement about root vegetables only being consumed at the weekend because they should be seen as some sort of treat. Number one, that's obviously nonsense because it doesn't negatively impact health. And more problematically, it actually pushes people away from a healthy choice that

they've probably started to make or that they're currently making. And they've made a real positive change and feel they have this good dietary habit. And now they're being told it's a problem. And then second, it also creates a rigid food rule and that has a negative impact on psychology. And so I think from a lot of the research now, there's a large body of evidence looking at how rigid dietary restraint is associated with a whole host of problems, both psychological health and then an ability just to maintain any certain type of dietary approach. And by this term, rigid dietary restraint, really this is where we have dichotomous thinking. So seeing things in all or nothing terms or having strict rules around food that can't be broken.

And when you have rigid restraint like that, you're essentially setting yourself up for feelings of guilt and shame around food. So in relation to that specific example you raised, that was a case where we that, not only is it unhelpful advice and a waste of someone's time to try and enact it, it actually comes with real serious downside because it creates a fear around food. And it has people avoiding certain foods that are actually healthy and they're doing that out of fear. And so it has people believing that they're doing something wrong, and it leaves them with a feeling of shame and guilt. And so I think that is why claims like that shouldn't just be left and put off and not called out, because they can have real damaging impacts. And so yeah, that's kind of some of my first kind of thoughts on that. Yeah, I think there are degrees to what you can slide if you have, you know, roles in the public communication sphere, as Danny and myself do. You know, there are certain things you can kind of just say, this isn't worth engaging with. But with nutrition, we have this and this is something that's, you know, being talked about a lot over

the last couple of years is we have so many people who want to be stakeholders, healthcare professionals of every discipline, personal trainers, and then just your average interested lay person. And so you've a lot of voices that are kind of competing. And the risk of the kind of information that comes from healthcare professionals, irrespective of their discipline, but particularly with medical professionals, where you get this high level of public trust and also authority bias, you know, information coming from that source, we shouldn't have to be having to correct something for being grossly incorrect. And that podcast that that claim came from, there were a number of frankly ludicrous and completely unscientific claims that were made in relation to nutrition as it related specifically to women.

Now, generally, you know, as a healthcare professional and someone who has at least trained to some degree in kind of an evidence-based approach, if you didn't know what you were talking about, most people wouldn't touch another discipline with a barge pole. But there's something about nutrition, you know, the ubiquity of, you know, food is something we engage with every day, where unlike other areas of health science, there's this almost sense of kind of entitlement that people have that, well, I can talk about this issue. And people don't have the kind of checks and balances that they might otherwise would if they were, you know, going to speak about something. So I think when it comes to information coming from other healthcare

professionals, irrespective of discipline, I do think that it is important that, you know, as Danny said, we don't just let the information go without being challenged. And, you know, because it's healthcare professionals, generally, you can either refute what they're saying by reference to evidence, or you can simply ask them for evidence in support of their claim. And they should be able to provide supporting evidence for that claim. And if they can able to provide supporting evidence for that claim. And if they can't, then they really don't have any business being in the conversation in the first place. But frustratingly, you know, we know that that's just not as simple when it comes to nutrition. No, and I think people are potentially cautious to question those who have qualifications and healthcare disciplines,

may it be medicine or anything of that kind of nature. And you don't really want to question it or you feel like, well, you know, they know their stuff. They've been to uni, they've done a scientific degree. But like you said, you also see a lot of people chipping in now who have various backgrounds whether it's a you know personal trainer health influencer blogger everything and like you said when it comes to food it's something that we are all familiar with we all eat and it seems like a very simple science And the advice is easily accessible in terms of the kind of top line advice. And so a lot of that's regurgitated. And that kind of brings me on to the next point, which is something I want to pick apart.

And I know that you both have discussed separately and also together kind of on relevant podcasts and articles. And that's, again, black and white thinking and the phrase that's often regurgitated, and that's around dieting. And it's the phrase diets don't work, which is a slight stretch and oversimplification of the actual situation in terms of what the evidence says. No one really goes into what the research says. It's just that's a statement we leave it there and I think for some groups of people that's a really good take-home message because they've kind of gone down these various routes but I think let's get into it a bit on this podcast and talk a bit more about what the research on long-term weight loss actually says. Yes so I can put a few ideas and I'm sure Alan has some things to expand on. And I think

you're right. This idea or this bite-sized piece of information of dieting doesn't work has probably most stemmed from those within, or at least promoting weight neutral approaches or the non-dieting community. And it's came out of this acknowledgement that when we look at the prevalence of weight regain following weight loss interventions, it actually paints a relatively bleak picture oftentimes in that there is a substantial amount of weight regain over time. And the long-term success around those who go on a weight loss intervention, it's actually not that high of a success rate typically depending on where we look. So that gets boiled down to, well,

dieting doesn't work. And so there's no point in doing it. Let's put our focus elsewhere. And I'm not painting that as that's what everyone is saying, but I think that's the interpretation sometimes people get when they hear that. And there's, of course, some validity to the idea, if we're saying, does it mean that there is a relatively low success rate when you look on a broad scale of people who undergo weight loss intervention? Yeah, you can make a strong case there, but it's much more nuanced, right? So we're looking at people who have gone through various different types of interventions with various different amounts of support. And that may indicate a different success rate than someone who is getting an appropriate support with a professional and has enacted different types

of behaviors and habits. So to give the idea that dieting doesn't work, so let's not bother trying also ignores the potential upsides that there may be for someone, whether that is in relation to their physical health or their quality of life, or maybe even psychological. And we do know, if you look at some of the literature, it's of course possible for people to lose significant amounts of weight and keep it off. I think one of the most cited places would be the National Weight Control Registry, which is basically this prospective investigation of tens of thousands of people at this point who have lost more than 30 pounds, which I guess is 13, 14 kilos, and kept that off for more than five years. And so you have at least the ability to see that it can be done. And we know from literature that there's different factors that would influence

how likely someone is to have long-term weight loss maintenance. And I think the point we need to get to is rather than saying saying should everyone lose weight or should everyone avoid trying to lose weight it's probably instead looking at who is this a good intervention for and who is this a bad intervention for who could be possibly harmed by that and then making a decision on a case-by-case basis yeah yeah part of the difficulty with where that conversation is now, where it went quite quickly, is because of the fact that a lot of the core tenets, you know, things like, you know, dieting doesn't work, like we're talking about now. These came a lot more from the kind of activism side of the equation, and less from the evidence side of

the equation. And activism and evidence don't really tend to mix very well. And I think there are potentially debilitating consequences to viewing this issue through a very kind of dichotomous lens one way or the other, i.e. to maintain that weight loss is warranted in all circumstances, under all conditions, and that weight loss is a benign intervention, right? Well, it's an intervention and no intervention is risk-free. Conversely, this idea, and we reached some levels of absurdity with the assertions of health independent of weight. And there is a gray area, particularly where prospectively BMI is used as the proxy for kind of adiposity. BMI can be useful at the extreme ranges at the population level. But when you're in this area of, say, 27 to 35, it's not always a

particularly good indicator of factors like regional adipose tissue distribution, gender differences in risk associated with adipose tissue distribution, and factors like this that are really important. So on both sides, the baby gets thrown out with the bathwater. And in reality, we should be trying to reconcile some of the discrepancies within that evidence base. On the side of the fence that says that, for example, weight loss is warranted in all circumstances, it's benign, it should be recommended. What people are not paying attention to there is literature going back to the early 90s that shows that where people have high levels of disinhibited eating or restrained eating

scores coming into a study, they're the ones that are the likeliest to start rebound weight gain immediately after the dieting phase. And what this has told us is that people who often rebound the quickest and regain the most weight were people who were having behavioral issues with food and body image and weight prior to the intervention. So they never should have been put on an energy restricted intervention in the first place. And this is where people on the kind of non diet side have a really valid point, because the field has largely failed to appropriately use screening tools prior to interventions to try and identify people who might fall into this bracket. You know, on the other hand, then we have this kind of very dogmatic

position now that weight loss is never warranted in any circumstance. And there's been ludicrous claims by people within that community, for example, that weight loss shouldn't be recommended for type 2 diabetes, because we have really good available drugs. Well, the first thing is that the drugs that are available only really work for glucose disposal. And we know that diabetes is characterized by this progressive decline in beta cell function. To date, the only intervention that we have that can really, truly restore beta cell function is Roy Taylor's very low calorie dietary intervention. So the idea that you would say, well, my belief on this issue means that I'm excluding this as a consideration,

I think is a really problematic kind of position to adopt. So I think there's issues with both sides of the conversation with this. And I think that there could be a lot more of a nuanced understanding brought to the table. Yeah. And I think echoing what you said and similar to the first conversation that we had, it's people taking camps and taking sides and and really identifying with those beliefs and feeling almost fear to step into an area where we can have a conversation about this because I want this conversation to be had because I feel like it's not being had because people are afraid to step out of their comfort zone to kind of look at the other side, weigh up the evidence. And it's not saying that dieting and weight loss or the pursuit of weight

loss is suitable for everyone. I'm absolutely not saying that. And nor am I saying that weight loss is essential for health. But there are some instances, and you've mentioned one Alan there in type 2 diabetes for example where some patients will really benefit from a weight loss intervention but again that still needs to happen with their consent when they've had informed consent and they know the risks and the benefits of each and for people to kind of completely push that aside and say you know there's other ways that we can do this I think that we're doing our patients and we're doing people a disservice by not giving them all of the available options. Yeah. And I think actually in practice, a lot of times what happens is we can reinforce our own position. So let's say someone is a practitioner and only uses weight neutral approaches, which is completely fine. That may

be their area of expertise and their practice. So what they're getting reinforced all the time is consistent success stories and people who are really finding this beneficial, who this intervention is really useful for. And then you're at risk of seeing that everything is going to get improved by it. And you maybe are more likely to move away from it. On the flip side, you see a lot of the times within the fitness industry, a weight loss is the answer to everything type idea from some people, because again, it's being reinforced that if your sole intervention used within your practice is getting people to lose weight, then you're going to have

a certain amount of people who are successful with that. And that kind of reinforces it. So you see positives on both sides, but you can also see people harmed potentially on both. And as Alan alluded to, it's about having the understanding of what are the pros and cons of each of these interventions and for each individual who is suited best to a different type of intervention at this time point and that may change over time but to say that there are no benefits of either one of them is just a miscategorization of each of those interventions i think yeah and you kind of touched on it already, but I think there are a lot of practitioners moving towards kind of a weight neutral health at every size approach. And that is a specific kind of training. And none of us are trained in that way. But I know that we've all had discussions separately and also together about this. And I think it would be good to kind of talk about some of the positives about moving away from a weight centric approach, because that's something that can can be really beneficial. But also let's talk about some limitations to that approach as well.

Yeah, I think it is important to really pay attention to the non diet movement, and particularly some of the literature for the intuitive eating intervention, there's a lot that we can take out of that, with implications, I think, for the wider field of nutrition as a science. And what I mean by that is, we're very quantitatively focused in nutrition. and diet is an intrinsically behavioral aspect. And it's also strongly influenced by all of these kind of environmental and other, you know, non-diet lifestyle factors. And so we tend to miss a lot of opportunity for doing good qualitative research or mixed methods research. And I think that that's something we can take from that space as something that would be a positive to try and implement more in the

field. I think on the more quantitative side, there are a number of benefits that seem to be relatively clear to me anyway, from that overall literature that the first is coming back to this idea of health at the extremes, you know, someone who is in their late 50s, advanced diabetes, you know, increasing pharmacotherapy, you know, that the level of the intervention that they're going to need, something like an 800 calorie a day liquid diet, really is reflection of of how far along they are with it with the disease process for a lot of people who are earlier in this in you know life and have have been on a dieting merry-go-round where we are bombarded with multiple body image cues and marketing to look a certain way have a certain diet and all of that. And it's been

amplified by social media, the ability for people that aren't necessarily in a major risk factor category to be able to improve their health independent of weight loss that is evident in the research, you know, people who are highly physically active, people who have very good dietary practices that are consistent. And, you know, people who take care of stress, sleep well. All of these additional variables are really important to the overall relationship between someone's long term health, obviously. But they're also really important to someone's overall diet, there's a kind of bi directional relationship with these factors. And so I think that the idea that there is a question over whether someone can improve their health independent of weight loss

should probably be put to bed, people can improve their health independent of weight loss. The question again, comes back to the context of the particular individual we're talking about and what's sought to be achieved, having regard to their overall health status. I think that when you look at some of particularly the intuitive eating interventions, you do see quite significant, certainly statistically significant, but also clinically meaningful improvements in things like blood cholesterol levels. And that's independent of weight loss. Some of the principles within the 10 steps, they're not sequential necessarily, but these 10 kind of construct principles of intuitive eating are inherently accessible to people. They're a lot more, I guess, well, intuitive, excuse the pun, than giving someone kind of more general, eat more fiber, eat less saturated fat.

Those types of recommendations are quite inaccessible to most people. So I think there's a lot that we can take that are positives from that space. The emphasis on behavior over outcomes, the emphasis on positive lifestyle factors that are independent of weight loss, and the general positivity of self-acceptance and these other variables, positive body image,

and these kind of additional factors that are really core to interventions like intuitive eating and the wider kind of non-diet approach but that we often just completely miss with the wider area of science where we're just focused on you know how many carbs did they eat for six weeks and how much weight did they lose and these kind of very quantitative factors that miss the big picture often yeah i think you're actually seeing a lot of those ideas being adopted by people who are outside of a typical non-diet approach and people nutritionists dietitians fitness professionals and so on who have seen the rise of some of these ideas and have taken many or some of them at least on board and i think that is on the net balance a

very very good thing because some of those positives, as Alan's alluded to, including that it's removing weight or someone's body shape as the primary goal, which has been for a long time within certain fitness circles, success was judged purely on weight and it kind of removes that, or at least gets a shift in focus. And then it also is preventing weight from being as that only outcome of interest. So it highlights these other areas of health and other behaviors that can improve health, getting people to think about the real outcome we care about is our quality of life, right? It's not actually the number on a scale, even for someone

who is trying to go through a weight loss intervention. So it kind of refocuses and recalibrates people's target to be on the actual real bullseye, which is improving quality of life and overall health, which encompasses both psychological and physical health, as opposed to just seeing this proxy of weight as determinant of whether we're being successful or not so i think that's been very beneficial yeah switching the focus onto the outcome like you said the it's quality of life that we're we're aiming for and whether that measure includes weight lost or it includes waist circumference or something to do with body composition that is just going to be one measure of several measures and it doesn't

you know tell us the whole picture but i think where weight centric approaches fall down or where people kind of can get their heads a bit stuck in the game is when it's purely on the number and purely on appearance. And I think that's possibly one of, as we said, one of the biggest benefits to this movement and these kind of nutritional approaches is that I think we do as well have to acknowledge the potential downsides, which is not very difficult to find, because unfortunately, it's highly prevalent. Again, tied to this kind of more activist side, which is almost a complete denial of the relationship between adiposity and disease risk. And sometimes when you get into this with people in that paradigm, you end up with these almost contradictory positions. For example, you'll have people commonly say, well, we're not

opposed to weight loss, we're opposed to the deliberate pursuit of weight loss. But actually, really, when you pay attention to the rhetoric of that movement, they are opposed to weight loss, simpliciter. And the idea that weight loss would result from a given intervention is almost decried. And then you'll get, well, we're aware of the risks, but we need to change the conversation. Right, that's fine. We can change the conversation without ignoring risk. And so we get you know, we get into these kind of almost, again, quite entrenched belief silos where people have just camped, and they're not going to move from that place. And ironically, what I find with, you know, again, when you look at some of those approaches within the non diet space, you know, and this comes from the activist

side, you'll hear people say, well, we're not the experts, we let the person be the expert of themselves. And I'm like, that's great. But if weight loss is involved, then they'll step in and make an assumption on behalf of that person that it couldn't be having a positive impact on their on their life or on their mental health or otherwise. And so they're willing to not be the expert of a person when they're following these principles and, you know, focusing on behaviors and not weight loss, but they're willing to second guess anyone that does lose weight and says that they've improved their health or mental health or whatever as a result of improving their health through weight loss. So those inconsistencies, I think,

in their overall logic are frustrating. And my worry is that with some of that rhetoric, there's obviously people who need to hear it. But the idea that there are people who might be attracted to this rhetoric and avoid taking some potentially necessary steps as an intervention for their health where it is warranted, that's potentially a kind of a worrying downside. And I think a bit more intellectual honesty from that movement would go a long way to balancing out this conversation. Yeah. And I think it's a really nice kind of segue into the next topic that I want to discuss because it's a condition that's largely wrapped up in this and that's often a blanket recommendation and I know that from both clinically as a practitioner but also as a patient who has PCOS and I think obviously PCOS affects women only and they seem to be subject of a lot of diet culture and weight loss is often

very much an issue for them and I know that you guys have written quite an extensive article on women's nutrition and I'd love to look specifically at PCOS for a minute and just talk about what are the evidence-based management options and maybe touch on the two different phenotypes that we see in PCOS and what I mean by that is we often see kind of this classic PCOS picture where you have all of the symptoms of PCOS and the patient may have higher adipocytes or their higher body weight. And then you have this other lean phenotype, which isn't really discussed in clinical guidance. It's not really discussed in mainstream leaflets for patients, but it's something that we're seeing more in the metabolic research. And if we could, I know that's a lot

that I've just asked for. Yeah. I think your point about the lack of discussion of the phenotypes is important because with PCOS, much of the focus, indeed, much of the research and consequently the advice is based on a particular phenotype, which is characterized by higher levels of central adiposity, higher levels of circulating androgens and hyperinsulinemia or high insulin levels. There appears to be in female physiology, a relationship between insulin and androgens, elevated insulin may drive androgen production. And you get this overall picture of HBA access dysfunction. This phenotype can exist with or without, it seems, actual cysts evident on the ovaries. So there's been more of a focus on the kind of endocrine aspects of PCOS in the diagnostics. For that phenotype, yes, we do tend to see that weight loss will benefit because of improvements in androgen levels of reduced

androgens. We do see therapeutic application for lower carbohydrate and high protein diets in this phenotype as well. And there's a benefit for having more of an orientation towards low glycemic index, low carb in this context really doesn't mean the low that we're kind of used to seeing a steak on a plate, it's really kind of in a, you know, 30 to 40% range. But we tend to with those lower, you know, 30, give or take 35% carbohydrate and higher protein, so 30, 25 to 30% dietary protein C, a preferential loss of abdominal fat and improvements in insulin sensitivity and a reduction in testosterone levels. The lean PCOS phenotype is a bit more of a head scratch. In my opinion, it seems to be under-researched. And some of the endocrine characteristics of that are

slightly different. So lean PCOS women tend to exhibit a much higher ratio of luteinizing hormone to follicle stimulating hormone. And they have high levels of leptin, which is generally an adipocyte. It's a hormone that's secreted by fat cells that tends to communicate to the brain about energy balance. And this phenotype will have lower insulin levels or insulin resistance. And there isn't a huge amount understood, or it's not as well understood. There's a hypothesis that in lean women, there could be a relationship between leptin and estrogen, and that that might be driving the HPA access dysfunction. So it's still coming back to HPA access dysfunction. It's just

like what's actually at play. But in so far as elevated leptin is evident, it could be that in this phenotype, weight loss actually would have negative effects, and that could act as a driver for menstrual irregularities and luteinizing hormone dominance. So in this phenotype, and again, this is more hypothetical, trying to kind of put some of these pieces together, you know, it could be that actually cutting carbohydrates and aiming for weight loss would actually aggravate the amenorrhea and loss of ovulatory cycles. But there's not really as much necessarily from a dietary perspective. We do have quite a well-established, now much more appreciated understanding of the effect of supplemental inositol. And this appears to be effective independent of these phenotypes,

i.e. where it's in relation to not just metabolic improvements, but also return of ovulation recycles and ovulation induction. We tend to see benefits for this combination of myo-inositol and d-chiro-inositol in a kind of 40 to 1 ratio of myo to d-chiro. And you tend to see reduced insulin resistance in people that have the hyperinsulinemia, but you also see regularization of menstrual cycles and spontaneous ovulation in people that are of the other phenotype so yeah it's um it's complex and there's there's not really as much as far as the dietary interventions go from the lean side of the fence no but i think kind of the mainstay seems to be kind of a low gi diet and uh i guess regardless of the phenotype there like you mentioned it's not advising people to go on like a low carb, high fat diet.

It's not super low carb and it's likely it will encourage maybe more nutrient dense foods as well. And from a supplement point of view, you mentioned inositol, but is there any other supplement? There's so many that keep coming up in the research, but they're like isolated studies. And I know that I'm kind of getting sent them by, by different people who are interested in wondering whether it'll work for them or not. And things like folic acid, and there's quite a few of them, I wonder whether there's anything of benefit or anything of note. There was some promise for, we did mention this in the statement for N-acetylcysteine, which is a kind of acetylated version of an amino acid. And there are one or two studies that have suggested that when the

aim is ovulation induction, that using it in additional to a pharmacotherapy intervention with clomiphene might help too, because you do get women that are clomiphene resistant. There's a couple of studies that have shown a benefit to N-acetylcysteine for ovulation in clomiphene resistant women, but the evidence is pretty shaky. And actually, there seems to be more promise for metformin than N-acetylcysteine. I mean, metformin seems like a pretty wonder drug. It does everything. It does everything. But one of the other kind of treatment arms that's important to mention is exercise and particularly resistance training, because going back to the pathology, if this is driven by insulin resistance and glucose handling,

having kind of a strength training training resistance training program would be beneficial for lots of reasons but also to help regulate glucose handling and help improve insulin sensitivity right and i think the one of the great things about resistance training is what happens when you have that muscle contraction after resistance training is you get a movement of some of those glucose transporters from inside of a muscle cell to the surface of that cell they're called these glute four transporters and they allow glucose to move into the muscle cell independent of the action of insulin so this is obviously great if we take a case where someone may be insulin resistant already, now you have a readily available way to move glucose from the bloodstream inside into these cells without having to even

rely on insulin because you have this non-insulin mediated pathway essentially. So resistance training for that purpose can be very beneficial, like you say, for reasons of glucose disposal. Okay, cool. Well, you know, I attended the second part of the podcast to be on the kind of overheard, but we're already running super over. So we're going to do this more as a quick fire. So essentially, these topics have been sent in via Instagram, and what things they've heard on Instagram that have caused confusion or keep coming up and they just need someone to bust it essentially so the first was one teaspoon of turmeric a day will cure cancer and I'm going to give this to Alan because he I know he kind of has gone off on why because this was this is your topic of interest no oh stuff like and the thing is you know you could probably find some study in you know a journal with at least seven words in its title

from you know a group somewhere yeah i i think the turmeric thing is one of those examples of where we do have research that shows that bioactive components in different foods, particularly spices, dark-skinned berries, have biological activity. But that biological activity is quite subtle. It might add up over time. The idea that it has a magnitude of effect to cure something like cancer is absolutely ludicrous. And I think people need to just be really, I would say skeptical, but I'd also maybe stretch that to cynical when they hear claims about diet and cancer now, because, you know, it's such a complex disease. Each cancer site is unique. And the idea that you've got this nutrient or food or spice or something that's going to cure it, I think is, it's a particularly nefarious myth, and it just needs to

needs to die. Absolutely. I mean, we're not even that absolute when we talk about chemotherapy and radiotherapy, and they're kind of extremely heavily researched in oncology. And I think, like you mentioned, when it comes to absolutes always be cautious next one's for you danny is it possible to speed up your metabolism with food green tea apple cider vinegar etc so in terms of food well every every time we eat food there is some impact on energy expenditure so this is something called the thermic effect of food or diet induced thermogenesis. And that's, we've known as being influenced pretty much by the size of your meal and the macronutrient breakdown. But then there's this extra interest in things

beyond that. So spices or green tea or caffeine containing beverages. And so overall for things like green tea, caffeine, different types of spices, you kind of have a mix within the research, but overall it seems that there's either not really much impact on metabolic rate or where there is a detected difference in metabolic rate, it is so negligible as to not really be practically important for people who are, let's say, aiming to meaningfully change their energy expenditure that's going to have a real world impact. So whilst we could point to maybe some studies that may show slight increases in energy expenditure, let's say across a day with high intakes of some of these different compounds, the absolute amount of calorie expenditure is

quite low, or in some cases just doesn't happen. And the impact therefore is kind of unimportant. So I would say it's not really a target to worry about of trying to have high intakes of certain types of nutrients or supplementing with green tea catechins or things like this, with the idea of this is going to have a meaningful impact on body composition primarily is what people are presumably doing it for yeah i think you summarized that quite nicely basically don't waste your time okay the next one is soya makes men grow boobs um so first of all let's just tease apart where that's coming from i think a lot of people kind of know the i guess where someone might draw that conclusion from and that's because there's phytoestrogens in soy which can mimic or similar to the estrogens that we have

in our body but are obviously very very less potent and so that's caused lots of other concerns like it will drive estrogen receptor cancers and things like that but man boobs is another concern and quite a few men have sent this in so who wants to take that one um i don't mind taking it I think you've kind of summarized where it comes from very well. And I think it's this idea that these phytoestrogens and soy are going to act the exact same as estrogen. And people then tend to look at various different mechanisms. For example, in men, if you see a dramatic change in the testosterone to estrogen ratio, that lead to like this tenderness in breast tissue or swelling or gynecomastia maybe and then people will look at things and say oh in let's say a male to female

transgender patient taking estrogen is one way we can stimulate breast growth so therefore if i'm having soy it's going to have the same effect. So they're kind of pulling these different mechanistic things that happen with high levels of estrogen and trying to apply that to what happens with normal soy intake. So in terms of actually any data on this, I think the only one that people can ever actually cite was a case study. I think it's like a six-year-old man who was drinking like nearly three liters of soy milk a day and had developed gynecomastia. And then that basically resolved when he stopped drinking the soy milk. But beyond that, when you look at any other evidence looking at normal intakes of soy-containing or soy-based products, you don't see any evidence to suggest that it lowers testosterone to any cleaning full meaning degree raises estrogen to a problematic level or leads to

the growth of breasts in males at least from what i can tell from speaking from personal experience i think i saw a study as well in rhesus monkeys so as long as the the people sending in the messages weren't rhesus monkeys i uh i think they should be fine okay i think so too uh the next one came up in various forms but the kind of catchphrase is fasting slash intermittent fasting and I don't know about you guys but this comes up every time I do a question box and I think it's become a bit of a buzzword and a jack of all when it comes to health and I think people are just you know for any ailment or whether it's weight loss or longevity or curing brain fog whatever it might

be everything just you know just fast you'll be grand and i think we should talk about the potential benefits from what we know from the evidence and perhaps some gaps in the research and i guess alan this is your your bag i mean i think we're still in a place with human research where we we have more gaps to fill than kind of evidence that we've built. You know, the fasting craze really seems to have taken off with Martin Birkin's Lean Gains, 2006, 2007. And it hasn't gone away. And partly it hasn't gone away because there is different forms of either intermittent fasting, where you have intermittent periods of a condensed or energy restricted period. And that can be random from day to day. And then you've time restricted

feeding, where you're deliberately shrinking your daily eating window, but you're not changing that pattern from day to day. And in terms of benefits, a lot of it has been overstated in terms of you'll hear people make claims about longevity. And, you know, it's really largely based on mice, and it's impossible to extrapolate that to anything meaningful in humans. What we do have, though, is the potential for this strategy. In the context of Western diets. People often spend up to 16 hours a day in what's known as a post-prandial state, i.e. they have food in the system being digested, absorbed, assimilated, distributed, and excreted. And a lot of the conditions that we had that we're looking at now, for example, liver fat accumulation

and the relationship that that has to insulin resistance, diabetes risk, cardiovascular risk, cardiovascular disease itself, the more you have circulating levels of cholesterol in this postprandial period, blood glucose levels as it relates to diabetes risks. So we've often tended to think about nutrition in an acute sense, you know, you eat this meal, and then you get on with your day, right. And most people aren't aware that, obviously, after eating, there's all the processes to process that meal. And then you eat another meal, and that compounds what you've just and then you eat again. And often people are eating later into the night. So there's the potential for a restriction on feeding time,

whether you want to call it intermittent fasting or time-restricted feeding, to be of benefit to a lot of people in the population who maybe eat kind of later into the biological night. And we know that that's implicated in kind of long-term adverse health outcomes, and also the potential for people that just, you know, spend a lot of the day in a fed state to think more about trying to shorten that eating window doesn't have to be extreme. So that's where we tend to see improvements. And there was a study, Rona and Tony, her PhD research at the University of Surrey, they did an intervention where they took middle-aged women and they just had them shrink their daily eating window by three hours by delaying breakfast by 90 minutes and then bringing dinner forward by 90 minutes. And

each of them could pick their own time. So it was just based on what your habitual breakfast and dinner time was, delayed 90 minutes at one end and brought forward by 90 minutes. So it was just based on what your habitual breakfast and dinner time was, delayed 90 minutes at one end and brought forward by 90 minutes. So the symmetrical compression of the eating window. And you saw a reduction in visceral adipose tissue, which is obviously a fat depot that's primarily implicated in cardiometabolic disease risk. So there is the potential benefit. The downside is that people decide they're going to shrink the eating window to an hour a day and have some lemon water and, you know, and all of this related kind of extremism that we tend to see in that movement. And there's not

really anything as far as human evidence that would lead us to suggest that that would be, you know, useful or actually result in any kind of meaningful change yeah in fact there's risk associated with that in terms of eating disorders and disordered eating you see one of the behavioral red flags is excessive amounts of fasting so again for certain people it may not be just a kind of benign intervention yeah and i think it's there's this kind of trend towards like putting your body through extremes for i don't know hashtag longevity and telomeres you know fasting is one arm but there's also you know cold water immersion like breathing techniques and you know there's all these all these different ways that people are trying to biohack themselves and it's i see this definitely in like a male cohort like it's very ego driven like how hard

can you push your body yeah it's real you know it's the silicone valley thing it's like hey i haven't slept for five days but you know i haven't eaten either and i'm i've optimized my core body temperature yeah yeah there's also a weird thing with the longevity kind of crowd where it's like this preoccupation with optimization and i think me and you alan maybe have privately talked about this where it's like a like a mortal fear they have right and therefore it's just this preoccupation with optimizing health in every possible way even in manners where they manners where there's literally no evidence to suggest this intervention will be useful. And I think, yeah, the longevity space is one

that's particularly prone to quackery. I agree. I think you get a lot of people who genuinely are absolutely terrified of their own mortality. And they're willing to do ludicrous feats to try and stave off the cold, icy hand of death. And it's fine for us all to take an interest in our health. But what you see with these people is you know from the type of things that they're doing on a day-to-day basis, that they don't have any room in their life for a glass of wine in the evening. So I wonder what toll this is taking and what kind of place this is really coming from. And it seems to me to be maladaptive, really, rather than coming from a place of like, yeah, I'm interested in my health and I go for a cold swim in the 40 foot of a Sunday morning.

It's not really that kind of crowd it's it's much more extreme yeah absolutely okay cool guys last one weight loss is just down to eat less and move more which is probably a slogan of Joe Wicks so let's chat a little bit about the calories in calories out debate. Um, probably one for you, Danny. Yeah. So I think this is one where I see there's so much misinterpretation about calories in calories out, which is really just kind of slang terminology for talking about the energy balance equation. So when we're looking at potential changes in the amount of energy that's going to be stored in the human body or not at potential changes in the amount of energy that's going to be stored in the human body or not it's simply the amount of energy coming in versus the amount going

out but for the sake of time i think what's most relevant to understanding how people are talking past each other here is that some people interpret calories in calories out to be different things and so you'll hear people say oh calories in calories out to be different things. And so you'll hear people say, oh, calories in calories out is nonsense. But what they're really saying is, oh, I think having to track or count calories is nonsense. That's fine if you believe that, but that's not the same thing as calories in calories out. That's not tracking calories. Saying calories in calories out is true or holds true in relation to body composition is

not the same thing as just telling someone to eat less and move more it's not the same thing as basing diet decisions solely on the caloric value of foods and it's not the same thing as saying oh well as any food is equivalent to another food as long as they're matched for calories. These are all kind of strawman arguments that are placed as the reasons why people say, don't listen to this calories in, calories out nonsense. In fact, it's just physiologically just undisputable that calories in, calories out does hold true. It's simply stating how much energy is either stored or lost in the human body and how that relates to body composition as we're concerned about it would be a caloric deficit is both necessary and sufficient for someone to decrease the amount of fat mass that they have so if we accept that the premise of

calories in calories out is accurate which it is the real kind of crux of your question is saying well is weight loss just down to eat less and move more i think everyone would should hopefully agree that the advice to someone to eat less move more is wholly unhelpful and likely ineffective in the vast majority of time so sure if someone decreased their caloric intake and increased their energy expenditure from baseline, that would likely create a calorie deficit and therefore they would lose body fat. However, just telling someone to do those things as an intervention usually doesn't succeed because we have these various different drivers of our energy intake and our energy expenditure. That includes hormonal regulation. So we call this

homeostatic control of intake and expenditure, but we also have behavioral factors and our surrounding environment that influence how much we consume or how much we move on a given day. And so just knowing that we should eat less, move more isn't really that actionable for nearly anyone, I would say, without more context. So that advice is unhelpful. But the fact that if someone does create a calorie deficit, that they will lose body weight and body fat is correct. And there's some kind of examples where a change in body weight can happen independent

of a change in calories in, calories out. A simple example would be if someone starts taking creatine and they're going to absorb more water into their muscle tissue, their weight will go up, but they haven't changed calories in or calories out. Or if someone dehydrates themselves, they can change their body weight without actually changing calories in or calories out but that's not what the equation is saying it's just literally talking about stores of energy in or out so hopefully some of that ramble made made sense yeah no the ramble did make sense and i think the qualification was important and in the kind of examples that you give for the isolated examples such as the creatine or the dehydration again while weight may change it's

not kind of fat mass or body weight it's it's water weight yes well that was a jam-packed episode I think we yeah I think from non-diet nutrition to calories in calories out is um pretty much the the full gamut well i knew that when i was getting you guys on i was going to get my money's worth so for people who do want to hear more rambling from both of you where is the best place to do so uh well for me for me probably the easiest place is if they just go to sigma nutrition.com uh there they can find any of our podcasts any of the sigma statements that we've written which uh we've alluded to a few today and then on social media probably the best place is Instagram. And my handle is DannyLennon underscore Sigma. Yeah, we have many ramblings on Sigma Nutrition Radio, which people can indulge in.

And yeah, you'll find me there. And you'll also find me over at AlineaNutrition.com as well. And you will find me on Instagram at the nutritional underscore advocate. Wonderful. Well, thank you so much for your time today. Thanks for having us. Thanks so much. Okay, guys, that was a lot of information to take in in an hour. And I could have kept talking to those guys all night. Actually, once we finished recording, we stayed on the recording and spoke for another 20 to 30 minutes

about everything else. So we like to chat. We're also all Irish if you didn't pick that up in our accents and are notorious for chatting. But hopefully you learned a lot from that. I know I did. And there was a lot of takeaway points and the questions were sent in from you guys which you can continue to do so and please

do send me recommendations for people you would like me to interview for the podcast or topics that you would like to cover but do go back and listen to older episodes because we are on season five and there's quite a bit of information to get through okay that's all from me see you again next time