The Rich Roll Podcast - Gemma Newman, MD On Optimizing Hormone Health

Episode Date: May 9, 2022

Today’s episode explores nutrition, lifestyle  and overall well-being with a particular focus on hormone health – particularly (but not exclusively) women’s hormone health, aging, and reproductive care – with Gemma Newman., MD. A Senior Partner at a family medicine practice in the U.K. and author of ‘The Plant Power Doctor’, Gemma is a graduate of the University of Wales College of Medicine with expertise in a variety of specialities, including elder care, endocrinology, pediatrics, obstetrics and gynecology, psychiatry, general surgery, and urology. Today’s episode is also viewable on YouTube: https://www.youtube.com/watch?v=5S3UzS5YhcA To read more about today’s episode and review the show notes, visit: https://bit.ly/richroll678 To pick up Rich’s latest book Voicing Change: Vol. II, visit: https://www.richroll.com/voicing-change-ii/ Final Note: As a compendium to this conversation, Gemma created an impressively thorough document detailing all scientific references for this episode and many other helpful, additional resources. I strongly encourage you to download this free document HERE. Peace + Plants, Rich

My general position is I just want people to eat more plants. I think that from what I've seen, the more plants, the better. And we see that in the data as well. The more plants we eat, the better. So it doesn't have to be plant exclusive, but plant predominant is definitely important for overall health. The way I see it based on the research is that the plant-based diet is abundant in

nutrients. As long as you're choosing a large variety of fruits, veggies, whole grains, beans, nuts, seeds, tofu, tempeh, all of those incredible ingredients, you're going to get everything that you need. But again, I think the health benefits that I've seen in my patients in the short term and the long term, and what we see in the data as well, show us that a plant-rich and even a plant-exclusive diet is brilliantly healthy. The bottom line is that plants are always good in terms of hormone regulation, and they can help to foster the microbiome that could potentially then also use other parts of plants to then benefit us. The Rich Roll Podcast. Greetings, internet. Welcome to the podcast. Today, we are back talking diet, nutrition, and overall well-being with an additional focus on hormone health,

particularly, but not exclusively, on women's hormone health. And we're going to do it with Dr. Gemma Newman. Gemma is a graduate of the University of Wales College of Medicine. the University of Wales College of Medicine. She has expertise in a wide variety of specialties, including elder care, endocrinology, pediatrics, obstetrics, and gynecology, psychiatry, general surgery, and urology, and serves as a senior partner at a family medicine practice in the UK. She is also the author of The Plant Powered Doctor, a primer on the power of plant-based nutrition to prevent and reverse many common chronic illnesses from diabetes and heart disease to obesity, and the science that explains why it works. More on Gemma and the conversation to come But first... We're brought to you today by Recovery.com.

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So Gemma first appeared on the show almost exactly three years ago. Our RP449 was quite a popular episode in case you missed it. And today, because over the years, this show has already devoted literally dozens of episodes to the general relationship between food and chronic disease. I thought it would be interesting and wise to get specific on a topic that I have yet to explore in depth, which is hormonal health, specifically women's hormonal health and how this differs from general health advice and the role that nutrition plays in impacting this important component of wellbeing. However, this one is not just for the women out there. We cover a variety of other areas applicable to all.

It's worth pointing out that I learned quite a bit from this conversation, and I think better understanding the general role that nutrition and lifestyle habits play in relation to hormone health is important, of course, for everybody. So let's do it. This is me and Dr. Gemma Newman. We're here, we're doing it.

Yeah. It took a minute, didn't it? It did. You were supposed to come something like six months ago. Yeah, but then. Richard got COVID. Yeah. Yeah.

So that got delayed and then I wasn't sure if you were ever gonna make it out, but here you are. I'm so delighted to sit with you today. I'm delighted to be here, I really am. I haven't been to LA in nearly 20 years. So it's been really cool. Wow, well, you picked a nice moment. We had some rain the other day, which was very unusual, but everything's been really cool. Wow. Well, you picked a nice moment. We had some rain the other

day, which was very unusual, but everything's uncharacteristically green. It must feel very, you know, much like, it feels like this is the Ireland time of year. It will quickly turn brown, but right now it's pretty great. It is. We were driving here this morning and I thought, wow, this looks so British. There's so much green. I know. Really surprised me. Yeah, yeah, yeah. Well, we did it just for you, Gemma, to make you feel at home. I did.

And I was trying to remember the last time I saw you, was it at the retreat or was it when I was in London? I can't remember. I mean, everything's a blur because of COVID. Yeah, I think the pandemic changes and warps time slightly. For sure. Probably at the retreat,

because I saw you in London between that and the last time I saw you. I can't sure. Probably at the retreat, because I saw you in London between that and the last time I saw you. I can't remember the order of events, the order I get. I don't remember what came before what. But anyway, you are here, lots of stuff to talk about. And because the first time you were on the show was many years ago, and also because it was recorded at the retreat in kind of a fireside format, I think it would be helpful and instructive to just sort of introduce yourself, your background a little bit,

and this journey that you've been on that led you to being this advocate for the plant-based lifestyle. Okay, so I've been a doctor now for 18 years. and I always knew I wanted to be a doctor. I felt that very strongly from a young age. But in my medical training, I think it's fair to say I didn't necessarily look after myself. A lot of late nights, a lot of studying. And then when I went into actually being a doctor, again, there was loads of night shifts.

Does anyone look after themselves as a medical student or as a young doctor? I mean, there's really not a lot of room for that. Probably not. That would be an unusual outlier case, I would think. You're right, I think it would be. And although there is, I don't know what it's like in the US,

but in the UK, there is time for sports and stuff like that, sort of recreational stuff. But I didn't really partake of that. I was a real bookworm. And yeah, I partied as well, of course. But I think it's safe to say that my focus was not my health then. Like you say, most doctors at that stage don't really focus on health too much, which is ironic.

But I felt like when I started work, something had to change because I was exhausted all the time and I was falling asleep I was coming home from late shifts and I thought I can't be doing this job for the rest of my life whilst feeling this way so I knew something had to change and at that time I hadn't done a great deal of research I just well, I will calorie count, I will exercise and I will cut the carbs because that's what the background hum was telling me to do. In med school, I learned about nutritional deficiencies. I learned pathology and anatomy and communication skills and lots of other things, but not a great deal about wellness nutrition. So fast forward, I did brilliantly with that. wellness nutrition so fast forward i did brilliantly with that i got my energy back i felt great i was proud of myself then i realized to my dismay that i still had risk factors for heart disease i checked

my lipid profiles and they were still raised and i thought back then that there was nothing i could do about it that it was just genetic it was my destiny and i'd have to cope with that later in life and then fast forward a few years, my husband Richard introduced me to your book, Finding Ultra. Oh yeah, that's right. I forgot about that. Yeah. And he was running a marathon. He was doing initially quite badly. He was getting inflamed, injured. And then he decided after reading your book and a few others that he'd go plant-based. And that was my first introduction to plant-based living. I was skeptical. I know we talked about this before, but

I watched closely with skepticism. He did brilliantly. His next marathon training run, he did like an hour and 10 minutes faster. That got me really interested. Not from an athletic point of view. I have done a couple of marathons myself, but I wouldn't call myself someone that's particularly athletic or focused on performance. For me, it was about my patience. So were you on board eating that way also in tandem with him or you were just observing him doing that and making mental notes, skeptical mental notes?

Yeah, I was observing. I didn't actually start. So two different types of meals happening in the household. Yeah, that's right. I didn't actually start. So two different types of meals happening in the household. Yeah, that's right. He was cooking for himself for a while and I was just watching and learning. And don't get me wrong, I had already read a little bit about the environmental side of plant-based living after he introduced me to your book and a couple of others. So I knew that there were some definite environmental benefits to plant-based nutrition,

but I didn't have that kick myself. I just didn't feel like I could do it. It seemed too difficult. It seemed, I don't know, a bit pious and not really me. I had all these preconceived ideas about what it meant. Right, this will mean that you're gonna end up carrying a picket sign, walking around angry with Birkenstocks on. Well, yeah, no, I just, I think for me, I just thought, yeah, there were certain

stereotypes that I had contributed, you know, sort of thought about what it meant to be plant-based, what it meant to be vegan. And I felt like that wasn't my identity at that time. So he did brilliantly. And I thought, well, if he can do so well just running a marathon, what could it do for health? What could it do for my patients? I was thinking about heart disease, diabetes, cancer, our biggest killers in the Western world. Could it make a difference? And I realized through many years of reading that yes it could i decided to jump in i did it myself um and i reaped the benefits um my cholesterol went down i used to get a lot of knee aches as well when i was running all through my 20s that stopped so you know that's my own personal experience, but of course,

it's not, um, that's not what I based my practice on. I have to read the research as well. Um, but what I found was that it was really beneficial for my patients. And that's when I felt, you know, the magic really happened for me is when I could see with my own eyes, um, the changes that my patients had experienced and that fueled my passion. And I've been really passionate about it ever since. So talk to me a little bit about the transition from you experiencing firsthand the benefits of this, your blood panels improving, et cetera, and moving towards then advising or advocating

this approach with your patients, because those are two different things. patients because those are two different things. Yeah, they are two different things. And I thought long and hard before I started to talk about this with my patients because I knew that there would be a burden of evidence, if you like. Like if I was gonna be saying something to my patients,

I needed to know that what I was saying was evidence-based. And so it took me a lot longer to have the courage really to to start talking about it but I think what many people don't realize is that a lot of the data exists and it has existed for a long time and it actually forms the basis of a lot of guidelines it's just that we're perhaps not consciously aware of that so the world cancer research fund for example tells us that fruits and veggies and whole grains and beans are the cornerstone of a cancer preventing diet you know the american college of cardiology talks about plant-based diets for prevention of heart disease we have the american college of clinical endocrinologists talk about how it's really

helpful for preventing diabetes and in the uk we've got the Royal College of GPs, they've got their green impact scheme. So there's actually a lot of sort of approval, if you like, from large bodies that are involved with disease and nutrition. But I think still there is that reluctance in a lot of people to really sort of take it in. Well, I think there's a couple of things. I mean, first of all, there's this notion that many medical practitioners have that lifestyle advice doesn't really land with the patient. Like I can tell them to do it, but they're not gonna do it.

So I just need to give them these meds and tell them to maybe not eat so much or some really general basic stuff. But the reluctance is from this place of low adoption rates. Yeah, I think, yeah, you're right. And you have to believe that your patient is capable of change, I think, in order to start talking about it.

And that's hard because nobody likes to be told what to do. And doctors like telling people what to do because I think, you know, we've done a lot of training. We want to make things right. We want to help people. So we feel like if only they'd listened to us, then, you know, they would. I think people want their doctor to tell them what to do though. Do you think so? I think people abdicate too much responsibility to their doctor's advice in general. I don't know what it's like in the UK, but in the United States, a general practitioner like yourself

only has a few minutes with each patient. And so there's not enough time to go into great detail on all kinds of lifestyle advice. And there's no kind of follow-up or accountability because those systems aren't in place. It's really just diagnosed, prescribed, move on to the next person. And it's not the fault of the practitioner.

It's just the way the system is set up. Do you feel that you, in your practice, like have a little bit more bandwidth to spend time with patients and follow up with them, et cetera? Because that piece is so important to all of this. It is important. And it's honestly the reason I went into medicine. And I think that I do have a great advantage if I think about it now, because working in National Health Service, I have a patient list, nearly 3000 patients. It's actually a really small practice.

a really small practice. It's equivalent to one full-time doctor. So 3,000 people under my care. And we have only 10 minutes. So yes, you're right. We do have a very short amount of time. It's not a great deal of time to talk about lifestyle. However, we do have the ability to bring people back. We have that sense of continuity because it's free at the point of care. And people don't have to pay anything to see me and people can come and see me as often as they want to they just need to book an appointment so it's very I'd say certainly compared to the US it's very easy to book an appointment there's still a lot of complaints generally in society about how easy it is to get a doctor's appointment but I think if we compare our healthcare system to the one here in the US, it's much easier.

And I'm able to offer that accountability and also that support and that feeling of care that I think is really lacking perhaps when you're dealing with a system where it's very much drugs prescribed next. So yeah, I do think I have a lot more freedom in that respect and that's what i love about it i love looking after my patients from cradle to grave again

it's slightly different where i work because we deal with everything we deal with pediatric issues obstetric issues um elderly care issues um everything and anything people come to us first whereas i think here they would more likely go to a specialist in their field. It depends, yeah, it depends. Well, yeah, if you have something acute, you're gonna find the specialist, but for the everyday stuff,

I feel like a lot of that now is in these urgent care centers that are all over the place. So there isn't, at least from my experience, and I don't know what it's like for most people, but I don't have like a good relationship with a single GP that I go to see that kind of knows what's up with me. It's just, if something flares up, I go to urgent care that needs immediate attention. And I think we're seeing the disappearance of that patient doctor relationship because of the big HMOs and all that kind of thing. Yeah, I see that happening a little bit in the UK,

but I think we still do have a lot more of that relationship. And I've got patients that have been with me. I've been at that practice now for 14 years and I've seen people grow up. I've seen families change, babies born. Yeah, it's nice. People, yeah, passing away and sort of that whole cycle of life.

I've seen it, I've been there for it and I love it. That's why I became a doctor. So you're gonna see a little bit of everything, but I suspect the low hanging fruit or what you see quite frequently are lifestyle ailments, like certainly obesity, diabetes and heart disease, right? Which are kind of the bullseye problems like certainly obesity, diabetes, and heart disease, right? Which are kind of the bullseye problems that a plant-based, plant-centric, plant-predominant diet

has shown to be quite beneficial in ameliorating or reducing the symptomology and the underlying causes. Absolutely, and you're right, that's the bread and butter really of what I see, mostly high blood pressure and diabetes, certainly in terms of chronic care. But you'll be surprised, there's a lot of other things that can also be affected by plant-based nutrition, which we may come on to. But I get a lot of people suffering from hormonal health issues, endometriosis, I get a lot of people suffering from hormonal health issues,

endometriosis, fibroids, period pains, menopausal issues. And believe it or not, those things as well can be improved potentially by eating more plants. And other issues, bowel disorders. I get a lot of people with gastrointestinal issues as well. So yeah, there is quite a broad range of things that can be affected. And it's lovely to be able to implement that. I don't necessarily manage to change the diet

of everybody that comes in. Because people come with their own ideas, their own concerns, their own expectations. But if they're open to suggestions, then yeah, it can be really special. Is it a situation in which, now that you have this book out, the Plant Power Doctor, right?

Like, oh, she's the Plant Power Doctor. Like if I go in there, she's gonna tell me to eat this way. Like, I don't wanna deal with that. I'm gonna go to this other doctor. I don't think I've had that yet. You see, what I try and do with my patients is if they're interested, I'll refer them to my website,

which is free and there's loads of free resources on there. So I don't tend to sell too much but you're in the media you're out there people know who you are come on you'd be surprised in my town I think people don't tend to sign up to me because of that

but a few of my patients have caught on to the things that I'm doing online and they follow me online so I do have to be mindful of that right but yeah balancing the public version of yourself and the daily practitioner version. Yeah, it's hard because, you know,

I think people do have certain expectations of what their doctor should be and how their doctor should be. Right, I don't want you going on podcasts all the time. You're supposed to be like in the office, like looking at my labs. Exactly, exactly. But no, I think I've had mostly, if not all positive feedback and people have been really inspired and it's been lovely actually.

It's been a really nice addition to my practice and one that I'll be forever grateful for because that's why I wrote the book. It was about kind of widening my circle of compassion, making sure that people who wouldn't have otherwise been on my list know about this information in a really accessible way. You know, it's full color and pictures and flickable and easy to access and it's got the recipes too. So it's literally, I wanted to make it dead simple.

Well, you achieved that. It's a beautiful book, so congrats. Thank you. You mentioned hormones a couple of minutes ago, and I wanna get into that. People who have been long-time listeners or viewers of this show know that I've had all manner of whole food plant-based advocates on the program,

medical professionals, including two recent appearances by our mutual friend, Simon Hill. And over the last nine years, I feel like I've covered most of the issues regarding this lifestyle and the role of nutrition and health generally. But one area that I admit to not having covered with any particular focus or intensity

is women's health specifically, how this differs from general health advice and the role of food and hormones. So how do we find our way into this topic? I mean, maybe start with some thoughts about when you say women's health, like what does that mean? How is that different from just human health in general? And we can get more focused from there.

Yeah, so I mean, I did do extra qualifications in obstetrics and gynecology, OBGYN, you'd call that here, and family planning as part of sort of my work as a doctor. So, for a while, I worked in family planning as well. And I think it's not that women's health is over and above different in terms of nutrition to men's health, but that there are various considerations that we would have physically that that men don't have um now obviously the most common thing would be the fact that we have periods um and we are kind of bound by that sort of natural cycle from the age of puberty to the age of menopause. Menopause itself is a huge life

transition, which doesn't occur in the same way with men. I think primarily because there's less of a fluctuation and a sort of steep decline in hormones relevant to men's health. It's more of a gradual decline as opposed to a precipitous one. Exactly. It's much more gradual. And I think that helps to ameliorate symptoms. Whereas for women going through perimenopause up to menopause, then you can actually have wild fluctuations of estrogen. It can go way up, it can go way down. And that's really one of the main things that's sort of responsible for a lot of the symptoms that women will get around the perimenopause, which we can, I suppose, define. But, you know, hormones affect men too, obviously.

They affect everybody. There's actually over 50 different hormones and they have to work together in synergy in order for us to perform at our best. And it affects every aspect of our lives, not just puberty, menopause, periods, fertility, but everything, mood, energy, our skin, sperm counts, all sorts of things. So it's actually integral to all humans,

but I'd say for women, there are a lot more considerations, especially around, yeah, the fact that we carry children and that we have periods and that we have to go through menopause, which are very distinct life phases that do require extra thought and attention, I think.

And so what is the role that nutrition can play in this and also lifestyle habits? So if we talk first about periods, perhaps, because that's probably one of the main things that women will focus on from around about the age of 11 or 12. The quality of your periods can change based on the nutrition that you have. So periods are starting earlier which I think is an interesting thing. I don't think that's just because of extra nutrition um i think there are also other factors at play um with regard to environmental pollutants and things like that

i think there's a lot of reasons why uh girls are starting their periods earlier and that's really significant because essentially that means that our our growth is kind of done. We don't tend to get much taller after we start our periods. And I think if you go through puberty and start your periods too early, it can put you at increased risk of actually things like heart disease at a younger age. I never heard that. Yeah, which is a really interesting thing.

And I think there's just a lot of extra hormone exposures in our environment that we haven't been able to consider before. So- Meaning like environmental toxins, toxins in skincare products, et cetera, in our foods that are dysregulating our natural hormonal cycles. Yeah, exactly. And things that mimic estrogens in our body, plastics, for example, phthalateshthalates bpa they have hormone mimicking effects which i think do affect things like fertility and men's sperm counts but also potentially also affect when young girls and women start their periods so yeah there's a lot to consider now that we haven't really considered in the past because they didn't exist but I think in terms of practical

things that people can do increased fiber is so important main reason being that if you're constipated you're actually potentially recycling unwanted hormones through the body hormones that you would have otherwise got rid of you're actually reabsorbing so trying to make sure that young girls and well children and everybody in general doesn't get constipated is quite a good way of reducing our excess hormone exposure um i think it's important to mention that you know our fat cells in our body are also hormonally active they can produce estrogen so if we have more of those then we also have more exposures to estrogen as a result of that which can affect men as well as women but i think that that's a really important thing that that again is not necessarily talked about much the fact that our

fat is also hormonally active too um and yeah so i think fiber is a really important thing um it reduces our hormone exposures it helps us to produce short-chain fatty acids which is also a great for helping our hormone regulation and feeding our gut microbiome which is important as well for hormone regulation which is also important for our immune system which affects our hormone regulation so all these things are linked wait you're saying it's all related? I have. Yeah. I had Dr. B in here the other day going deep on fiber once again. Yeah, of course. Yeah. And his whole thing about, you know,

eating 30 different plants, you know, setting that as a goal and the importance of fiber for any number of things and just how critical it is. In this conversation, it tends to get lost. We focus on macronutrients or protein or, you know, our omega-3s, all of which are important, of course, but most people are fiber deficient. Like, where's the, again, back to the low hanging fruit, like what is the quickest, easiest change that you could make that could have the biggest impact

and increasing the fiber in your diet seems to have just a multiplicity of downstream health benefits. It does and there was a study, I think it was actually led by Dr. Neil Bernard, looking at how this could affect people in their periods. And they had a two month cohort cohort of women half were on a healthy plant-based diet the other half were a control group and they wanted to see could it affect

their periods and what they discovered was that it did make a statistically significant difference in the length and that the heaviness of the women's periods and also just by increasing fiber yep just by increasing fiber and it also showed a raised shbg sex hormone binding globulin which is an important protein that essentially holds on to hormones until we need them it's kind of like a storage molecule if you like and what's interesting is it was able to increase that for the women who are consuming a healthy plant-based diet, which is important because that can help regulate their unwanted hormone exposure as well.

And is that a function of just an increase in plant foods and by definition, an increase in fiber, or is there an aspect of that that has to do with the removal of the meat and dairy products? It could be a bit of both. So this is postulation based. So that study didn't say specifically why, but we know that fiber is so crucial

for reducing recycling of hormones, as I mentioned, but also meat and dairy does have a role to play with regard to hormone exposure itself. So when we consume dairy, we're consuming the milk from a cow who's been pregnant and obviously is lactating, which has extra hormones, bio-equivalent hormones to human hormones.

But also in the meat that we eat, there is some hormonal exposure there as well. But also, interestingly, I think, is that meat is one of the main ways that we get potential for microplastics exposures, which are also affecting our hormones. I think in the UK, phthalates are highest in fish. In the US, phthalates are highest in chicken.

And there is some data to show that there was an association between increasing meat consumption and increasing endometriosis symptoms. So maybe define phthalates and then endometriosis. I'm not sure I even know what endometriosis is. Okay, so let's do a little backtrack. Endometriosis is a condition that could affect

up to about 10% of women. And it takes many years often to diagnose because the women who are suffering from endometriosis just think that perhaps they've got really heavy periods. But it's so much more than that. So what it is, is where the womb lining tissue, which normally just grows in the lining of the womb and is shed once a month with your period, starts to grow in other parts of the body. We shed once a month with your period, starts to grow in other parts of the body. We don't know why this happens. It predominantly happens in the pelvis. So you get that tissue that grows in the lining of the womb in other parts of the pelvis, often sticking

perhaps to bowel or to the bladder. But interestingly, you can get endometrial deposits anywhere, even in the brain very rarely or in the lungs. And the problem is when you have your monthly bleed, those cells will also bleed. And when they do, they cause irritation and inflammation. So no matter where they are in the body, they start to bleed? Yeah, they will bleed.

And it can cross the blood-brain barrier. Yeah, very rare. But yeah, it's mostly around the pelvis-brain barrier. Yeah, very rare. But yeah, it's mostly around the pelvis or deposits perhaps on the outside of the womb. But the problem is that inflammation and irritation then causes a lot of pain. And it can cause parts of the bladder or the bowel to stick together.

It can affect fertility. It can cause painful sex. It's a really sort of far-reaching condition. And if women are suffering from horrendous period pains, nausea, vomiting, have to take days off work, painful sex, problems getting pregnant, this is not normal and they have to go to the doctors because many people will think, it's just my period but interestingly you know periods periods can be really painful um more painful than a heart attack actually in some some research tells us that they that the pain of having a period because um it's because of the prostaglandins that are produced by those womb lining cells so you know when you're having a bleed, these prostaglandins that cause

contraction of the womb, that's what causes the pain and the, you know, the cramping, those sort of feelings of nausea. If the prostaglandins get into the bloodstream, that's what causes you to have things like diarrhea and vomiting, nausea, it can get really bad. And I think women don't always sort of know how to advocate for themselves. People think, oh, it's just her period. Well, actually for a lot of women, they really do suffer. And especially when you have endometriosis, which is a whole other condition related to your periods,

but causing so many more complications. So it goes undiagnosed often because people just think you're having a severe period episode or you're ignored and just consider to be normal. Yeah. So either doctors will think, oh, she's just having a heavy period. I'll give her some painkillers or she'll think, oh, I'm just having a heavy period. I'll just have to wait a few days later. It'll be okay. But for some women, it's completely life-changing and it can have a huge impact. And as I say, up to 10% of women have this condition. And is there a test for it? And then once it's diagnosed, how is it treated? So this is why it's hard to diagnose because the main way of doing so is through a laparoscopy.

So you have to have an operation essentially to see those deposits, which are usually in the pelvis. Right, which no one's going to do unless it's so severe. Exactly. So people will try and muddle through. They might take some painkillers and hope for the best. But actually, it's really important to get that diagnosis because once you have a diagnosis, really important to get that diagnosis because once you have a diagnosis um one of the main ways of treating it is is um to actually kind of blast those little deposits burn them off and that can help to improve fertility and pain um but i would love for women to know that diet

and lifestyle can have an effect on endometriosis as well a positive effect. And having a healthy plant-rich diet could improve symptoms greatly. So yeah, I would love for, if there's one message for this part of the podcast, it would be for women who have endometriosis to know that hopefully if they have a more plant-based diet, they could see some improvement in their symptoms. Interesting. But they don't quite know what causes it

and there isn't any kind of like simplistic cure. No, there's no simplistic cure, but I suspect that our extra hormone exposures in the modern world play a part, just because as I said, there's an association there between the consumption of certain animal products and the development of further endometrial deposits. And we don't yet know. I'd love for there to be more research.

It's the same with fibroids. I would love for there to be more research into fibroids. Well, let's talk about that. Define what fibroids are. Okay. So fibroids are essentially growths in the womb and they are estrogen dependent. So much like endometriosis, which is in a way fueled by estrogen exposures, so is the development of fibroids. And you can get extra painful periods again with fibroids without realizing it. So you'd

be thinking, oh, I've just got a heavy period. But actually the reason that you've got it on this occasion is because your fibroid mass, the lump is pushing against the womb lining, which is causing it to increase in the surface area. Then it bleeds more than the period is heavier. So not all fibroid lumps push into the womb lining. Sometimes they can grow on the outside of the womb or in the middle of the womb. But for the ones that push onto the womb lining, they cause extra heavy bleeds. And, you know, if the fibroids get big, then they also have just a mass effect in the pelvis, which can, you know, affect, you know, the way that you pee or the way that you're able to pass motions. So it can have other downstream effects as well. And again, I would

really love to see more research into the causation and amelioration of fibroids, but suffice to say in terms of lifestyle, there are some things that we've seen could be associated with it. Again, we come back to the meat consumption that can have an impact on the growth of fibroids, perhaps because of the extra estrogens or plastics that we're exposed to. Alcohol is another one that has been associated with fibroids. Physical exercise has been something that's potentially been associated with less severe fibroids, but we just have association data really. So I'd like to see more of it. And is there a test to know whether you have fibroids or if you have them, you just know it? You don't just know it, unfortunately,

but you can get a scan that's much easier to diagnose fibroids because you can arrange for an ultrasound scan and you'll be able to see those lumps there. Sometimes with a scan, you can see what could be endometrial deposits. So if you have an unusual appearance to your ovaries, it could be something called a chocolate cyst because you get sort of dried old blood then on the ovary itself, which looks like a sort of a dark cyst.

And you can sometimes see those. Because those cells have bled during the period. Yeah, exactly. So you can kind of get a hint of endometriosis through a physical exam. If your primary care physician or your OBGYN has done an internal exam, you can sometimes get a feel for whether the endometriosis there based on whether the womb or the ovaries feel fixed when you do an internal exam. And you can again, maybe get a hint of it with an ultrasound

but the only way of truly diagnosing endometriosis is with a laparoscopy. But fibroids is much easier because you only really need to scan. And the appropriate lifestyle interventions for fibroids look like what? Well, I'd say really focus on whole foods, healthy plant-rich diet, number one. You'll be increasing your fiber. So as I said before, reducing your hormone exposure from your own body.

You'll be hopefully helping yourself to potentially reduce any excess weight and you'll be avoiding xenoestrogens from plastics exposures as well so that would be the main thing i'd say exercise is important um interestingly uh there's some research to show that certain things are great for reducing the pain of periods which can affect endometriosis and fibroids. So ginger and turmeric have been shown in a couple of studies to be really helpful in reducing the amount of prostaglandins that are being produced at the lining of the womb. So, I mean, essentially, if we kind of figure out, this why um oral contraception can help periods actually because oral contraceptive pills um reduce the amount of endometrial lining cells that are produced which then reduces the prostaglandins which which is what causes the pain and the cramping

so uh yeah so contraceptive pills can help with the pain anti-inflammatory painkillers can help with the pain for the same reason they they reduce the prostaglandins. But if we wanted to go sort of down a lifestyle route, then ginger and turmeric have been shown in studies to have the same benefits as anti-inflammatory painkillers for reducing period pains. So on some level, this is a disease of inflammation or a disease that's exacerbated by exposing the body

to inflammatory foods and environmental factors, right? So it would follow logically then that a diet that is anti-inflammatory in nature, I mean, it's good for everything, right? Would be particularly good at ameliorating the symptoms of these conditions. Yes, I think so. And if we look at other hormonally driven things, so not just endometriosis and fibroids, but also polycystic ovaries, again, it's another condition that affects fertility, affects our periods,

condition that affects fertility affects our periods but can also be improved using lifestyle again it's not something that tends to come up in these kinds of conversations but pcos polycystic ovarian syndrome is very much like diabetes in that it's driven by insulin resistance and insulin resistance can be improved by using whole plant foods, eating a much more whole food plant-based diet. And so, yeah, that's another condition that could potentially also be improved using lifestyle and have long reaching benefits. Sure.

So increasing your fiber, turmeric, ginger, what are some of the other anti-inflammatory foods that top your list? Well, we've got to go for berries, fruits, vegetables, nuts and seeds, tofu, tempeh. I think soybeans have a terrible reputation still, unfortunately, but they are really good for hormone regulation because not only do they contain all essential amino acids, but they also, they contain a special kind of phytoestrogen, which is actually beneficial.

So it's actually more of a modulator rather than something that is an active pusher of estrogen, if you like. Right, so let's like really underscore that because I think what happens is people hear soy, they think estrogen, you spoke earlier about dysregulated estrogen causing these problems. So without further inquiry, it would appear

that eating something like soy with these estrogen compounds would be not a good thing. So I want you to be really clear about soy, estrogens, phytoestrogens, the differences. Okay, so soy contains phytoestrogens or estrogens, but it's actually what we call a CIRM, a selective estrogen receptor modulator. Right, and if you're British, you say estrogen.

Yes, sorry. Keep going, sorry to interrupt you. My estrogen. So it's selective in its action. So what it does is, if you are wanting to reduce your risk of breast cancer, it's really great for that because it blocks the receptors

that are responsible for breast cancer. If you want to improve your bone health, it's actually really good for that because it's more likely to selectively bind to the receptors that are in the bone area of the body so it has selective effects which are actually beneficial in terms of our hormone exposures it stops us from being exposed to bioequivalent hormones and instead blocks those so it's good for reducing risk of breast cancer, especially if you start to eat soy products young in life. So for young girls, teenagers, young women,

there is some evidence to show that if you have soy products in childhood and adolescence, it's much more likely to reduce your risk of breast cancer later in life. reduce your risk of breast cancer later in life. But if you're a dude or a mate and you get on the soy early, you become a soy boy and develop man boobs. Well, you're probably more likely to develop man boobs if you drink actual cow's milk, if you think about it, because that's a bioequivalent estrogen. But in actual fact, there is data to show

that soy can potentially reduce the risk of prostate cancer. So you don't need to worry too much about soy. Or in. So you don't need to worry too much about soy. Or in fact, you don't need to worry at all about soy. Is there a difference between soy or tofu versus like tempeh or a fermented soy? Like I've always understood that a fermented version is better. Yeah, I think there are different qualities, I suppose.

Interestingly, soy products have been shown to be beneficial for flushes, sort of period flushes, vasomotor symptoms in women. So yeah, but in sort of Japanese populations, they don't really have the same amount of flushing and it's thought to be because they have a lot of fermented soy products, sort of miso and tempeh and edamame beans.

And not that that's fermented, but it's a more natural form of soy. But yeah, I think if you go for minimally processed sort of tofu, tempeh, edamame beans, miso soup, that kind of thing, you're gonna have perhaps even better benefits, but yeah. What about natto? Have you had natto? I've not had it, but I've heard it's disgusting.

I've heard that as well. It's atop the list though, of like the most nutritious fermented soy product. And it's an acquired taste that they enjoy in Japan, but is not necessarily readily available in the West. No. I mean, yeah, maybe I'll try it one day, but I haven't tried it yet. It's sort of the soy version of durian, right? But actually durian's delicious. Yeah. But it's an acquired taste. I mean, durian's a hardcore thing. Yeah. I mean, the people that

love it really love it. Yeah. It smells quite strong though, doesn't it? Yeah, for sure, for sure. But I actually wanted to say before we get off the topic that interestingly, going back to the gut health MD and his passion for the gut microbiome, the effect of soy on flushes and things like that can be affected by our microbiome or estrobilome so some people unless we have the gut bugs to sort of process the genistein from the isoflavone in soy we may

not necessarily get the same flushing benefits which is why it's great then to have an overall plant-rich diet because what you're doing there is you're promoting the kind of gut bugs which would then hopefully be able to metabolize the components of soy that benefit us in terms of vasomotor flushing. Right. So if you have some form of dysbiosis, that could be a causal factor in a dysregulated hormonal state and also a dysregulated period, right? Or some kind of period issue. Yeah, potentially. So yeah, I'd say the bottom line is that plants are always good in terms of hormone regulation and they can help to foster the microbiome that could potentially then also use other parts of plants to then benefit us. How do you think about when you're advocating a plant-based lifestyle,

how do you think about the difference between a plant exclusive diet versus a plant predominant diet? As somebody who's seeing a lot of patients and for many, I suspect this is like a new idea. How do you communicate around that? And what is your kind of general position on that? Yeah, my general position is

I just want people to eat more plants. And I don't tell my patients to go vegan because I think we do have a lot of data that you can have a very healthy plant-rich diet without necessarily going 100% vegan. I am somebody that identifies as vegan, but it's not something that I would say my patients have to do. I think that from what I've seen, the more plants, the better. And we see that in the data as well. The more plants we eat, the better. So it doesn't have to be plant exclusive, but plant predominant is definitely important for overall health. And I just, you mentioned sort of low hanging fruit earlier. That's kind of how I feel about it right now.

Only 8% of what most of people in the Western world eat is fruits and veggies. It's more than 50% processed foods. So if I can get people more on those fresh whole plant foods and less on the processed foods, then that's a win. So yeah, that's how I tend to advocate for it at work with my patients. Because not everybody's gonna feel 100% ready to just dive in.

Yeah. So, yeah. Have you had any patients come to you who are on the carnivore diet? I haven't, no. Is that a thing in the UK? Because it's like quite a thing here in the States. I know it's a big thing here and it's getting more popular in the UK, but you know what?

If I'm honest, I've only really seen it in online and in wellness circles rather than in my actual patients. I think instinctively most people feel that having a meat exclusive diet could cause long-term issues. How dare you? I'm sorry to say. No, but I think, yeah, it's not been something that I've actually experienced in my patients, but it's a tough one because in my practice, I never like to say to people that they're doing something that's wrong because we all have different paths to health. Having said that, it's really hard because people sometimes feel great on a carnivore diet to start with. They may have got rid of a lot of health issues that they were having in the past. And for me, I think that probably comes down

to a fairly strict exclusion diet. You're basically taking everything out, which is fine for short-term, but it's not really something that you could consider long-term health. Yeah, that argument gets used against the plant-based diet as well. Like, oh, you feel better when you went plant-based

because you just got off all the processed foods, but it's not sustainable. And over time you're gonna be nutrient, mineral, and vitamin deficient. Yeah, it's a shame that people say that about plant-based diets, because the way I see it based on the research is that the plant-based diet is abundant in nutrients. As long as you're choosing a large variety of fruits, veggies, whole grains,

beans, nuts, seeds, tofu, tempeh, all of those incredible ingredients, you're going to get everything that you need except the B12. But again, I think the health benefits that I've seen in my patients in the short term and the long term, and what we see in the data as well, show us that a plant rich and even a plant exclusive diet is brilliantly healthy. What about the argument, I'm sure you've seen this at least online,

that plants are toxic, that they have toxins that they've developed as natural defense mechanisms and that makes them intolerable to the human body. Have you heard that one? I've heard that one online, again, not with my patients. I think a lot of extreme ideas tend to come from online spaces and perhaps I don't know why that would be,

but I think if we look at the properties of plants, yes, they do have certain sort of phytonutrients that we benefit from, but the toxins idea, I think, is actually something that is really damaging because often it's those plants, so-called toxins, that provide us with really important factors for our own health

because our bodies can use them in ways that actually help us to support our microbiome and our immune systems. So I think that's the difference between perhaps mechanistic data and actually seeing what people do in real life and seeing what they eat in real life for longevity and health, which are two sometimes completely opposed ideas. When everything comes together, when mechanistic data and observational data and randomized control trials all come together pointing to one direction, we can feel a lot more confident.

Whereas if we're just looking at a single trial or a mechanistic trial on an animal, for example, we're not gonna really have the same picture. Let's talk about menopause. Yeah. So what is it and what can women do who are experiencing it reduce the symptomology around it? I'm actually really glad to talk about menopause

because I think it's something that many women feel that they can't talk about. It's weird. It's like this weird, like it happens to every woman, right? But it's this sort of not really shameful, but like something that, oh, we just don't talk about it. Yeah, and I try to think about where that comes from.

I do think that we live in a patriarchal kind of society that really values women for the way that they look more than the way that they contribute to the world. And I think a lot of women feel that if they talk about menopause, that their significance in the world is diminished somehow, that their function to produce children is gone, therefore their worth is gone. That's something that I've noticed a lot um

certainly in my patients but also in general society that people feel really reluctant to speak up about it and um quite low about it like it's it's something that a lot of women feel that they've lost something about themselves and I'd really like the conversation to change because I think that if we can have an empowering idea about what menopause can do, then it can hopefully help women to actually feel that they're even more contributing to the world in ways that they couldn't do before. You know, there's only very few mammals that have a menopause. This is really interesting. There's three mammals that experience menopause. Obviously humans are one of them.

Do you have any idea what the other ones could be? Well, I would think it would be chimpanzees or apes. You'd think so. Right. But actually it's not. Don't tell me it's dolphins. Nearly. Really, whales?

Yeah, it's orcas and pilot whales. Wow. Orcas, pilot whales. Wow. Orcas, pilot whales and humans. That's so bizarre. I would have just presumed that every mammal, every female mammal experiences that. No, and this is significant because what it tells us, I believe,

is that we have a very specific purpose past our reproductive years. We have a very specific purpose past our reproductive years. You know, we have a very specific survival advantage in having a menopause, whereas every other mammal does not. And there's actually something called the grandmother hypothesis, which essentially tries to explore this. And the idea is that, you know, the reason that humans have menopause is because women in society have such value in making sure that we continue as a species

and we maybe look after younger children. We would bring families together. We would bring communities together. There's a very strong survival advantage to having women exist past their reproductive years. And I think that should be celebrated because it's something very special. So, yeah.

The idea that evolution has prioritized this because when the village expands and there's more women around to caretake for the many young ones, then everybody benefits as a result. Everybody benefits and there's a survival advantage. That would be the case with chimpanzees and apes and all other manner of mammals as well.

Yeah, you'd think so. But it's interesting because when you look at pilot whales and orcas, they have a very matriarchal society, don't they? They go around in matriarchal pods and it's the grandmother that makes sure that the mother and the babies are all together and protected.

So, yeah. Right, so we're off the rails here being a patriarchal society, right? We're completely off. We are evolutionarily meant to be a matriarchal society. Yes. Okay. I think so.

That's my hypothesis. Yeah, interesting. Yeah. So this occurs in every woman at a certain age and it can, you know, the symptoms range in severity. They do, and that's another interesting thing is the symptoms can range in severity based on where the woman lives to some degree.

So, I mentioned Japanese women and vasomotor flushes. I mean, that's one of the main symptoms for women, certainly in the US and the UK is hot flushes or flashes. Whereas interestingly, Japanese women don't tend to experience that. There was some anthropology work done in two provinces of India that showed that menopause brought about increased quality of life in those women because they were able to achieve more status. They were able to spend more time

with men. They had more of a say in the household over the sons and the wives and other younger children. So in actual fact, when there were questionnaires to those women, they had an increased quality of life and far less menopausal symptoms. But what is the, I'm trying to understand what that's attributable to, the increase in quality of life. Yeah, I think that a lot of the symptoms of menopause can be dreadful, but also that the society in which we live, if it's more supportive to women going through menopause,

can dramatically reduce the effect on our lives. So when you have a society that is supportive or where the woman is considered to be a value wise contributing then it can be actually quite empowering and it can hopefully potentially lead to less in the way of symptoms. That's not to say that it's all psychological. No, there's some very physical and very real problems. But I think it's important to just be aware that in society and the way that we view women is really important because it can affect our long-term happiness. It can affect the way that we feel we can contribute to the world. And that can also affect the symptoms that we experience much with any kind of medical or health condition. That's fascinating.

Yeah. The social environment and a supportive social environment can have that kind of impact. Yeah, and it's true. Or it seems to appear that that's the case. It seems to appear that way. And it's true for all sorts of things.

There was a really interesting study that showed that people who had increased happiness scores, positivity, a good sense of humor, their longevity was increased even when they were living with chronic disease. So, you know, I think the importance of a supportive community shouldn't be underestimated, which is why opening up this kind of conversation is really important so that men and women can understand how to support the third of women that are right now peri or post-menopausal, it's huge.

I mean, that dovetails into the Blue Zones discussion and the importance of connectivity and community. And also of course like holistic health like how we think about these things which we can put a pin in but sorry interrupted you continue yeah no well i was just gonna sort of start talking about some of the symptoms which again are not that well known apart from the flashing or the flushing because women don't tend to talk about it too much but i've been- I've been married to Julie for over 20 years. And I know about the occasional hot flashes,

but beyond that, like I'm probably like a lot of guys, like I don't really know what's going on. Yeah, it's okay, but it's good that you can be more aware and hopefully we can sort of expand on that now. And all the men who listen to your podcast can hopefully- Right, I mean, I wanna, yeah, this is about women's health, but it's also about like helping men understand these things

so that they can be more empathetic to their partners if they're in partnership with women and learning how to like communicate around it in a positive manner. It's true. In fact, I think that Rod Stewart said that if more men knew about menopause, there'd be far less divorces.

So do tell. So I will. So we've got the vasomotor flushes, which can be really debilitating for some women, where you just have this tremendous heat going through your body top to bottom, sweat like crazy. It tends to happen a lot at night as well, but it can happen at any time of day. Vaginal atrophy is a big one. And it doesn't just mean that you have soreness or some sort of dryness there. It can actually be quite severe for some women. So vaginal atrophy occurs when your estrogen levels are going down and it can cause painful sex and dryness,

but also it can cause severe burning, itching. Like it can hurt to sit down. If you had an episiotomy scar from when you were giving birth, they can sort of come open, they can split and bleed. Like it can be a really severe problem that again is very little talked about, but can really impact the quality of life.

Mood changes can be quite severe increased anxiety is very real and many women will put it down to oh i'm just depressed they may think that they need an antidepressant but actually it could be that the hormone changes around menopause are responsible for some of those changes in mood body aches this is a really interesting one. Many women don't realize that severe bone and muscle pain can be attributable to those hormonal changes. Up to 30% of women going through menopause get body aches, but they won't always attribute it to those changes in hormones, which is another big one. Dry skin, hormones which is another big one um dry skin dry eyes some women only experience severe dry eyes which can again be very debilitating you know having to use drops not being able to see properly um it can actually really impact quality of life as well um low libido your sex drive can sometimes

go down understandably if you have vaginal atrophy, but sometimes there are other things attached to that as well with regard to identity and feelings of worth and attractiveness to your partner, that there's all sorts of other things that can sort of play a role there. So yeah, there's quite a lot of different symptoms. You are more likely to get constipated because there are estrogen receptors that are in the gut. So you have reduced gut motility, which then has an impact on, again, your hormone regulation. Because of the lack of estrogen, your body tries to come back to balance. And so you get metabolic changes as well. In the Western world, about about 65 of women have obesity because of the

way that the fat deposits more around sort of the center of the body and as a way of trying to compensate for the lower estrogen that's being produced by the ovaries because as we talked about earlier fat cells can produce estrogen so again that these are things that a lot of women don't necessarily realize are related to those changes in hormones. Bone loss. So unfortunately, from about 40 onwards, we'll lose about half a percent of our bone mineral density. But when you go through menopause, that drops precipitously.

Many women will lose about 20% of their bone mineral density in the first five to seven years after menopause. And that causes you increased risk of fractures. Yeah, that's very significant. of their bone mineral density in the first five to seven years after menopause. Wow. And that causes you increased risk of fractures. Yeah, that's very significant. Yeah, it's really significant. So I think that this is a public health issue. And I think that if more women knew that the time around menopause can be a time of empowerment,

then they could actually potentially prevent further problems. So HRT or HRT is something that, again, we don't tend to talk much about, but is a really important- Hormone replacement therapy. Hormone replacement therapy. It's a really important thing

to open up a conversation around because it's one of the number one treatments to ameliorate a lot of these symptoms in women who are eligible and who want to and including things like bone mineral density loss and heart disease risk as well and i think there's a lost generation of women who felt that it was too dangerous to even consider hrt and in those women i think you know there's a huge injustice that has been done there because HRT as a hormone replacement model is a great way to ease that hormonal transition. Rather than going through all those fluctuations,

you're replacing a lot of the hormones that you would have otherwise lost and you're maintaining your bone mineral density. You can improve a lot of the bone ache issues you're actually reducing potentially your risk of heart disease as well but there is a window of opportunity with regard to heart disease risk and that's around the menopause like if if you're within 10 years of menopause or less than the age of 60 that would be a good time to reduce your risk of heart disease moving on in life. And the same with the bone mineral density loss, there's that window of opportunity there in that sort of five to 10

year window between sort of 45, 55, where if you are eligible, it's worth at least exploring the idea of HRT. So with that in mind, how safe or unsafe is HRT in general now? And what are the factors that determine whether a woman is a good candidate for this? Yeah, so there will be certain women that are not eligible for HRT, primarily those who've experienced breast cancer. But there are other potential reasons why they wouldn't want to have HRT as well obvious things like pregnancy or a recent blood clot or an undiagnosed bleed for example but in actual fact I would say excluding those women most women would be pretty good candidates for HRT the main problem that really scared a lot of women back in sort of 2002 was the women's health

initiative study which showed that there was a potential increased risk of breast cancer in fact the study was halted early over concerns about excess breast cancer risk and unfortunately And unfortunately, the headlines around that study went around the globe and made the use of HRT drop by about 66%. In other words, the headlines being something along the lines of HRT will cause breast cancer. Yeah, exactly. And it scared everyone.

It scared doctors, it scared women who were taking HRT. So many women stopped taking it. But interestingly, Professor Langer, one of the principal investigators on that study, wrote a paper condemning the headline of the study as being irresponsible and wholly inaccurate. And many of the lead investigators on that study were not consulted before it was even published. Investigators on that study were not consulted before it was even published. And one of the main problems with the study was that they used women age 65 or thereabouts, and they were starting HRT brand new.

And of course, by that stage, a lot of those risk factors for breast cancer and excess risk of heart disease, for example, were already in existence before they began the treatment. And I do believe it's let down a whole generation of women. There was a really interesting study in the BMJ from 2012 that showed that if you take HRT for a period of five years, you actually have reduced risk of heart attacks and heart failure. There was no increased risk of breast cancer or blood clots at all. And there was an interesting study by David Katz actually in 2013. And he estimated that in the 20 years after 2002, that there were anywhere between around 20 to 90,000 women who died prematurely from not having access to HRT because of the protection it can offer

for heart disease and bone mineral density loss, as well as obviously all of the protection it can offer for heart disease and bone mineral density loss, as well as obviously all of the other symptoms that we've talked about, with the flushing and the mood changes and the vaginal atrophy and the way that these things can impact their lives day to day. And the optimal time to begin HRT

would be early in menopause, right? Before you've already suffered bone loss and all these other ramifications. Yeah, and it's, I mean, the age of menopause, right? Before you've already suffered bone loss and all these other ramifications. Yeah. And it's, I mean, the age of menopause does vary. The average age is about 51, but it's normal for it to start anywhere between ages sort of 45 to 55. And I think it's actually vital to think about if you're going to think about starting it then, because you are preventing, it's a prevention, isn't it? So you're preventing the bone mineral density loss,

you're preventing the atherosclerotic plaques that we start forming because of the lack of estrogen in the body and how that's cardioprotective. And it's a way of then, you know, essentially lengthening your time where you're sort of functional and you're not having some of these problems. And what is the composition?

Like what is the hormonal composition of HRT? So it's basically a combination of estrogen and progesterone. Interestingly, if you have estrogen only HRT, then there's absolutely no excess risk of breast cancer at all. But the reason that progesterone is often added is to help protect the womb lining because if you have a normal womb and you just give unopposed oral oestrogen then you could have excess risk of bleeding and increased risk of endometrial cancer which is why progesterone is given in combination with the oestrogen replacement

but if we look at that I mean, there's loads of different types and formulations of HRT. But I do want to stress that if you're going for like the gold standard, which would be an estrogen gel or an estrogen patch alongside micronized progesterone, then taking that for about five years, there was a systematic review to say that there was absolutely no increased risk of breast cancer at all. So I'd love for women to know that, that if they want to look into it, they should.

It comes, as I say, in the form of patches, gels, tablets, and yeah, there's loads of different brands, but essentially it's just estrogen and progesterone. And what percentage of women currently are on HRT? Is it a low percentage? It's low and it's increasing gradually. I think it was probably at its lowest just after the 2002 study.

It's gradually creeping up with a lot more awareness now about menopause and the symptoms, especially in the UK. I don't know if that's translated over here in such a big way, but I get lots more women coming to me in clinic asking about HRT, which I'm really pleased about because so many women over the years have said, oh, it's not natural. It's not for me. And it's harmful. I'm worried about breast cancer. And I want women, oh, it's not natural. It's not for me. And, you know, it's harmful. I'm worried about breast cancer. And, you know, I want women to know that it's a very valid option.

And it's actually, you know, it's the menopause guidelines suggest that it's the number one treatment for bone mineral density loss, as I mentioned. Yeah, you mentioned the word natural. There is an interesting thing within wellness and holistic health circles that, you know, obviously are gonna prioritize natural remedies,

food is medicine, et cetera, at the cost of medical interventions that could be helpful, right? So there's a weird, you know, in the Venn diagram between evidence-based medicine and, you know, lifestyle protocols and the kind of organic wellness, alternative holistic health.

I could see a tension between those two things. Like somebody who's like, well, I'm just gonna eat organic food. You're saying yes, but this intervention could be beneficial, but hey, that's not really part of my protocol. I'm trying to like not be on any kind of exogenous interventions.

Yeah, and that's something that I respect. If someone doesn't want to take extra hormones and they shouldn't have to. And I completely understand that perspective. I think what bothers me is the idea that the choice of women is often taken away because of unfounded fears. And I think for me, it's important to be able to offer something that could benefit and whether women want to have it or not is up to them. But we have to consider what's really natural, I guess, in the environment that

we're currently living in. I mean, you could say it's natural to die in childbirth because if you're in Afghanistan and you're in a village somewhere, you've got about a one in 14 chance of dying from childbirth. Is that natural? Yes, I suppose it is, but it's clearly not something that anybody would wish to happen. And so I think when it comes to severe menopausal symptoms, but also longevity, I want to be able to provide women with every possible option that is deemed to be healthy and appropriate. And if they wanna take it, they can. Right.

You mentioned earlier that the age at which young women are experiencing their period is getting earlier and earlier. Is there also a change in the window for menopause? Like, is that happening earlier also? No, so I think it may be again, a reflection of Western society and the various exposures that we have,

but menopause in some cultures is actually seemingly getting a bit later. There is some potential genetic differences in when you would start the menopause anyway. So for example black women may find that they start their periods on average about 48 49 whereas white women may start on a on average about 50 51 but yeah i think menopause can vary based on diet as well there was an interesting study to show that eating more vegetables could potentially bring the age of menopause slightly younger. Again, not dramatically,

like maybe three months on average. So they were looking at sort of large population data. But I think that that's very interesting because again, it speaks to the effect that our diets can have on our normal physiological processes. Is there a mode of eating or particular foods that could lessen some of the negative symptomology around it? Absolutely. And I'd say, again, I'm gonna bang on about fiber. Fiber is crucial and minimally processed soy products are really beneficial as well.

Making sure that you have a nice variety of things like nuts and seeds for extra minerals like selenium are important. Even sort of things like, I know we haven't touched on thyroid function, but again, that's another hormonally regulated organ. You wanna be able to make sure that you're having great sources of iodine, selenium, zinc.

And that's true for all of the hormones in the body, but especially for things like the thyroid. And what are some of your favorite foods that are high in those things? So with selenium, you could just have like a Brazil nut a day. That would be pretty good, but it's also in whole grains, whole grain rice, whole grain bread, other nuts and seeds, and the same with zinc as well, which again is important for things like sperm production. I know we're not talking about men, but sperm production. Oh, we're gonna get to that. Yeah, so there are loads of great foods.

So just think fruits, veggies, whole grains, beans, soy products. I'm a big fan of flax seeds just because they're great at helping to improve the suppleness of blood vessels. And yeah, they've got loads of great omega-3s from plant sources as well. Just make sure you grind them first. Grind them first.

Otherwise they pass right through. Yeah, exactly. Let's talk about male hormonal health. Is menopause like a real thing? And also, I'm interested in your thoughts on TRT because it's obviously the other side of that coin. Yeah. So I think that for men, I mean, I don't have personal experience of this, but certainly with my patients, it doesn't seem to be as much of a thing for men as for women. And I mentioned earlier, I think it's because it's a very gradual

decline. Like with most of the hormones in our body, testosterone production can start to wane over time. So, you know, I think in certain conditions it might be beneficial for testosterone replacement, but I don't see it as being something as vital for male health as estrogen replacement would be for female health based on the changes in the body that occur for women that just simply don't occur for men. Yeah, I know so many guys my age that are on testosterone therapy. I'm not, but they talk about it.

It's something that guys of my age tend to, are you doing that? Should I do that? Should I not do that? Are there negative health outcomes with respect to that? My understanding is that if you get on it, then that's it. You have to stay on it. Because obviously if you're taking it exogenously,

then it's gonna shut down your body's, whatever your body is making, right? Like it's telling your body, like you don't need to make any of this because you're getting it. Yeah, I think this is where men should be cautious and speak to their own doctors about whether it's necessary or not,

especially if you're somebody that is actually hoping to perhaps father a child at any time, because like you say, you're turning off your own testosterone production there, whatever is still going on. And that can have ramifications for your fertility. So I think that that would probably be the main consideration depending on the intentions of the person

that wants to take testosterone replacement, just to think carefully about if it could actually impact their fertility. But yeah, I think- Most guys my age, they're not worried about that part. Probably not. Actually, they want the opposite. Not everyone, but.

Yeah, so yeah, it's not something that is as prevalent or indeed, I don't believe is necessary for men as it is for women. But it's a conversation that I think is occurring a lot more in wellness spaces. What would be the reason for doing it? Probably to increase things like muscle mass, mood changes sometimes that can occur in men um as as the testosterone levels that you're endogenous endogenously producing fall um yeah i think one of the main reasons that my patients would go on testosterone replacement is if they have um excess estrogen exposures um so it tends to happen more more when men are carrying excess weight as well. That because as I mentioned before,

the fat cells can produce estrogen, which can have perhaps a slight feminizing effect. So yeah. What else is unique to male hormone health that you can speak to? I think one of the main things that is worth talking about for male hormone health is the gradual decline or the gradual apparent decline in sperm counts over the course of the

last couple of generations and the increased rates of something called hypospadias which is where the urethra the the weed tube sort of forms and grows on the underside of the penis and the increased rates of only having one testicle at birth this is something that i suspect is related to again the plastic exposures in our environment the phthalates exposures um i didn't know that that was a thing yeah increase in men being born with one testicle. Yeah. What percentage of the population? I don't know the percentage.

Significant enough that it's a thing. It's been noted to be increasing. And again, as I said, the hypospadias issue as well, where there's a sort of a distortion to the penis as a result of changes in the exposures in the womb, basically, because obviously this is the way that the baby has been born. And yeah, I do see that there is a correlation there between that and increased rates of exposure

to things like microplastics, thalates, BPA. And it can potentially affect sperm counts too. So simple things that I think men could do that would be useful would be, I mean, studies have shown that vigorous exercise is quite good for sperm count assuming that you're not putting too much excess heat on the testicles themselves because like for example with cycling or hot baths because that can have an impact on the sperm production but otherwise vigorous exercise is good sources of zinc and selenium as i mentioned things like nuts and seeds are really

helpful coenzyme q10 again that can come through those kinds of healthy foods nuts seeds whole grains um yeah and minimizing plastics exposures generally which i think probably the low-hanging fruit would be to drink your water from glass rather than plastic to to avoid something that's come in a plastic bottle if it's been sitting in the heat, like in your car, if it's a hot day, for example. And you don't know, it could be in a cooler in the grocery store, but it had to be transported from somewhere.

It could have been on a truck for days or weeks. That's true. Excruciating heat. That's true, we just don't know. Getting rid of plastic, I mean, it's so hard. It's so hard. It's so completely ubiquitous. I know.

And I'd say it's almost impossible. I think recently there was a study to show that it's been microplastics have been found in the human bloodstream. It's something that we can't escape at this point, but we can minimize. And I don't want people to come away from this conversation feeling scared.

I think I'd rather they feel empowered to know there's a few things that we can do to minimize our overall exposure. And that would be heating. If we're using a microwave, for example, then just put it in ceramic or in glass as you heat it. You know, if you're drinking water, drink it from a bottle. Maybe if you can invest in a water filter, do so. Simple things that hopefully will over years

accrue to benefits. What about the role of dietary fats and hormone health? Yeah, I mean, interestingly, I have read data to say that saturated fat consumption has been associated with lower sperm counts in men. So that's something of interest. We also know that when you're eating a high saturated fat diet then it tends to be mostly from animal products and again you've got those extra

plastics exposures and things that can affect hormonal health from there so it's hard to necessarily separate the two um but in a more general sense we have lots of data to show that a saturated fat rich diet is very linked to things like heart disease um and public health campaigns can make a difference so you know i know that there may be listeners that think oh well you're only feeling better because you're eating more whole foods and it's fine to have things like you know grass-fed beef and so on but if you look at data from countries like finland for example, they had the highest rates of heart disease in the world back in the 1970s. They wanted to do something about it. They had a massive public health campaign. Many people reduced their red meat consumption,

stopped smoking, ate more vegetables. And then, you know, moving fast forward about 20, 30 years, they've managed to reduce the heart disease rates by 80%. So we can see that these are basic, simple things that people can do that can have tremendous impacts on our health moving forward. Right, within the whole food plant-based community, there's varying opinions about the positive or negative consequences of fats in the diet.

We have the Caldwell-Esselstyn camp, which is very low fat, no oils. Typically that protocol is something that's advised for people that are experiencing heart disease or have suffered some sort of arthrosclerotic event. And then there's another camp of people who are saying that's hyperbole, a healthy dose of olive oil in your diet is fine.

Like, how do you come down on this hot debate? Like, this is very divisive. It is divisive and I hate divisive debates. So I try and stay out of them. I don't know if you noticed, but I don't tend to get into it online well I'm gonna put you square in the middle of it right now you're gonna have to state your position okay so my position is we have to eat more veggies as I mentioned before that's the number one you're

dodging that's a dodge I ever heard one okay looking at the data that we have I think it's fair to say that if you're having good quality olive oil with polyphenols in it it can have some health benefits i don't think that um having olive oil in your diet is an unhealthy thing to do and i think a generally mediterranean style of diet is known by many people many nutrition researchers to be one of the best ways of eating for overall health, which includes olive oil. Yeah, I don't think that for the majority of people having oil here and there is going to be at all harmful. I'm not somebody that thinks that seed oils are particularly harmful either because they are rich in PUFAsers and moofers polyunsaturated fatty acids monounsaturated fatty acids which we know are health um beneficial to health if you're replacing

saturated fats in the diet with those kinds of oils so yeah i think it's hard to sort of come down hard and fast but i'd say looking at the data that we have, trying to compare one thing to another, seed oils have no demonstrable issues when it comes to heart health. But I would say that if you are aiming to lose weight, then it's not a great idea to have a lot of things like seed oils in your diet because they're very calorific and they don't really contain a lot in terms of the nutrients that you'd be looking at to help fill you up, like the fiber-rich foods would. And also, I have a certain cohort of patients, certainly, that notice when they have a lot of oils in the diet that it can flare up things like

inflammatory arthritis. And I think it would be remiss of me to avoid mentioning that, that certain people who have a whole food plant-based no oil diet find that it's beneficial for inflammatory arthritis as well as potentially beneficial for heart disease. Right. And I would assume there's a difference between raw olive oil that you sprinkle on a salad versus cooking with it, like the oxidative impact of high heat on some of these oils, that's a whole different thing. It is.

Although I would say that the heat at which most people cook at home is not gonna cause too much oxidation of olive oil. I think that's something that's probably overstated. What is the oxidation temperature point? Do you know? I don't remember, Rich. You put me on the spot there.

I stumped you. Yeah, I'd have to look that one up. I know that like, well, you know, every oil has a different- Smoke point. Yeah, smoke point, right? So coconut oil is much higher. It is, but-

It doesn't oxidize until you get super hot. So it's sort of advised that if you're gonna cook with one, that's the one to cook with. Well, that depends because coconut oil also contains saturated fat, which is still saturated fat, even though it comes from a plant. So I think if someone wants to concern themselves with the smoke point, then avocado oil is probably a good choice,

or cold-pressed canola oil would be a good choice as well. That's always been the number one enemy one. Sorry, but the data suggests that cold pressed canola oil is a pretty good oil to cook with because it contains the unsaturated fats and it has a higher smoke point. So yeah, if you don't wanna cook with it, you don't have to.

Controversy. In the daily practice of being a doctor and seeing patients, what do you find to be, you know, when you're in this discussion around changing your lifestyle, maybe adopting a more plant predominant diet, and then following up with these people, like what do you find to be the common blind spots

or stumbling blocks or places where people can go astray? I think our food environment is probably the biggest thing. So we seem to have this feeling in the wellness space that we are all individuals and unique and we can make choices that are not unrelated to other things in the world. And actually most of the choices we make around food are unconscious choices about, I think UCL research stated that there was over 200 unconscious food choices that we make every day and only about 13 to 15 conscious food choices.

Wow. And when- I didn't know that we made that many food choices in a day period. Well, exactly. But that's what fascinates me is to think when the research tells us that so many of the factors that control what we eat are actually out of our conscious mind,

it's much harder then to make changes for the long-term that are healthy, especially if you don't have the mental bandwidth or the budget to think about these things. Having said that, we know that whole plant foods can be some of the cheapest things you can buy, as long as you can get access to them. So one of the main stumbling blocks for me

has always been people's habits and ability to have the bandwidth to make those changes mentally. So I really start simple, just go for very simple swaps, find their favorite meals and make them with more plants, basically. Maybe get them to write down the favorite things that they like to cook and add more beans, add more lentils, add more vegetables, and then gradually crowd out the other things. It's been one of my number one sort of ways to get people to eat more veggies. Yeah. Yeah, I feel like it's two main things. One, which you just referred to,

which has a lot to do with being more conscious about the environment that you keep. Like if you can create an environment where the healthy choice is the most convenient because you've cleared all the bullshit out of your cabinets and you only have healthy choices. And when you wake up in the middle of the night,

like, sorry, you know, it's gonna have to be- You got the munchies, you get your carrots out. Yeah, you know, that Ben and Jerry's just ain't there. So it's about a conducive environment to making the better choice. But I think perhaps even the bigger issue in stumbling block is really the social issue. Like people get all up in their heads

about what other people are gonna think about them, what's gonna happen when they go to Susie and Dave's dinner party and they don't wanna make a fuss or I have to go on vacation with my neighbors and it's just gonna be too problematic. And people like relinquish their boundaries or are just too afraid to stand up for themselves or to like make that conscious choice because they don't want to be

difficult. Yeah, I can totally relate to that because that was my instinct first of all, when I started on this journey, my main thought was, oh, this is going to be so awkward for everybody. People are going to think this is so strange. You know, it's, I think as social creatures, it's one of the main considerations that a lot of people have. And I guess it comes down to living in alignment with the things that you most want. Do you most want to be somebody that pleases others? Do you most want to be somebody that lives in alignment with things that are important to you? Are those things one and the same? If you can have a conversation with yourself

around the values that you're living by, it becomes much easier to then make conscious choices that are in alignment to those values. So I would actually encourage everybody to have this conversation with their loved ones or even just with themselves. They could write it down in a journal, write down their top values in life

and how their food choices can relate to those values. And then it becomes a lot easier because you're taking away a lot of the extra choices that you're having to make or the social situations that you're having to navigate because you are consciously living in alignment with the things that matter. So if it matters to you to minimize your risk of heart disease because you have a relative that died young, you want to see your children grow up, then you write that down and you find ways

to make it work within that kind of framework, if you like, your values framework. If animal compassion is important to you, it's probably a lot easier because you've already made that decision for another outside purpose. It's something that's outside of yourself. And perhaps the same can be true for someone that cares deeply about the environment and the planet. They've already made that decision based on a value that's so strong to them that it actually makes it a little bit easier to stick to. I think health overall is probably one of the first ways people go towards plant-based nutrition, but it's also one of the hardest ways to stick with it

if that's your only goal, because it's quite self-focused. Whereas if you can focus on something outside of self, then it potentially could make those choices a lot easier, either environmental health or animal compassion or reasons to stay healthy for others. It tends to be, in my experience, potentially could make those choices a lot easier, either environmental health or animal compassion or reasons to stay healthy for others. It tends to be in my experience,

ways that make it stick a lot more. Yeah, that's a really good way of thinking about it. One of the questions that I get all the time, I'm sure you do as well, is I wanna do this, but my partner doesn't want any part of it. And you began this journey, Richard was doing it ahead of you, two different dinners, meals, et cetera.

But for a lot of couples, that becomes very problematic, especially when those values might come into conflict with each other. Yes, you're so right. And I think my advice from that, being the partner that was most reluctant, perhaps I can speak to this more, is the idea that what most reluctant perhaps I can speak to this more it's the idea

that what I needed was patience and time and sometimes people will never come around sometimes the people you love the most will never want to do the things that are important to you when it comes to diet and I think that taking away that expectation is important because when you start to expect things of other people, that's where you can start to become very unhappy. You know, you have, it builds kind of criticism in your mind. It builds comparison. It builds expectation. And that can be quite toxic for your relationship. So my best advice is just to do the thing that's making you happy, do the thing that brings you in alignment with who you want to be and show your partner through your actions, how much happier, how much healthier, um, and how much more abundant you feel in your life. And then if

they want to come along for the ride, they can. Right. But you have to be detached from that expectation. Otherwise you're going to be vibing them all the time and then that piousness creeps up and that just becomes a disaster. Exactly, you've gotta let that go. You just gotta let that go. Even if it's in the back, well, if I keep doing this, they'll eventually come around.

No, you gotta like get rid of that. I do think that that's probably the best way for you to sustain a healthy relationship with the people that you love the most. And it's hard because often the people you love the most may you feel need it the most, especially if they have a health condition that could benefit from doing that.

But you have to let it go because it's not your life. It's their life. I mean, that's advice for this particular scenario, but for a zillion others as well, like in terms of like partnership dynamics. Yeah. And in a partnership, you will often have expectations of a partner that are unspoken, and that could be true for any kind of scenario. And that's not to say that you shouldn't communicate the things that are important to you. Of course you should, but it's the expectation

that is attached to that, which I think can become very negative in the relationship. So letting go of the expectations of your partner is probably the key to a happier life in all sorts of ways. Did Richard do that? Yeah, he was very patient with me. In fact, when at one point, I think, cause steak used to be my favorite meal and burgers. I'd always order burgers when I was out and steak, I think, cause steak used to be my favorite meal and burgers. I'd always order burgers when I was out and steak. I loved steak. And once he even cooked a steak for me, that shows how much he loves me.

Oh, strategic. Yeah, exactly. It's like reverse psychology. Right. So it was in the back. Oh, if I do this, right? Yeah. Who knows?

But that brings up an important issue, which is, somebody who's listening to this or watching it is thinking, well, my life is just gonna become infinitely more complicated. It means like we're gonna have to prepare two different meals. I'm gonna have to spend all this time in the kitchen.

I'm gonna have to plan out everything in advance. It's probably gonna be expensive. And suddenly my life, which was kind of going along pretty good, suddenly gets hijacked by this new lifestyle habit that is gonna commandeer suddenly my life, which was kind of going along pretty good, suddenly gets hijacked by this new lifestyle habit that is gonna commandeer all my time, energy and money. And is that the person that's wanting to start this or is this the partner of the person

that's wanting to start this? It's the plant curious person who's contemplating the change, but now suddenly feels like maybe this is a little bit too difficult. Yeah, so it's kind of moving from contemplation to action that people tend to have a stumbling block. Right, well, they're hearing you and they're like,

well, my partner's not gonna be into this. So am I willing to- Rock the boat. Yeah, do this thing that's gonna potentially cause fissures in my relationship and take up a lot of my time. Yeah, and those are very valid concerns. And I guess what I'd say to that person is, you have to find the thing that helps you know

where you're going for the future. I think a lot of the time we kind of coast through and we do things because they are the path of least resistance. And sometimes the path of least resistance is sometimes the path of least resistance is a great path and it works and everything's going well but sometimes over the course of maybe weeks months to years we start to notice actually this isn't really working for me anymore you know although this is the easier route i'm not feeling this i either don't feel healthy or there's something niggling me and in my

conscience about things i want to do differently and sometimes changes do require a certain amount of forward thinking and sometimes the biggest changes that we make in our lives are as a result of pain points things that come up in our lives that we don't like. Hello. Yeah, exactly. Pain can be our biggest teacher. And for those who are hoping to start making changes, but that pain point isn't quite there yet,

then maybe they won't make a change. Maybe this won't be the right time for them. But my hope is that if we plant these seeds together today, some people will have enough water to plant, to water those seeds. And other people may have enough sunlight to provide those seeds with a little bit of sunshine. And maybe those seeds will grow into plants of change based on today.

So the person who's sticking that seed into the soil right now and getting ready to water it, but doesn't know how to water it. Like, how do you think about the early phases of this? Like I'm somebody who went all in, that's just my personality type. I recognize most people aren't like that. I suspect you're somebody who would counsel people

to make tiny changes, master them. Like, how do you get somebody engaged in this and give them some actionable advice about how to begin in a very practical manner? So number one is literally write down the foods that you buy in your weekly shop. Number two is write down all the foods that you make with those ingredients. And if you can find one meal a week that you'd like to have more plants in, then that can be your first step is literally just cook one meal a week that is plant-based and see how you feel. And then if that works for you, then you can cook another one and then maybe cook another one.

Yeah, but all I do is eat takeout. Well, if you eat takeout, then interestingly in the.s i don't know if it's the same but in the uk uh we have a pretty good plant-based um ready meal range in a lot of our supermarkets and interestingly i had a patient who was elderly type 2 diabetic never cooked for himself and i said to him why don't you just swap that one ready meal that you buy for this ready meal, which has all plants in it? And in doing so, he was able to come off insulin and improve his type two diabetes. So there's always a starting point for everybody. If you're somebody that just eats takeout, then you know what, for you, the best thing would be perhaps just to start with one

home-cooked meal a week, rather than trying to change everything. Just cook one meal at home rather than having all meals take out. For my elderly patient who was just eating like small ready meals from the supermarket, switch to a plant-based one and see how you feel. See if it changes your health over time. So it's just, it is for a lot of people about those baby steps. For others like you, they jump in and they'll get started and they'll figure it out along the way and they'll enjoy that process. And that's great. But for most people, it's just little steps. And there was research by BJ Fogg to show that only one change is enough to then start changing, shifting that identity and then sort of adding in something new after that. So yeah, just one thing, one thing is all you need to do. I'm getting BJ Fogg in here. I've been going back

and forth with him on email forever. He's getting in here soon though. Yeah, I like that idea. I mean, I think, you know, in listening to you, I'm reflecting on some of my habits now and what I find myself doing from time to time when I'm busy or Julie's out of town or she's like, I'm not cooking tonight, I go get plant-based takeout. But you have to be really careful because when you're getting takeout food, you're not preparing the food.

There's gonna be more oil in it than you think. There's gonna be more salt in it than you think. And if you're opting for some of these meat and dairy analogs, like maybe not so good. Not all of them, they're all, it depends on what, because there's a spectrum in terms of health, the health factors that are what these things are about. But how do you think about the Beyond Burgers

and the Impossible Burgers and all of that kind of stuff? I like to be fairly practical in the advice I give to people. I think if somebody likes the taste of an Impossible or a Beyond Burger and wants to have it once or twice a week, then there's no reason why they shouldn't for the most part. Especially early in the transition.

But then having said that, there is interesting data emerging that there was a study that one of my friends did actually on a specific brand of plant-based meat replacement, meatballs and mints. And in the study, families were given these meat replacements to use alongside the normal meat and other foods that they would prepare. And what they found is that in the families that had the meat replacement, they had a favorable change in their microbiome over the course of those, I don't remember how many weeks the study was,

but it was perhaps about four weeks to my recollection. They had really great shifts in their microbial health from using meat replacement analogs. So I think we do need more research to understand the effect on the body but we do also know that for you know in the majority of these meat replacement analogs there will be less saturated fat um there will be less or no heme iron which are both potential issues when it comes to heart disease risk and inflammation in the body and you And I think they are too easily demonized by a lot of people.

And yeah, that's my take on it. I wouldn't say you should have them every day, but it's the same with any kind of food. It's great to have variety and whole foods as your main go-to, but I think a lot of people are too quick to cast off these meat replacements. Right. Yeah. Well, again, it's a spectrum, some are worse than others. Yeah. And there's a difference between health promoting and neutral versus deleterious to your health. Exactly.

I think what is becoming a bigger issue over time is that now there are so many products out there that taste really good and you can kind of psychologically rationalize eating them like, oh, it's vegan, it's plant-based. Like it's gotta be good for me, right? And wake up only to realize like, you're just eating French fries

and Beyond Burgers all the time. That's not a whole food plant-based diet. And it becomes incumbent upon you to like really make sure that you're eating plant foods close to their natural state as wide a diversity as possible, rather than diluting yourself that because you're not eating cheeseburgers, you're eating a plant version of that,

that you're gonna sidestep heart disease, right? Exactly. So, and it's hard, it's kind of like, the stuff finally tastes good for the most part, and it's gonna continue to get better and better and better. I think what we're gonna see is like a split. We're gonna have foods that are gonna taste exactly like that thing, but they're gonna be probably

on the more unhealthy side. And then there's gonna be other companies who are creating plant analogs to some of our favorite foods that are doing it with health in mind and lesser ingredients and natural ingredients. And my hope is that there's a lot of focus and energy and money going into that right now, because I think that's what we need more of. I agree with you. I think that you're absolutely right. We want minimally processed, less ingredients, more whole food based analogs for sure and the the ingredients do vary really widely

so yeah i think when you look at the data on plant-based diets um and the healthy plant-based diet index which was um really interesting data you you see as you pointed out that if you're having an unhealthy plant-based diet with things like French fries and ice cream and all the things that you can essentially- Coconut ice cream and Oreos and potato chips. Oreos, yeah, crisps, potato chips, all of that kind of stuff, you're not gonna reap the same benefits at all.

And you're right, people can delude themselves. They think, oh, well, it's healthy because it's plant-based. Well, it's not always. So what's your day in food look like? Oh, I love, oh, what do you call it here? Oatmeal. Oatmeal? I call it porridge.

What do you call it? Porridge. Porridge. That's what they call it in, what's your town called again? Where I live. Yeah. Buckinghamshire. Right, of course.

It's like the most British thing ever. Sorry. Yeah. And what part of England is it? Surrey? It's not, I work what part of England is it? Surrey? It's not, I work in Surrey. You work in Surrey, okay. And I live in Buckinghamshire,

which is kind of between, well, I live sort of near Windsor where the Queen lives. So that's kind of near where it is. You'd probably know. You just get more regal with every moment, Gemma. Well, I'm from Devon, which is not as regal. That's down by the sea. Yeah.

Isn't that where Earthling Ed's good, like his fish, his plant-based fish restaurant is? Good Catch or something like that? I don't know, but I'd love it if it was because Devon needs more plant-based options. I think it is. I could be wrong, but anyway, go ahead. A day in the life of food.

Oh yeah, so I forgot where I was going. Yeah, so I love porridge. I love to put flax seeds and chia seeds in it, berries, almond butter. You've got a lovely mixture of whole grains. You've got your nuts, you've got your seeds, you've got your antioxidant rich berries. So yeah, that's a real win for me.

And yeah, in my book, I've got a lot of wholesome recipes that are also kind of comfort foods, favorite comfort foods like mac and cheese, which obviously doesn't have cheese in, but it's a nice kind of whole foods version. I love things like spaghetti bolognese, but rather than using mince, I use lentils and beans.

Mince is like meatballs in American. Oh yeah, no, I don't know. Do you not have mints? It's like- Mince, M-I-N-C-E, right? That's how you're spelling it? It's sort of like ground beef. It's like ground beef. Right.

Yeah, but I don't use ground beef, obviously. What do you call it? I don't know, crumbles? Crumbles? I don't know what we call it. What do we call it? Mints? We don't have a word for that. Chop meat. Chop meat? Chop meat. Yeah, I don't know, crumbles? Crumbles? I don't know what we would call it. What do we call it? Mints? We don't have a word for that. Chop meat.

Chop meat? Chop meat. Yeah, I don't know. There's lots of suggestions from all these different corners of the room. Yeah, so I love comfort foods. Mints and porridge. I eat mints and porridge.

Yeah, so I don't eat much mints at all. I tend to have beans and lentils with my spaghetti bolognese. I like burritos actually. I'm a big burrito fan. Well, you're in the right place for that. Yeah, we had some amazing burritos. We went to Cafe Gratitude.

Oh, you did? I had lunch there yesterday. Were you there? No, well- Today you were there? It was day before yesterday. Yeah, I missed you. No, it's good there, right?

Yeah, it's really nice. Yeah. Do they have burritos in England, in the UK? Yeah, we do. And what else? No, that's not it. I've got lots of things. I love a good curry.

I've got a great curry recipe in the book, cauliflower and chickpea curry, I love. I also really like stews and that's kind of wholesome winter. I'm thinking of all my favorite winter foods because we've had a very long winter in the UK, but now we're coming into the summer. I do love things like salads. I add in things like tempeh and tofu into my salads

and what else? And is Richard still the cook or do you cook also? Yeah, I cook. Richard cooks a little bit, but so between us, we share it. Yeah, cool. Well, let's round this out with maybe some practical guidance to kick people into this kind of lifestyle. Like when somebody comes to you and they're ready to go,

like what kind of words of wisdom can you provide to empower them to embark upon this journey with confidence and perhaps a few practical things that they could do to make it work within the construct of their busy life? Well, I think the number one thing is think of simple swaps that you enjoy, which we've already touched on. Number two would be, again,

to think about the values that are important to you. And if you could try and live by those each day, it really helps you with the food choices you're making as well as everything else. Maybe just three, just three values that would be really helpful. I don't know if you have any sort of top three that you have in your head right now.

Well, I was just thinking if I was you and I was seeing patients and I knew that they could come back and make another appointment and follow up, I would try to, because I'm competitive, I would try to find a way to gamify it. I'd say like, well, here's your numbers in these categories. I wanna see them go down 10% in each.

So I want you to come back in 30 days and we're gonna do it again. So it's almost like goal oriented, like it's very practical, like here's what we're driving towards. And if you can come back every 30 days or every 60 days or something like that, and we can evaluate the progress, that creates a level of accountability and engagement.

Yeah, I do that at work. I definitely do. And it's quite nice because you've got actual numbers to work with and you have a goal for people to have in mind. I think making those goals specific and time orientated really helps. So, I mean, generally for people at home, if you want to do that for yourselves, then maybe you could get your blood tests done, your blood work done, and then decide, okay, in the course of four or eight weeks i'm going to get to this

number and this is how i'm going to do it but certainly my practice i found that with my patients getting average blood sugar readings getting cholesterol or lipid panel profile or blood pressure readings actually they can change over time as well with nutrition it's quite nice to then be able to have that accountability to be able to bring them back and to encourage them as well. Yeah, I think for some of my patients then gamifying it is good, but for others, they just tend to need that little bit of extra

like compassion and care and make sure that they know that I'm gonna be there and I'm gonna check it again when they come back. So yeah, it's a good strategy. I also think being specific, it's fine to say it's okay to do this gradually, but how are you specifically going to accomplish that? Because to just say, well, I'm just gonna try

and I'm gonna start eating more plants seems very vague. But if you say, listen, I know you love cream in your coffee, so for the next 30 days, you're gonna do almond milk or soy milk or whatever it is. And you're just gonna master that one thing. Like that's all you have to do is like that one thing. And it makes it very doable because, and it's kind of like a go, no-go thing, right? You can wrap your head around it.

This is what I'm doing. And then after 30, 60 days of that, it's like, okay, well, that's just, I don't even think about that anymore. What's the next thing that I can do? Yeah, exactly. And I think that makes it more like, okay, well, that's just, I don't even think about that anymore. What's the next thing that I can do? Yeah, exactly. And I think that makes it more like, cause the human brain is weird, right? And if you're just like,

well, I'm just gonna eat more plants. Like, what does that mean, right? And I think that that will wane in terms of how people are kind of consciously engaging with each meal and each food choice that they're making throughout the day. Yeah, you're right. And it's also so individual to people as well. So I could have one person sitting in front of me

who thinks, okay, well, I can start with my milk and I'll have someone else sitting in front of me that thinks, okay, well, I know I can just start with my breakfasts. And I'll have someone else sitting in front of me that thinks, okay, well, I know I can just start with two tablespoons of milk flaxseed a day. Okay, and then, so it really depends on the person,

what route I go down based on what they feel they can achieve based on what they already are doing, which is, yeah, it's quite good to individualize it in that way and make it really super specific. I also think people future trip, I'm sure they say to you, I can't do it because I have to go to a wedding this summer, you know, in four months or something like that. It's like, that doesn't matter. Like, this is a sober thing. It's like, what are you doing today? Can your head hit the pillow sober tonight?

That's all you have to worry about. What is your next food choice? When you, okay, you're gonna go to the grocery store today. Like, what are you gonna buy? Like just focusing on making that next right choice and not worrying about what you're gonna do tomorrow. Obviously with food, there is some planning involved. Like you're getting food for the next day or for the following week. But to

the extent that you can just be rooted in the moment and not freak out about like the rest of your life or, oh my God, I'm never going to have this food ever again. Because I think that that really works across purposes with the goal. It's so true. That is so true. And I think about that in other aspects of life as well. You can generally manage to do something just for today. You can manage to make the right kind of choice for your health and body just for today. Or you can choose not to feel angry just for today. Or you can choose not to worry about something just for today. angry just for today or you can choose not to worry about something just for today um yeah and this is a slight tangent but I actually have this daily mantra that I do which is exactly that it's in Japanese and in English it means just for today do not be angry do not be worried be grateful

Do not be angry, do not be worried, be grateful, do your duties fully and be kind to all living things. And that is the mantra that I actually repeat to myself twice a day, every day in Japanese. And it's just for today. Well, you know what I'm gonna say right now. I'm gonna make you do it in Japanese. Okay, oh gosh, okay, the fresh is on. That's beautiful.

I think that's a good place to end it. I can't imagine a better ending than with that mantra. It's called the Gokai. The Gokai, where did you find that? It's part of my Jikudin Reiki practice, which is a whole other topic of conversation. Yeah, that's a whole, I know a little bit about that, but that's a whole other podcast. Yeah.

Next time. Next time, next time. But yeah, it's a great way of living, being, thinking. You don't have to put pressure on yourself to be your best self every day. Just try and do it today. The Plant Power Doctor paid a house call today and I think we're all the better for it.

Thank you, Gemma. Thank you, Rich. Thank you for all that you do. I appreciate you. The new book is The Plant Power Doctor, available everywhere. Pick it up. It's quite an accomplishment, a beautiful book,

beautiful photographs, plenty of recipes, but amazing takeaways to improve your life on the daily thank you so i wish you well and come back and talk to me again sometime i can't wait for the next time i gotta make it out to london yeah i'm trying to figure that out at some point when you do i'll be there we'll both there. We'll cook you amazing food. You can stay with us if you want to. Excellent. In Buckinghamshire. In Buckinghamshire.

I feel like I have to see it now because in my mind there's just beef eaters everywhere. No, no, it's, well, Windsor, yes. We could take you to Windsor, which is only a 10 minute drive away and you'll see beef eaters everywhere there. Good, thator, yes. We could take you to Windsor, which is only a 10 minute drive away and you'll see beef eaters everywhere there. Good, that's a promise. And final thing,

like if people wanna learn more about you, where's the best place to have them go? You do a lot on Instagram. I do a lot on Instagram. Yeah, plantpowerdoctor on Instagram. But my website's got loads of free resources, jemmanewman.com. So yeah, check that out as well.

All right, thanks, peace. Peace and plants. Plants. That's it for today. Thank you for listening. I truly hope you enjoyed the conversation. To learn more about today's guests, including links and resources related

to everything discussed today, visit the episode page at richroll.com, where you can find the entire podcast archive, as well as podcast merch, my books, Finding Ultra, Voicing Change in the Plant Power Way, as well as the Plant Power Meal Planner at meals.richroll.com. If you'd like to support the podcast, the easiest and most impactful thing you can do is to subscribe to the show on Apple Podcasts, on Spotify, and on YouTube, and leave a review and or comment. Supporting the sponsors who support the show is also important and appreciated. And sharing the show or your favorite episode with friends or on social media is of course awesome and very helpful.

And finally, for podcast updates, special offers on books, the meal planner, and other subjects, please subscribe to our newsletter, which you can find on the footer of any page at richroll.com. Today's show was produced and engineered by Jason Camiolo

with additional audio engineering by Cale Curtis. The video edition of the podcast was created by Blake Curtis with assistance by our creative director, Dan Drake. Portraits by Davy Greenberg and Grayson Wilder. Graphic and social media assets courtesy of Jessica Miranda, Daniel Solis, Dan Drake, and AJ Akpodiette. Thank you, Georgia Whaley, for copywriting and website management.

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