Dr Ayan Panja: When I say snake oil, I mean the difficulty I think in medicine is that there are so many experts and I'm not going to name them but early on in the book I talk about a couple of people I have a huge amount of respect for who are experts, you know, they're professors or whatever. And one of the one of the things is, why should someone read my book? What have I got to offer apart from the fact I sort of fixed my own health? And the reality is is that I've been treating patients for for years, and a lot of experts are, they do amazing work, you know, and they present studies on on all sorts of things from circadian rhythm to vitamins and minerals or whatever. But actually when you apply it to the individual, that's a totally different skill and that's what we do really well I think as as GPs. That's part of our training, we're experts in people.
Dr Rupy: Well, first of all, congrats.
Dr Ayan Panja: Thank you so much, yeah.
Dr Rupy: How'd you feel?
Dr Ayan Panja: Nervous actually. Very good. It's been a long journey and I'm just glad to be here but now a bit of trepidation's creeping in in terms of how the book lands, but yeah, really glad that I sort of finished it and it's out there.
Dr Rupy: What are you most worried about?
Dr Ayan Panja: I think I think, I'm talking to someone who's written loads of bestselling books, I think that feeling of, yeah, just what are people going to think of it? Is it, does it make sense? And the thing about writing a book as you know is that you lose yourself in it and on the way here today I was thinking, do you know what, I actually I've forgotten what's in the book even though I wrote it. And I was sort of reading through it thinking, oh yeah, I forgot I wrote that. It's a really odd thing, isn't it? Even though you've created something, you kind of wonder whether what's in it actually, you suddenly have these doubts and you think, oh, is this actually valid? But I don't know, I'll take your view on it because you've read it, so.
Dr Rupy: Mate, I we were saying this before, when you asked me like, do you actually like it? I was like, Ayan, I love it. I think it's brilliant. It's really good and I genuinely mean that and I knew it was going to be a fantastic book and I know it's going to be a bestseller because you've been ideating this book, this copy, the structure of it for years. And you can tell, I can certainly tell being a GP, that you've been in the game for almost a quarter of a century now, right? It's pretty crazy when you think about it. Yeah, and that really comes out in the book and the way you've laid it out and the refinement of it. So I think it's fantastic.
Dr Rupy: Where I wanted to start with this is when you're reading the book back, how, what kind of frame, what kind of mindset are you reading it from? Are you trying to think about, okay, how can I pack more into this book or from the perspective of a reader who's picking this book up for the first time, what their opinion's going to be?
Dr Ayan Panja: Yeah, it's a great question. From an author point of view, I always think, oh, I didn't put this in there or that in there. But from the reader point of view, I want it to be really easy and in one line, people often kind of go, what's your book about? Which is actually a really hard question to answer, isn't it? That sort of 10 second pitch, what is it? And really what the book is, is it's a way of improving your health by laying out your story and understanding your story. So it's very individual. It's not just about, yeah, you need to exercise a bit more and eat a bit better. We kind of know all that stuff. This is much more tailored to the reader. So immediately when you pick up the book, I start with my own story and how my health kind of collapsed when I was 40 and how the book contains in a way this formula that you can apply to anyone. Anyone can pick this book up and lay out their health story and think, hang on a minute, I can see what I need to do to improve my health. And it's not necessarily the things that people might think are the things that improve our health.
Dr Rupy: Yeah, yeah. And when you were writing the book, I'm sure you had a similar issue to me in that you probably wrote a manuscript that was way too long at the start and you had to go through that period of refining and just shredding and you know, I've heard authors say that you almost have to kill your babies in the sense that there are so many chapters that you want to cram in there, but from the perspective of the reader and someone who actually you want to take on a journey, you've had to cull a bunch of stuff. How was that process for you?
Dr Ayan Panja: Yeah, it's interesting because I actually I had the opposite because I wrote it in such pressured conditions and actually at the back of the book there's an acknowledgement section and I'm, I don't want to put a downer on it, but it's very frank about the fact that I had to really cram this into spare time that I don't have because I'm so busy. But so I didn't have too many words on a page, but I had so many ideas and actually recently I was thinking, oh, you know, it's a silly thought this, but I didn't put anything in there about gargling activating your vagus nerve. You know, doesn't matter, it doesn't need that in the book. But but you know, so silly things like that pop into my head. But I think what I've tried to do is keep it sort of, so there are sections in the book called deep dives where you have to go into the science because I think it's all well and good kind of taking the reader on a journey of their own health, but some people and a lot of people want to know what's behind that, what's under the bonnet, you know, why will this help me? And so there are some quite, I say sciencey sections which some people might think, hang on, this is just like too deep for me, fine, just skip over it and carry on. But I've tried to keep it relevant to the reader and I think I'm really hoping it will just relate to each person and you'll spot yourself in the book I think because the sections of the book are very, very sort of structured and I'm not a structured person, but I realise people like structure. So it starts off with the foundations, you know, which is the first bit. And the foundations of our health are really two things. One is our behaviours and the other is our biology. And if you don't really have some understanding of those two things, you can't really improve your health. So I kind of spend quite a bit of time taking the reader through how to, you know, why our behaviours are important, how to change them, you know, and I've got some nice little frameworks in there that I think work that I've used myself. A lot of it is is not just from myself actually, a lot of it's learning from patients and their stories over the years. For example, behaviours, there are only, you know, we all know the theories on behaviour change and the great work that BJ Fogg does for example on, you know, you have to have motivation, ability and prompt, you know, we used to call it trigger. And you need these three things in order to change a behaviour. Yeah, great. We sort of know that and thankful to him for creating that framework. But actually if you think of real life, there are only a few reasons that people change their behaviours. So one for example is tragedy, you know, so your best friend dies of a heart attack and you suddenly think, you know what, that's it, I'm going to change my behaviours. No one wants that one. Another one is one I call in the book under orders. So you get on a flight, can't smoke if you're a smoker. And actually you can sit on a flight for 14 hours and not think of smoking. But as soon as you get off, you want a fag and it just shows you how powerful the brain is when you're in certain instances. Another one I call friendly jealousy. So this is one where you turn up, like I have today at your place and I sort of see that you're well built, you look amazing and I think, you know, I want a bit of that. So I sort of go away and think, yeah, I'm going to spend a bit more time looking after myself because I want to look like Rupy. And so it's very sort of relatable to people. These are it's very real and there's I've tried not to use too much jargon in the book because I think, you know, a lot of people like that kind of academic, very highbrow, serious stuff. Great, we can do that, but actually is it relatable? I'm not so sure. And so I really want it to be relevant to people.
Dr Rupy: Yeah, yeah. And I that definitely comes across. It's funny you say you're not a very structured person because on reading the book, it I definitely get the impression that there is structure whenever you see a patient. It might not be apparent to you, but you know, when you're describing some of the clinical cases, I really get this idea of, okay, there's Dr Ayan, he's in his clinic and someone comes in and he's already thinking about how the biology is related to the systems and how he's going to prescribe them, you know, a lifestyle prescription based on some of the other sort of diarising and and a bit of more in-depth knowledge about the triggers for their symptoms.
Dr Ayan Panja: Yeah.
Dr Rupy: I probably said that in the wrong order there, but like from from reading the book, I really got the impression that there is a lot of structure whenever you see someone coming into into clinic.
Dr Ayan Panja: Yeah, there is a little bit. It's weird because as a GP, the difference between us and hospital doctors is that we see the same population with different presentations. So it's about the person, whereas in hospital medicine arguably, you know, one of my best friends is a head and neck cancer surgeon, but so he's seeing the same conditions but different people. You know, so the lens is slightly different. And normally what happens on the phone or in person is someone tells me a story. And if it's not something defined like, oh, I've broken my leg, went to A&E, I'm going back to fracture clinic, I need a sick note and some pain relief. That's pretty well defined and you don't need any of this stuff. But if it's if it's something nebulous and it's like, well, I've just not been feeling right for a while, you know, I get bloating after meals, I've been getting these headaches and my joints ache a bit and I've had loads of bloods and they're normal.
Dr Rupy: It's like a daily occurrence in GP. You're always going to have people coming in with pretty much that description.
Dr Ayan Panja: Yeah, and and three things light up in my brain really. Number one is I think, okay, could this be an early warning sign for something that's going on internally? So in that biology section at the beginning, I talk about how symptoms relate to systems. So if you if you are getting aching joints, it means there's something going on in your biological systems that is awry, that needs fixing. And then I let, you know, I let the patient sort of tell me the story and I fit it into what I call the health loop, which is really the first part of the book that lays out your story. So you and I sitting here now, there are eight things that give rise to our health right now at this moment in time. And not in any particular order, they are diet, exercise, stress, sleep, genetics, environment, exposure to sunlight and historic infections, which I'll come back to. So they're pretty, they should sound fairly obvious to most people. And the way that I blend it into the story is everyone's story is different. And then you lay out these eight factors and if I haven't got enough info, I'll often ask the patient, tell me about your typical day, because a lot of those will drop out, you know, so they'll sort of go, well, you know, I work in a bar and I go to work at 8 p.m. I get back at 4 a.m. So immediately I'm thinking, wait a second, you know, you're that's not great for sleep or whatever. And so you get these clues and then once you've laid that out, that in itself is often enough for people to think, hang on a second, you know, there's something really obvious here. So for example, why historic infections is important is that they often leave a stamp on your immune system and leave you with mystery symptoms like fatigue or problems with your gut. So, but people often don't think like that and doctors don't think like that. We often ask about, oh, when did it start a couple of weeks ago? And we sort of forget the rest of the story that really starts when we're born. So, so you're quite right in some ways. I do sort of, I am sort of thinking that. So that's, so the three things I'm thinking is, how does it relate to the health loop? What's your typical day like? And I match it then to their past medical history that I've got on the computer usually. And the three things together will enable me to then effectively ask them to mess around with their habits. And the messing around bit is what I call how, what and when. How you eat, what you eat, when you eat. It's not good enough to kind of go, well, yeah, your diet's okay. It is sometimes if you don't have health issues, you're lucky, but sometimes those things are really important, you know, and there's a case in the in the book where there's a guy who's relatively healthy, but he eats standing up. He's a hairdresser, so he never sits down. What's the problem with that? Well, your digestive enzymes don't get enough of a chance to work. So, you know, immediately there's something you can change there, sit and eat. So it's, so the lifestyle prescription bit is often, I used to write them on post-it notes because they were literally sort of two or three little things that I think are manageable that they're going to be able to do. There's no point in writing a list of stuff that no one's going to be able to do. And that's it, they go away and it seems to, it works. I think that's the thing and having done this on myself, I know that these small things make a big difference, you know, if you make sort of subtle changes, you can completely change how you feel.
Dr Rupy: Totally, yeah. So we've talked a bit about the biology, the behaviour change element and the structure that you use. And I guess the whole book is full of examples of how you put this into practice, but also how the user, the reader, hopefully there'll be hundreds of thousands, maybe millions of people reading it, can also action this in their lifestyle today. Before we get on to that bit, let's talk a little bit about the systems. So the systems by which the health loop or those different eight elements, what do you call them? Eight elements or eight?
Dr Ayan Panja: Yeah, just eight factors in the health loop.
Dr Rupy: Eight factors. That's it. Yeah. So the system, the six systems that, you know, essentially work in alignment with those. What are those systems that we're talking about?
Dr Ayan Panja: Absolutely, yeah. So they're everything that works together in our body. So your gut is one, cardiovascular system is the other, your nervous system, your musculoskeletal system, your hormonal system and your immune system, which overlaps greatly with the gut because about 70% of our immune system is in the gut. And there's two important points here. The first is even as doctors when we were trained, we didn't learn that all of those things communicate with each other. They're interconnected. And to give you a really crude example of how they work, anyone who's stayed up really late and revised for exams like I used to with 10 cups of coffee through the night, you know, and popping caffeine pills and stuff. You know, the next morning when you're going in and you're sleep deprived, if you think of what those systems are doing, you know, your gut is churning, your heart's like racing at like 150 and your brain is just buzzing. And again, so I've just mentioned the nervous system, the cardiovascular system and the gastrointestinal system. And in a way, although that's a very short-term example, or the example of, you know, a tiger jumping out at you and what would happen with flight or fight. That happens in the longer term in slow motion to us as human beings when the systems start to go wrong. And the example I give is the one of a house, you know. And a house or a flat, you know, this place has several systems. It's got an electrical system, it's got a plumbing supply, it's got, you know, carpentry, it's got all sorts of systems that make a home. And a really good example of how symptoms relate to systems going wrong is the leaking shower, you know, if you if you sort of see a brown patch on your ceiling, there aren't any in here actually, but you can either sort of like paint over it, which is not the right thing to do. Or you just wait and if you wait, what happens is that, you know, eventually the plaster gets wet and then it comes down the wall, goes into your light switch, screws up your electrical system, then it affects the Wi-Fi, then it, you know. And in the same way, the same sort of thing happens in our bodies. And symptoms are often an early warning. I've got to stress here, I don't want people to kind of rush off to their GP if they sort of think, oh, you know, this doctor said that, oh, this could be an early warning symptom of something else. The whole point of this is that you can work through this yourself. It's it's not a self-help book exactly and it's but it's definitely in that area of self-care, but it's much more targeted rather than, hey, you know what, I'm going to just be healthy and eat lentils this week. No, it doesn't always work like that because lentils may not suit you. And this book kind of helps lay those things out with with I say clever tools, but they're very simple. They're very simple.
Dr Rupy: Yeah. I think that one, you know, takeaway from the book that I hope readers get are the interconnectedness of all those different systems. You know, I think what you said is absolutely correct and probably unfortunately it's still correct with the medical schools today where you're taught about the gastrointestinal system, you're taught about, I don't know, let's say gastritis for example, and you're taught about antacids, the particular triggers, but you're not really taught about what could be driving that and how that can have an influence on all other parts of the body as well and all those different symptoms. Nor you taught about sort of the the eight factors that could be having an impact on that gastrointestinal system as well.
Dr Ayan Panja: Yeah. I think you're right. The other thing I notice is that we're definitely in a world of why, not what, you know. And medicine gives you a lot of what, you know, when you go to the doctor, it's like, oh, you've got this and why have I got it? I don't know, but try this and if it doesn't work, come back and we'll try something else. That's very common occurrence, you know, and I still do that. I'm not saying I don't do it, but it's not really adequate in 2022 to to kind of have that model. And sometimes people are like, well, why have I got it? And and I think one of the things I really hope is that this book really gives you a lot of why rather than what. So for example, you know, I know you know this, but the child who's sort of born slightly premature, not breastfed for whatever reason, maybe born by caesarean section, has a load of antibiotics when they're young for ear infections and tonsillitis. Just those factors mean that this child is likely to have some gut symptoms at some point. What can you do about it? Well, you have to buy the book. No, what you can do about it is quite a lot really. A being aware of it is is half the battle, you know, people don't know this stuff often. Although awareness is increasing. And secondly, just making sure that, you know, how to look after your gut flora, for example. I'm no expert on gut flora, but I know enough to hopefully tell people, you know, give people enough info to kind of look into that. So it's that kind of thing. It's sort of, you know, nudges and small changes, but tailored to you.
Dr Rupy: Yeah, totally. And so guiding people through the book. So we've learned a little bit about the systems, all those different systems, the six of which we just mentioned. We've talked a bit about the factors, so the health loop and figuring out what the factor is could be that are driving the issue or the symptoms that you present with. And then you drill down into a few key sort of activities that you tend to send away your patients to do in their own time or if you have time to do in the clinic as well. One of them you just mentioned, or similar to what you mentioned, is basically just doing a diary of like, okay, when were you born? What were your early insults? What were your early health complaints? And that what what are the other sort of things that you tend to do either in clinic or get the patients to do when they come back and see you?
Dr Ayan Panja: Yeah, yeah. So that's a really interesting one and it's very individual because sometimes just the health loop, how, what and when and a lifestyle prescription, which normally exists, which is basically the health loop but kind of flipped on its head. It's like, well, you know, you need to eat earlier or you need to change the type of exercise that you're doing or you need to move house, you know, because it's full of mould or whatever, you know, because something will come out. So environment is like a big, that bit of the health loop is a sort of dumping ground for lots of things. But the other things I tend to do, if nothing comes up, then what I do is what I call drill down and diary up, which is what you were referring to.
Dr Rupy: Yeah, drill down and diary up. I love that sort of phrase.
Dr Ayan Panja: Yeah, and in the book, there are a couple of cases where nothing seemed that obvious. It was like, well, this person's doing everything right. Why are they, why are they ill? And what that does is it really dissects a particular, you know, area. So for example, people might say to you, well, no, I'm really fit, I exercise a lot. I'll give you a real life example of this. And you may have heard this before, but about 15 years ago, I saw a chap who was really on the surface, really healthy, absolutely, you know, built like a bodybuilder. And I remember he went to the local neurologist, he was on all sorts of quite heavy drugs that we wouldn't necessarily prescribe in general practice, but the neurologist had tried him on them and none of them really worked at all, maybe a little bit. And he'd come back to see me for a follow-up and was just in tears going, my life's just, this is it, you know, I don't know what I'm going to do. I can't live with these headaches. And this is before I knew any of this stuff and I hadn't really worked it out. It's a long time ago. It's nearly 20 years ago to be fair. But and I said, look, I'm really, I don't know what to do. I'm really sorry, you know, but you're obviously still going to the gym. And he goes, he goes, oh no, this is, yeah, I do go to the gym, but this is six cans of tuna a day. And I just went, it was like a record scratch and I was like, wait a second, I don't know anyone who eats six cans of tuna a day. And I went, do you mind swapping that out for chicken? Because it's just a bit odd. Anyway, his headaches went. And the point is, there's nothing clever there at all. That's, you know, a 10-year-old could sort of figure that out. But it feeds, you know, the system in the book will reveal that because, you know, when you when you actually look at the factors in the health loop, that would pop out. Or if I if I got him to tell me about his typical day, which I probably asked in a different guise back then, but in a much more new GP style way, because you just want to get crack on, don't you and get through the fact that he's got headaches, you want to give him something that's going to help. That would have come out. And so I don't, I still don't know to this day whether it was the mercury in the tuna, whether he's allergic to some, you know, he's got some sort of non-IGE allergy, which I cover in the book, to tuna or whether it's the BPA in the tin. I have no idea and I don't care because it doesn't matter. The point is he sort of fixed his health, you know, the health fix. That's that's the point. You know, that's a really simple example. And in the book I talk about the power of too much and too little.
Dr Rupy: Yeah, that was literally going to come back to that because that's almost like a good heuristic for anyone to sort of take away, you know, too much of something or too little of something equals potential issue.
Dr Ayan Panja: Yeah, but the other beauty of that is you get this, you know, it's a bit like when you, not that I have because I can't do it and I always, I have to say I always call the emergency services, but if you're changing a tyre, you know how you've got, you know how you sort of have to do that. And actually although your right and your left hand are going in opposite directions, you get this double kind of torque. And it's the same if you've got not enough of something that is giving you a health issue, but also you've got too much of it. As soon as you sort of reduce the too much and add in a bit of support on the other side, a really, really good example of this is cramps. A load of people get cramps, but they're drinking five cups of coffee a day and they're probably a bit low on magnesium because their diet might not be fantastic. And again, you reduce the caffeine, boost the magnesium and the cramps go away. It's not rocket science, you know, but again, I think the other difficulty is, you know, even colleagues of mine, doctors find it all a bit, they're like, oh, is it safe to recommend that? I'm like, what? You know, and you're not sort of prescribing a drug and things like magnesium are available over the counter from pharmacies and health shops and stuff. So it's, you know, and people, the public know a lot of this stuff already, but actually when you when you see it in print and you've got like a framework to hang it off that's, you know, safe and kind of, you know, not, I'm not giving anyone specific advice, it's more laying things out. I think it just makes it doable.
Dr Rupy: Yeah, yeah. And I think there's some of the biggest takeaways for me from the book. A, being aware of what you want to try and change or being aware of where you want to go and actually visualizing that. And B, being aware of the importance of reinforcement. I think reinforcement and literally like saying things to yourself in the mirror or writing something down in your notes that I do this every single day. I look at my affirmations every single day and it just kind of gives me that direction of where I'm going as well as reminding myself of like, okay, positive reinforcement. And then the compassion element as well. I think those three things, awareness, reinforcement and being compassionate to yourself when you do have like a couple of days off. Like silly example, yesterday I had to go to Birmingham, I couldn't do my normal workout routine, I couldn't stretch. It meant that I was a bit like stiff on the way back coming back on the rail. And it's very easy to fall into the habit of like, I can't believe I missed that and that's why I'm in pain, it's my own fault, I should have made time, I should have worked up earlier, all that kind of stuff. But actually the compassion element I think is really, really important.
Dr Ayan Panja: Yeah, beating yourself up, you mean. Yeah, that kind of thing. Yeah. There's a section there about, I call it, you know, think different, feel different, but how? And I think people struggle with this. It's like, oh well, people always tell me to. And I and I, you know, I've got, I have them myself, we all have them, but these kind of cognitive distortions like over generalizing. So, you know, if a mate suddenly cancels on you and can't meet you for dinner, you think, you know, someone might think, oh, maybe he doesn't like me. You know, you jump to conclusions, don't you? And so there's a whole section about not allowing, again, that's a little bit of the monkey brain thing, kind of, you know, those negative emotions are really easy to creep in, you know. And and so there's a little bit of that later in the book because what what I'd like you were saying, what what the book does, it starts with behaviours and biology, so that's the system stuff and the behaviour change stuff. Then it goes through these real world cases and they're based on over the last 25 or so years, all the kind of health wishes people want or the commonest things I hear as a GP which aren't easy to resolve, you know, so things like pain, fatigue, gut symptoms, mystery illnesses, you know, things that are not resolving. And it's all through the framework, the health loop is laid out and you see exactly what each person went through. And then at the then towards the end, there are these sections, you know, which kind of give you a bit more nuance. And then right at the end are effectively a bunch of health hacks. And I know a lot of, you know, without kind of stereotyping a certain type of person will want to jump to the end because they'll think, wait a sec, why is there no point in reading this whole book? I'll just go to the hack. It won't work because A, you don't need all of them. B, you're probably doing some of them anyway. And C, you know, you want to tailor the ones that you want to you, you know, do you know what I mean? And the only way you can do that is by understanding your own story. And that's that's the powerful thing about this. It's not, you know, every reader takes away something different from it. And at the end, you you kind of write down what you notice in week one and week two and it'll just hopefully kind of, you know, I'm really, I'm really excited to see what.
Dr Rupy: Yeah, it's going to be awesome. Yeah. And I think the section in particular, which is really about the stories and the way you narrate them and how you guide the reader through your sort of structure and your head and how you, you know, came to hopefully a successful outcome with with these patients. I think that resonated with me particularly and I think it will resonate with readers as well because a lot of people will read those stories and be like, that's me. That's me with the pain. That's me with the intractable headaches. And although they might not have the same root cause to their symptoms, you've taken them through the health loop, the lifestyle prescription and actually how you drill down and diarised and, you know, went through all those different structures to come to a conclusion, to come to a diagnosis and to come to a formula as to, you know, how they can help themselves. So I think that's going to be super important for for for people.
Dr Ayan Panja: Yeah, I think so. And I think what I also, I'm very, when I at the beginning when you asked me how I felt and I said I feel nervous, one of the things I'm nervous about is, you know, colleagues, other doctors, what are they going to think, you know, because because should I really care? Well, no, I do a bit because, you know, actually it's important that your peers don't think you're some sort of, you know, snake oil salesman or something, which I'm not. But the point is that this, what's in this book is common sense and what I would love to happen in the future because, you know, access to healthcare is really hard now, is A, for someone to go to their doctor and go, look, I've tried X, Y and Z. Because because some people will use this and nothing will happen possibly, you know, which means you do need to, you know, definitely seek help and it's not, it's not a substitute for seeking medical advice. I have to kind of reinforce that. But, but at least you can, you know, my hope is that a lot of people will sort of do what's in this book and then not need to see someone. You know what I mean? So God knows what percentage, but I don't know, 40% or whatever will sort of say, well, hang on, actually all this has sorted itself out. But the other, the other group where they think, well, it hasn't really gone away and they've got an unresolved symptom, obviously need to, you know, go and seek help, but they should, hopefully they've done a lot of the doctor's work for them. I say doctor, but any healthcare provider, it doesn't have to be a doctor, it could be, you know, a nurse, it could be a pharmacist, it could be, you know, a nutritional therapist or a dietitian, it doesn't matter. But that way, you know, you've done your bit and hopefully, you know, I think the other difficult thing is a lot of people who use this and it works and they come back and they go, oh, I just wanted to say thanks, you know, I feel a lot better. They just want to feel even better and that's where it gets challenging. But then all you do is you go back to the beginning and you just refine and refine. But you know, not to sound morbid, we're all going to die one day and we're all getting older and so, you know, I don't know about you, but certainly my health now at, you know, peri 50 is better than it was at 40. And I'm not an angel. I don't do everything right by any means, you know, so I do, you know, I do probably 60% of what's in my own book. But, you know, but we're all, you know, learning.
Dr Rupy: I actually think that's quite refreshing because, you know, an author to say that they only do 60 to 70% of what they recommend in the book is just an admission of like how we're all on our own journey, right? And I sometimes I think health nuts that people follow are almost a bit too aspirational. It's almost like, you know, you've got to do the small steps to get there. And sometimes it just seems a bit unachievable. And if you're trying to get that like beach body in 30 days or whatever, it's, you know, you're on a losing path. So I think that's that's a really important, a really important part you said. And the other thing is, I did want to push back slightly on what you said about wanting to ensure that your colleagues make, you know, don't think that you're selling snake oil. And whilst I think it's very important to be well regarded amongst your medical colleagues, you also have to have a lot of conviction about your message and your compass and just ensuring that, you know, what you're putting out there is 100% your truth because you're always going to get people who for whatever reason will have an opinion that is antithetical to yours and call you out as a snake oil salesman. You're clearly not.
Dr Ayan Panja: Yeah, it's it's a good point. I mean, you know, when I say snake oil, I mean the difficulty I think in medicine is that there are so many experts and I'm not going to name them, but early on in the book, I talk about a couple of people I have a huge amount of respect for who are experts, you know, they're professors or whatever. And one of the one of the things is, you know, why should someone read my book? What have I got to offer apart from the fact I sort of fixed my own health? And the reality is is that I've been treating patients for for years and a lot of experts are, you know, they do amazing work, you know, and they present studies on on all sorts of things from circadian rhythm to, you know, vitamins and minerals or whatever. But actually when you apply it to the individual, that's a totally different skill and that's what we do really well I think as as GPs. That's part of our training, we're experts in people. And I try to kind of distill that into the book. I think the other thing in medicine is that there are people who are specialists who who feel that, you know, all this stuff is sort of soft and fluffy and they have the, you know, some of them quite arrogantly, you know, try and nullify things that they don't really know about themselves, but they think, well, it's not that complicated because they're doing something much more technical. Good for them. But, you know, and I'm not that worried about it, but of course there will be, you know, with any book, there's always going to be critics and and I'm ready for that, you know, because I I I know what's in there is is solid. There's a whole section actually on evidence-based medicine at the back of the book and in some ways how how valid it is, but also on the flip side how ridiculous it can be. And this book is very much about the individual. It's it's not population health, which is a slightly different thing. So, so I think, yeah, we'll see how it lands. I'm I'm nervous but excited at the same time.
Dr Rupy: I think you should focus on the fact that it's going to help lots of people understand their health a lot better and gives people a framework in which to conceptualize symptoms because most people think about symptoms in that they record it, they go to the GP, the GP gives a prescription, they go away and it gets better. And I think what you're doing is perhaps, well it's definitely harder because that's actually where you get the most growth and the most value from seeing your GP, understanding your health a bit better. And I think that's what we've done very well. And one thing that I think is really important in the behaviour section of the book is this whole concept of consistency and essentially putting a behaviour into place that actually, you know, is something that you can maintain. And there's a line in the book that really stood out to me because I agree with it massively and it's something along the lines of health coaches are potentially the biggest unlock for the NHS. It's an underutilized resource that we really need to double down on. I wonder if you could talk a bit about health coaches and how you see that being super important for the NHS going forward.
Dr Ayan Panja: Yeah, I think, you know, luckily nowadays we as GP surgeries who are part of these bigger organizations called primary care networks, we have access to health coaches. And my understanding is is that a health coach really has the time and skills and role that will be able to kind of help people to change their behaviours. And that's based on this assumption if you like that changing your behaviours changes your health because I think I think that brings me to this other thing about lifestyle medicine. I actually don't like the term. I've never liked it. It's just been put on whatever that might mean. And actually lifestyle is a mixture of your habits or your behaviours and your environment. That's all it is. And in order to, if we accept that sort of definition that I've effectively made up, but that's how I understand it. You know, I'm not saying that's an official definition, then behaviours is one big chunk of that. You can sort of change your environment, but really you're going to have to change your behaviours if you're going to change your lifestyle and that's going to have an effect on your health. Do you know what I mean? So that's why I'm excited about health coaching. I do think we haven't quite, certainly in this country, yet unlocked their potential and we haven't sort of, some people do, you know, I've got a friend called Mo Sekeram who is doing great things down in South London with social prescribers and health coaches. And I think his, that patch definitely has and some of the stories that he tells are just wow, you know, how did you get this person from here to here? And so, yeah, that that is exciting for me and I I think it's it's all about behaviours and I think health coaches are are invaluable for that.
Dr Rupy: Yeah, because we're asking people to do pretty mammoth tasks, you know, even the uh the the the commonest thing that I see, it's getting people to quit smoking or change their dietary habits, right? It sounds simple. The information is there, but the implementation, that's the really, really hard bit. And I think if you had that accountability with a regular health coach and that touch point, you know, it makes it easier, not, you know, not a walk in the park by any means, but it definitely makes it easier. And I think that's certainly an element that we need to like lean into in medicine.
Dr Ayan Panja: And also and also groups, I think, you know, health coaches can can run groups and something sort of magical happens in groups that doesn't happen one to one, you know, and and and I from people who've done this, you know, across, you know, the other side of the world, you know, in the states, um, uh, James Mascall actually, you know, gives really good examples of where, you know, you think that, oh, because someone's got better or, you know, well done to that nurse or doctor that sort of changed this person, helped this person change their behaviour, but actually in groups, it's much quicker and much more effective because the group itself support, they support each other. You don't really need the therapist or the practitioner involved beyond a certain point. Do you know what I mean? And that's something I think would work very well in terms of maintaining health or groups, you know, people with chronic pain, for example, benefit a lot from that kind of setting, whereas I think if you're constantly dependent on one practitioner, you know, that's limited in some way that a group isn't.
Dr Rupy: Yeah. You mentioned throughout a number of different cases actually, the impact of adverse childhood experiences as well. And I think it's pretty undeniable and I think it's become a lot more common knowledge, particularly with people like Dr. Gabor Maté and then the bestselling book, The Body Keeps the Score, that childhood experiences have a drastic impact on your propensity towards disease later on in life. This is an inconvenient truth for us general practitioners because within the confines of a very short consultation, you have to sort of tease out what could be the root of a lot of issues that people are presenting with. I wonder how you broach these topics in consultations, particularly when you have to ask about a whole load of other things, you know, diet, lifestyle, what their stresses are like today, considering, you know, we we know how important it is.
Dr Ayan Panja: Again, really, really brilliant question and I was talking about exactly this to a friend the other day. I think when you're a new or green GP, you can identify symptoms quite easily and you think, oh, hang on, it sounds like you've got anxiety, for example. And then you sort of think, okay, counseling, maybe an antidepressant, you know, you have this sort of suite of things that you can offer this person. That's all fine, but if you can sort of unearth where that's coming from and you can't always do it in a 10-minute consultation, but actually if you lay things out and you just let the person talk, it becomes pretty obvious. And so actually psychiatrists do this really well. So a psychiatry history will take sort of an, you know, my wife's a psychiatrist, but it will take an hour or more. And I'm sure you remember there's this whole section called the personal history, like where you went to school, you know, what your family, you know, and that stuff is really important, you know. And I'm not saying I go into those depths in a 10-minute consultation, but often just by asking them their typical day and there's this thing in the book called a timeline, which you can plot yourself, which is really sort of your life on a on a line. And occasionally I've done that where I've drawn it out for someone with someone and they've just sort of burst into tears because it suddenly just contextualizes why their health is what it is at this point in time. The two main things for me is not to sort of judge and be that person, you know, and I've got to admit I I've seen this and I've been like this myself years ago where not really understanding why this person is just not stopping smoking or giving up drinking because it's killing them. Not understanding the trauma pain addiction cycle at all. I just didn't know about it. The fact that they don't, you know, they've ended up like that because they've had some sort of trauma that leads to some emotional pain and that leads to a maladaptive behaviour, an addiction. But it doesn't always have to be a drug or anything. It can be working too hard or just getting annoyed, you know, these behaviours that harm us. And the main thing is that I'm very compassionate with this group. You know, there's no shame. It's like, well, you know, you've got to stop drinking. That's not going to help that person because they they often go in cycles where they go, I've done it this time, Dr. Panja, you know, I've I haven't had a drink in 48 days, you know. And part of me and that person are thinking, okay, how long is this going to last? Because and it's not their fault, you know, it's because of their past and and you know, and this this what really fascinates me is how people with trauma who who grow up in an environment of chaos. Say you grow up in a house where everyone's arguing all the time and there's constant stress, you sort of adapt your self to cope in that environment. So when you're a grown-up and you, you know, you meet someone and you settle down or whatever, you're used to that kind of environment. So you can't sort of handle things being calm. So guess what, you cause disruption and suddenly you're arguing with your partner and you don't really know where that's come from, you know. Or or anxiety is another big one. Some people get it because they have imposter syndrome. Some people have it because they don't think they're enough. You know, it's not just, oh, you've got anxiety. The treatment may be partly the same. Sometimes it's medication, sometimes it's, you know, changing their lifestyle. But I think to sort of really, really help someone, it's important to get to the why of the why rather than what. You don't always need to dig that deep to be fair. Sometimes it's just like, yeah, I'm taking sertraline or citalopram and it's working and I'm just, you know, I'm okay, doc, thanks. Fine, carry on with it. But, but yeah, sometimes you do need to dig a bit deeper. But you're quite right, you know, all of us have our story and you know, I think there needs to be sort of more awareness that you just don't, you know, when you're walking down the road, you don't know what's going on in someone else's life, do you? And it's so easy to sort of judge. And I saw something very interesting recently actually, talking about this, sorry, my brain's gone off on a tangent, but there was a there was a games exchange shop in in the town I live in where, you know, they do sort of old Xbox games and whatever. And so my son spends quite a bit of time in there sort of. Anyway, I was there and there was a, this was a few months ago, there's a guy standing in front of me who clearly had terrible anxiety. He was shaking. And um, and he, you know, and he had his son with him. And it was interesting because the way this, because he's so anxious, when he speaks, he comes across as really rude and he spoke to the chap behind the counter and he just, he just sort of, he went, how come this one's more expensive than that one or something? He just, you know, I can't remember something like that. And the guy behind the counter who's a nice guy just went, oh, because that one's newer, a newer edition. He's like, and this guy was like, right, you know, whatever. And then suddenly the guy behind the counter went, do you know what, you are so rude, aren't you? You know, you're always like this every time you come in, you're banned from this shop and just banned him. Oh, wow. But it was, the whole thing was like a mismatch because he just doesn't realize that this guy's trembling, he can barely speak because he's so anxious. And that happens quite a lot in, you know, people who come across as being rude or quiet, actually, what you just don't know what's going on inside. And actually the more of their story that they understand and that you as a therapist understands, the more you can help yourself or help the other person. Do you know what I mean? And so this isn't one of those deep, deep, deep dive books, but it's deep enough to kind of think, hang on a sec, maybe I've got issues around control or trust or, you know, failure or, you know, it'll just, it'll definitely open those doors, I think. And I think I personally think that's really important. It's what's missing in this modern world of, you know, everything's by clicks and apps and stuff, which is great. I've got nothing against that. But sometimes you just need to kind of look a bit deeper.
Dr Rupy: Yeah, absolutely. It's interesting you mentioned that story because I've had two experiences literally in the last two weeks that are on par with that. So I had a friend of mine who had to sit down one of his employees because she'd been accused of bullying in the workplace. Everyone reported her as a toxic person, you know, this is the root of all the issues that we have in this company. And um, so sat her down and uh, she just burst out crying. She's had issues at home, uh, you know, she'd had a family member try to commit suicide, like all these elements led to her behaviour in the workplace that people just instantly labelled as toxic. And I'm not excusing any sort of behaviour in the workplace, but digging a little bit deeper and you get to know the real sort of issues, the real causes, the root issues as to why that person has acted in that way. A sort of a high level example for me, my car got smashed the other day. Uh, the police were called by a neighbour who saw the driver just do a hit and run basically, smashed into the side of the car, ran off, police came, woke me up because I go to bed at like 9:30 p.m. Um, and uh, so they took, gave us the details and said, yeah, this person, whoever they are, they've hit the car, this is the number plate, we think it's the number plate, it was the wrong number plate, and they've run off. And I was like, ah, what an asshole, you know, these people, they're always driving super fast down my road and all this kind of, I just made up this story in my head. Uh, next day, I get a letter posted underneath the windscreen of my car that I can't move because it's basically a write-off, saying, really sorry I hit your car, was rushing to get to the hospital, my son was very sick, here is my number, here are my details, please just call me straight away. And that person must have left it at like 6:00 in the morning because I get up fairly early and I just saw it that morning. And so it's just, you know, like a scratching the surface of what we're talking about here, the root issues. I made up a story about whoever this person was who smashed into my car, you know, instead of essentially generating a more positive story. I could have, and it was just, you know, I could have made that story up like, oh, he must have, you know, smashed my car, must have been in a rush, must have been an emergency. And actually it was. And that was the the sort of ironic nature of it.
Dr Ayan Panja: That's a great point because that's that story you made up, you can see how some people, people I know actually would run away with that and go, yeah, actually this is like a really dangerous area and maybe I should just move house. You know, it just goes on and on and on and it just totally spirals. You could, you know.
Dr Rupy: And it generates further thoughts, you know, like this always happens to me. I can't believe this. You know, and to be fair, I was kind of going down that path myself and it's very easy to fall into that trap.
Dr Ayan Panja: So you actually do something in the book. It's a flip, a quick flip. Is that what you?
Dr Rupy: Yeah, flip exercise. Yeah, it's it's um, again, this is so.
Dr Ayan Panja: I could have done that. I could have used that exercise last week.
Dr Rupy: It's just, you know, this is again, it's it's it's just something to make you feel, I'm not saying there's any kind of like massive scientific evidence behind it, but it's just something that works in the moment. And it's basically flipping a positive example, a positive spin on something negative. So if you've got negative thoughts all the time, or for example, your car is a really good example, you know, you you kind of look at it and it's, I know what it's like because you sort of think every time you look at it, you just think, you know, but um, and and what you can do is, you know, say to yourself, do you know what, it could have been a lot worse. We could have been sat inside it and we could have been hurt, you know. And a lot of people will say, well, hang on, that's, that's just nonsense, you know, but it does make you kind of appreciate things a bit more and you kind of, you're you're and if you start looking at things, I don't, I don't mean toxic positivity, that's a different thing, but if you start sort of looking at things slightly differently, it's much, you know, it's much, it's much more difficult to sort of drag yourself down in that spiral of, you know, stinking thinking where you just sort of, like we were saying a minute ago, go from, going from your car being crashed into to sort of upping and moving sticks just because of one event, you know, that type of thing. So it's just a quick fix. It's not for everyone, not everyone will need it. It's just one of many tools, you know, the book is in a way a toolkit as well as your own health journey. So that's one of them. The other one I go through all the cognitive distortions like you were saying, over generalizing and, you know, kind of seeing things as black and white. Again, we all do this. Like you just said, oh, this always happens to me. That's not true. That's just something that someone has as a false belief and how to get rid of them. So, so there are lots of nice little vignettes that are sort of, you know, to bolster this, this central thing, you know, the health loop.
Dr Rupy: Yeah, yeah, that's fab. So we've talked about the systems, we've talked about the health loop, all those different factors, coming up with a diary or timeline, your lifestyle prescription. And then you have this, this term that you use throughout the book called the drawstring effect.
Dr Ayan Panja: Yeah, yeah, I love that.
Dr Rupy: I love that as well because I imagine the loop that's on literally on the front of your of your book cover and it all sort of coming together.
Dr Ayan Panja: Yes.
Dr Rupy: I wonder if you could talk a bit about the drawstring effect.
Dr Ayan Panja: Yeah, that so this is just something I I experienced myself when I was unwell. And actually just to give you a flavour of that and and you know, not ruin the opening of the book, I I really went from being relatively healthy to just not being able to function. Honestly, I mean, I was and actually I did a TEDx talk years ago and that was kind of when it was because I couldn't remember my talk. And I remember thinking, God, my brain is not working. What is going on here? And um, and at the time I was doing a health program at the BBC and I was going in every Wednesday. Um, and I just could not remember my lines, even like one line to a piece to camera. I'd be like, sorry, what was that again? You know, and I I didn't know what was going on. And at the same time, I was really fatigued. My joints were, I couldn't move, I remember I couldn't move my neck at giveaways. It was that bad, you know. And um, what else? Yeah, my digestion had just gone to pot, you know, I just was not well. And it took me, I haven't revealed in the book what it was actually, but there was, it took me a while, six months or so to really figure out what happened. But once I, the once I sort of changed one thing, and the first thing for me was actually at that time changing my diet. So I suddenly went on what I guess you could call a paleo diet. So it was mainly sort of, you know, vegetables, meat, fish, nuts and a few fruits. And literally within two weeks, I remember thinking, no, it was quicker than that, even it was about 10 days. I'm thinking, wait a second, you know, not only is my gut working better, but I can move my neck, you know, and it wasn't because I was pre-diabetic or anything, you know, it's irrelevant why in a way, but and I I just sort of started to feel better. And the point being that once you make one change, even if you've got other symptoms, everything else just tightens up, you know, suddenly it's like, hey, I'm not feeling tired now at the end of my daily walk. I, you know, my my ankles aren't hurting or, you know, and you just, you'll notice these things. And I hope by the at the end of the book when you notice what's happened by the end of week one and week two, you'll you'll make a note of the things that have improved. And it's it's exactly that. So once one thing improves, everything else starts to magically improve. I say magically, which makes it again sound like snake oil. It's not magic. I mean it's sort of, you know, as a metaphor, but just it and I'm sure people have noticed this. Um, you know, a good example for me, when was the last time I noticed something like this? Probably when I gave up coffee for a bit, quite a bit. Several months it was in the end, although I've gone back to it now, but I drink a lot less. But I I'd forgotten to, it's one of my behaviour change things, it's called a happy accident where you you sort of do something without meaning to do it. I hadn't planned on giving up coffee. I was just so busy one day, I'd forgotten to have it and rushed out of the house. And then by the afternoon, I thought, I haven't had any coffee today, but do you know what, I feel more awake. I feel better. And so I did it the next day and I thought, wait a minute, I feel even better. I wasn't quite as irritable. And then I did it the next day and the next day and then I thought, and then a lot of things started to improve. My sleep got better, my energy levels got better. You know, it's that drawstring effect. And that was just one intervention, you could call it, you know, one little thing and I just thought, wow, that's amazing. You know, so sometimes, you know, just, but but and there are lots of books out there that that talk about small changes and changing one thing. But it doesn't lay out your story. There's no point in that one was an accident and I didn't actually even think about my caffeine intake, but now that I do, if I'd used my own method, I was drinking a lot, you know, I'd have two cups before I left the house, then another one as soon as I got into work and then maybe one slightly, not, I don't tend to drink caffeine in the afternoon ever, but but I'd sort of have one at lunchtime and that's quite a lot of.
Dr Rupy: Yeah, just using that heuristic of too much of something or too little of something.
Dr Ayan Panja: Exactly. Yeah, and you can look at it in any way, the too much, too little or it's a happy accident, you know, or it's, you know, so, um, yeah, there's something for everyone in there. There really is, you know, but the other thing I'm nervous about, there's a couple of swear words in there and so my, although I've sort of dedicated the book to my kids, I'm not really hoping they don't read it because it's sort of the F word appears a couple of times in there, but that's just, you know, people saying that word rather than that you.
Dr Rupy: Yeah, yeah, exactly. Yeah, yeah, it's a genuine account of a patient.
Dr Ayan Panja: Yeah.
Dr Rupy: I was going to ask, what are you using your ideal framework for right now? Do you have things that you're you're working on or?
Dr Ayan Panja: Um, so the two big things in my life right now is I don't get enough sleep. So yesterday, for example, I got home at about 9:30 or something and so and then I had a load of other work to do. And in general practice, it's like, oh, the day just starts when your work day finishes. And then I knew I was coming here and I thought, oh, pants, I better look at some notes, you know. And so before you know it, you look at the kitchen clock and it's like, oh my, you know, it's like 12:30 or something. So I'm a bit red-eyed from that. But so sleep is something I really want to improve. And again, what I learned from patients, someone I saw a few years ago who was just, as I'm about to, who had just turned 50 and and these decade birthdays like 40, 50, 60, a big sort of moments for a lot of people, aren't they? And this particular person was taking stock and and again, when I was asking him about his typical day, he goes, well, the one thing I've learned is, you know, you've got to get to bed by 10 o'clock. I wish I'd known that 20 years ago. And and I'm like, yeah, you're right, you know. And that's one of the things like in the back of the book, the hacks, you know, where if you if you were someone that didn't need any behaviour change and you just did everything, you know, that's one of them. So, you know, get to bed at the same time every day if you can and get up at the same time and get to bed early, you know, and don't go to bed with a full stomach. If you just do that, the drawstring effect from that one thing will kind of, you know, and a lot of, you know, some of my colleagues or or people kind of go, well, hang on, you saw this girl and apparently her IBS has sort of gone. And that's not because I've not done anything. She's just made some changes in in her routine, like the how, what and when, you know. And so, yeah, it's it's um, I've lost my thread now, but it's sort of, yeah, you know, those things are really important. And I think sleep is a big one for me. The other one is, yeah, given my, I've been sort of slightly sort of busy at work with colleagues, you know, off sick or whatever. And so that has meant stress levels have gone up because it's been so busy and I've noticed I've been craving more comfort food, you know, that monkey brain thing. So someone brought in a load of brownies the other day and I was just sort of staring at them thinking, if I have one, then I'm going to going to have another one and another one and another one. And then it was a practice kind of meeting and so and everyone else is having them and I was thinking, and then, you know, there is this sort of pressure as well, isn't there thinking, well, people think I'm weird if I don't have one, which is not true, but, but um, and so I've been, I've been giving myself a few more treats than normal and it's, you know, it's that time of year, isn't it? So, so, um, so I was, you know, I'm not perfect and so I'm working on those, this thing about trying to get to bed earlier.
Dr Rupy: But the next time that we talk, you're going to have done that D E and A then.
Dr Ayan Panja: I hope so. Yeah, I won't be looking quite so bleary-eyed. Yeah, yeah, yeah. I really hope so. But um, yeah, and yeah, life's just very busy, isn't it? I think, you know, I was having a chat with a friend the other day and how time, you know, is the most precious commodity, isn't it? And and, you know, after, for me, after 40, it just zips away. And again, if you listen carefully to what, you know, you learn so much from patients over the years and a lot of them will say, it just goes really quickly or some of them will say, you know, when my kids were young and I was sort of tired and grumpy because they were sort of keeping me up at night, they go, these are the golden years. I'm like, really? Are you kidding me? And now I sort of think, oh yeah, actually they were so cute, you know, when they were little, but and you're worried that actually you haven't got that much time with them because at some point they leave home and then, you know, it goes, doesn't it? So I'm trying to be a bit more mindful of those things really and um, yeah, trying to suck the marrow out of life while I can.
Dr Rupy: It's a good analogy. Well, mate, I love it and I think the health fix is actually going to be useful for a lot of people working within the NHS because I think a lot of the cases could be attributable to people who have stressful jobs, they're on the run the whole time, they don't necessarily make the healthiest choices and they can't stick to a behaviour that they know inherently as a result of being, you know, part of the medical workforce, that is going to be beneficial for them in the long term. And so utilizing some of those hacks at the end, but also the sort of understanding of how interrelated all those different systems are is going to be game-changing for a lot of people. And hopefully they become evangelical about the drawstring effect and the ideal framework.
Dr Ayan Panja: I really hope so. You know, I was thinking about you the other day because you, you know, you've been sort of going to hospitals and doing these sort of pop-up canteens, which is amazing. And one of the things that I love about that is and what I remember, every NHS doctor loves hash browns, don't they? Because that is like an absolute sort of, not that there's anything wrong with them, but they're tasty, but that is what you get in a hospital canteen. And the sort of diversity of what you get and nowadays you go in and there'll be a big coffee shop chain normally in each hospital. But it's not unhealthy, but what's on offer is kind of limited. And when you're sort of tired and stressed, which you are in those jobs, you immediately reach for the comfort stuff. You know, I do it if, you know, and again, this is the thing about if I've got that stuff at home, I will just go for it. And what what, you know, what you're doing, I think, is is sort of actually, you know, if you eat something that's got, I don't know, butternut squash and chickpeas and, you know, some harissa or whatever, you that's just so much more satisfying. And I think you're right. I'm hoping people in the NHS do sort of see this as an adjunct, you know, where they've ruled stuff out, you know, but actually, you know, and it's not all about one thing, is it? And your thing is very much food and recipes, which are amazing at. And I I really hope that um, yeah, people, it lands well with people. I sort of played down the because I think a lot of people are going to buy this thinking, yeah, he's going to talk about diet. It's all going to be about diet. No, really, it's one bit, you know, and it is important and again, I've rationalized it. It's like, you know, if you eat highly processed foods, you won't feel great because your immune system doesn't know how to sort of react to that, so it will start to kind of react abnormally at some point. But if you eat whole foods, you're probably okay. And then we drill down a little bit into a case where someone had high blood sugars and that needs a slightly different approach with, you know, low refined carbohydrates and eating healthy, healthy carbs effectively, which are vegetables. So, so it's sort of cutting your cloth really for yourself in a way. So.
