Dr Rupy: We made it to 200 episodes. What a journey. Now I've been regularly podcasting since 2019 and it's been an absolute whirlwind. Whilst this podcast obviously was initially focused on nutrition and and medicine, the conversations have spanned a wide range of topics including happiness, motivation, purpose and finding joy and meaning during life's inevitable struggles. I'm obsessed with food and flavour and how we connect with each other through the shared experience of eating. And I think it's because of this appreciation for connection as to why it's felt quite natural for me to cast the net wider when it comes to the conversations that I've had on this podcast. This pod isn't just about nutritional medicine, although that is the foundation of what started it. It's become just as much about finding meaning and sparking joy and it just so happens that we use food as the metaphor for this. And whilst I'll always have food to to focus on, I hope you as the listener will allow me to expand the conversations beyond the science of food to explore other elements of lifestyle that I feel are just as important from both a scientific lens and an emotional one. On today's episode, we've decided to go down some of the most impactful conversations I've had over the last couple of years. And we're starting off with Deepik Ravindran talking to us about how food as medicine has changed his practice and the concept of dualism in medicine as it relates to pain. Now remember, if you're interested in these kind of subjects, you'll absolutely love my newsletter, the Eat, Listen, Read newsletter. Every single week, I send you a recipe, something to listen to, something to read, something to watch that will help you live a healthier, happier week. It sparks joy, it generates curiosity, and we have over 60,000 regular readers and listeners, but readers for sure of the newsletter and I think you'll love that.
Deepik Ravindran: Coming from an Indian background myself, I got a lot of I told you so's from my family who are non-medical, right? So when I, when they were trying to suggest to me that food and spices and all these different sort of what I would have regarded back then as old wives tales were important, I kind of brushed it off as like, you know, some woo-woo stuff. And and now it's coming like full circle. Have you had those moments with your own family?
Dr Rupy: It is. Even now if I were to tell my father or if I tell someone, you know, I think you can think about an anti-inflammatory diet. You know, this is my nowadays in the last three, four years ever since I've kind of got up and become this other person, I even my wife sometimes get irritated. No, no, this is not what I'm asking you what drug to take for pain. You can't tell me what to eat. And and I think my family back in India as well sometimes are a little bit more thoughtful when they now approach me saying, you know, okay, I know you're going to tell me about sleep and I know you're going to tell me about stress, but what I'm asking you is can which tablet can I actually take? So yeah, I don't think that's going to leave us for a little while there. And and I think that's the cross probably we'll have to bear because that's how society has been brought up in terms, isn't it? That's our challenge we have to is to tell other members that there are options that are as safe and probably safer than what we've always done.
Deepik Ravindran: Yeah, absolutely. And I want to circle back to some of the final parts in your book that I found actually the most useful from from my perspective as a as a physician. But you talk a lot about certain philosophies from the book. I mean, you talk about Descartes in the the entrance about this the impact of dualism on modern medicine. I wonder if we can just describe for folks what modern medicine is practiced based on, like in the understanding and the separation of the body and mind and where that came from and and how that's Cartesian in nature.
Dr Rupy: Yes, and thank you. I think that is a very, very important underpinning and you're right, it is a philosophy that we need to start moving away very quickly from. So Descartes was the French philosopher, mathematician, philosopher, really awesome all round gentleman from the 1700s. And he at that time was responsible for bringing on this theory. Now at that time, the church was very much in favour of saying that the human body must not be touched on, must not be operated or because everything was one with God. And that was a very powerful philosophy and belief at that point of time. And Descartes came up with this approach and thought process that the mind is one with God, but the body is not necessarily one with God. And he also talked about his understanding of pain at that time. And this is this very classical picture that's there in almost every textbook around pain management that used to be taught about where you had this little boy with a small fire that was burning near his foot. And Descartes' vision of how pain was was that there would be a fire, there would be this rope that would stretch from the feet, it would go through the back of, he got the spinal cord part right. So he thought about this wire that stretches through, goes into and he suggested that there was a small part in the back of the head, what he called as a pineal gland, which is where the signal stopped. And his understanding was that because pain travelled in that rope, you could cut that rope or you could take the body apart and find a way to either block, cut, numb that rope or wire, and then put it back together again and there would be no pain because the mind is one with God, but the body can be treated in this manner. And that kind of Cartesian approach of the mind body dualism was really advantageous because it allowed for the church to accept that as long as the mind is one with God, the body could be operated on and that led to modern medicine really rising from there. You know, the fact that surgeons and other specialities could adopt that reductionistic approach of drilling down up to a cellular level, up to a genetic level to say what is a problem. And then the assumption was that it's a machine, so you could just put the component parts back together again and they would be fine, they would be same. And I think it was good because it allowed for a lot of advances that we see in modern medicine to be ready now, but it has also had its significant disadvantages and they are now in the last 30 to 50 years, we are beginning to know that that kind of separation is probably a flawed approach which has led to a lot of over-medicalization maybe, because we're always stuck in a model of which structure is it that a particular pain is coming from without realizing what else could be contributing to it. And we've now come to a point wherein we've realized like there are things like social determinants of health, we realize what are the other factors like epigenetics, you know, what are the factors that trigger our genes and those are environmental and we realize that all of that also contribute to our health, to what is considered as a threat and to what is manifested as pain. That doesn't sit well with a Cartesian model or his reductionist approach. So I think we are in various pockets of society talking about moving away from this mind body dualism which is very artificial, which is flawed and leads to poor policy and decision making. And it's time to probably firmly bury it and put it behind us and actually say the mind body dualism is wrong. Now that we understand the neuroscience of how things happen and how pain is processed, we need to even firmly move away from there and look at the person as a whole in what I call as a trauma informed manner and that should be the way forward for modern healthcare itself.
Deepik Ravindran: Yeah, I think that's a great way to frame the rest of our discussion about how the traditional model of dualism is flawed and what the origins of that are. Just as a side note, I always wonder whether that Cartesian approach was really a work around for Descartes to get around the the the church.
Dr Rupy: Yes, absolutely. I agree. I think you hit the nail on the head. Another different kind of nail.
Deepik Ravindran: Different kind of nail. So before we we talk about pain, I think we should talk about note this concept of nociception or the the the biochemical process of nociception and the interplay of intero and exteroception on nociception as well because the definition of of pain has recently been reclassified as well that you've written about in the book. So why don't we start there and then we can branch off into other subjects.
Dr Rupy: Absolutely. So, I think the first things to start off is the definition of pain itself. So it has been a very cosmetic change in the definition that was proposed by the International Association for study of pain. You know, they did their first definition in 1979 and I think they've now revised their definition in 2020. There is very little change in the actual definition in terms of words, you know, just a mild cosmetic change, but what is most important is their sort of what they call the supplementary notes. And they had about six points where they talk about it and for me, the second point where they said that there is a difference between pain and nociception, which is very vital. And to me, I think that is a message which I've been trying to get out to the general public and I hope your listeners, if I can explain it well today, will also take away because that I think is the core to what my book is based on and that I think is enough. If people can accept and take that on board, that should give them the hope that there are so many other things that they can do for their pain than what they have been doing up to now. And what I mean is when you have an injury, when you have a fall, when you have a fracture, when you've broken some bone or you have a heart attack, there are chemicals that are released at those nerve endings which are closest to the site of injury. Those chemicals are released and then they travel in those set of nerves there. So there are no pain pathways, they travel in the same nerves that are sending every other signal as well from that part of the body. And those signals then travel up to the spinal cord where they then either get amplified or modified or dampened down and then that remaining signal travels up to the brain. Now, the arrival of that signal, that is called a nociceptive signal and that process of chemicals being generated and being transferred in these nerves up to the brain is what is called nociception. So that means nociception is only referring to that condition where you have chemicals being released in response to a a stress, a threat. It can be a physical injury and these days we realize that you can have that external, so you can have that information coming from the external side, which is what is called exteroception. So when you see something that is frightening, when you feel something that's hot or injurious, when you have a chemical or a physical injury, then that all releases nociceptive signals. But when that signal reaches the brain, the brain then has to process that signal and and it and it looks at it and what it has got and that is the fantastic thing that we've realized now is that the brain is actually a prediction machine. Now, it actually is almost the understanding of the brain in the last 10, 15 years is what's led to Google's Alexa and Siri and all of these fancy algorithms that sit in our kitchen doors and islands. And it talks about what happens when that signal arrives. It's already got a prediction model inside and it compares it to its previous experiences of having received such a signal, the context in which that signal has arrived, and then it has to decide in a microsecond, does it have to institute a form of safety and protection or does it compare it to a previous model and say, you know what, this has already happened before, it's nothing to be worried about, it's not a unsafe or dangerous thing and actually then the prediction model suggests that you don't have to do anything much and therefore no protection mechanisms register. So all of that processing and prediction mechanism is done in a flash of a second and if the brain decides that it needs to protect you, then that is when the experience of pain will arise. So when somebody complains of pain, the intensity and severity of pain is very much a function of how that signal has come, how much protection the brain has decided it must provide and how it then institutes that protection. So pain, the experience of pain is then automatically different from nociception, which is the signals that is coming through. Now in some people who have had a fracture where the injury is acute, the nociception is significant and it's almost the entire part of the pain experience. But when you have chronic pain, when you have pain that goes on for months and months, when you've had a back problem that has been on there or a knee problem or a migraine or irritable bowel, then in those situations, what we are now understanding is that there is the pain experience because the nervous system has stayed sensitive and it feels that it needs to constantly protect and that's where the chronic pain can persist from. The amount of nociceptive signals may not be that much. So I don't want to tell make your listeners feel, you know, often at this time when I say this, people say, are you saying it's in my head? And and actually no, it's not what I'm saying. It's not that it's in your head there, but the signal processing is happening within the spinal cord and the brain and they are unfortunately located in the skull. So that's where the processing is happening, but the signal is very real, the indication is very genuine. However, at the end of the day, somebody has to protect you and that patient needs protection and that brain if it thinks sometimes in error that protection is what is needed to be done because that's what it did the first time, then that's the same model it'll go back to. And and that is why we need to understand that difference between pain and nociception because that nociceptive signals can respond very well to a drug or an injection. But when you realize that often things are in combination or the pain experience is a lot more, that's when you have to bring in other ways of dampening the system down. And probably the one thing that you were asking me was interception and exteroception, weren't you? The last bit there. So interception is when the signals actually can come from the inside. So if you, this is something that has been now understood in other fields as well, you know, they talk about it in how the brain responds to information. So everyone understands that the brain is receiving millions of bits of information, but it can only act on a few things at a time. And they talk about this kind of metaphorical gate or a some kind of a barrier at the base of the brain which either filters what information it should come through. So interception is that some total of all the information that is coming from the inside of our body. So for example, only if I ask you to think about it now, will you realize that your bottom's sitting on the chair, that your feet are on the ground. Otherwise, this information is coming all the time. There's information coming from the intestine, from the bugs, from the microbiome all the time, but the brain has to make that constant decision on which one it allows, which one it does not allow in. And those decisions on what it allows in is based on what it thinks it needs to protect you with. And I think that some total of the information from the inside is interception and the some total of the information that comes from the outside, whether it's through touch, through the five senses, vision, taste, smell, is exteroception.
Dr Rupy: Here's another one of my conversations with Professor Robert Thomas talking about toxic load as it applies to cancer risk. Also, we talk about how dietary nitrate, not to be mistaken for nitrite, can help improve health and lectins in food and whether we should worry about them or not.
Professor Robert Thomas: This is probably going to be a difficult question to answer, but do you think obviously in combination with the other effects of sedentary lifestyle, low vitamin D, poor diets, would that toxic load have an impact on lifestyle related illnesses that we're seeing today?
Dr Rupy: Um, yes, I mean I I I think with the exception of dementia, which which is sort of going going up as you know, it's it's it's it's it's a very rapidly increasing disease, not just because people are getting older. Um, you know, I think if you've got toxins, I think they they can directly affect the brain even if you're healthy in other ways. Um, but for other diseases such as diabetes, heart disease, pancreatitis, I think there is clearly a balance. You know, you can you know, you can you can get away with it. It's a bit like the barbecue story. You can get away with it. I mean, I probably drink a couple of glasses too too too many on on a on a Friday evening. Um, you know, I I have tried to convince myself it's just the resveratrol, but you know, there are lots of negatives in alcohol. Alcohol itself is a toxin. You know, let's not fool ourselves. Um, but you know, it's a balance. If you if you eat that with lot, you know, if you have a good meal with it, um, you know, and then you go for a run the next day, it's it's all about the balance, you know, and and getting the balance right rather than putting people in a, you know, in a sort of on a pedestal and criticizing every move move they take. And I believe balance is. And you know, the same with sunbathing. I what there was a famous thing called slip slap slop in Australia to get people to slip on a hat, slop on the sun cream. And I said, nobody mentioned food or smoking. You know, if you smoke in the sun, you've got two lots of carcinogen damaging your sun and it's been shown over and over again that that increases skin damage. On the other hand, if you drink a glass of red wine, eat some hummus and some olives, those counterbalance the direct damage from the sun. In fact, I saw a paper the other day saying, um, something like dietary sunscreens they're called. So, you know, if you're going to go in the sun, which we all enjoy and it's good for you to a certain extent, you know, make sure you, you know, you have fruit and vegetables and herbs and spices that day.
Professor Robert Thomas: Yeah, I I think I came across the same paper. It was like the equivalent of two cups of grapes or something like that in combination and it improved the what's the word they use? Phyto protective effect, photo protective effects in combination with with skin block as well. So that's super interesting. And I I agree with you, we should also be talking about diet when it comes to skin too. Let's talk about um the foods that we should be embracing and specifically those plant nitrates that we were talking about earlier and and what effect those might have versus the the nitrites that you you find in processed food.
Dr Rupy: Yeah, yeah. Um yeah, I mean everyone gets super confused about nitrates, nitrites, nitrous oxide, nitric oxide. Um, I mean I was interviewed um about there was a paper coming out about processed meats and and the the journalist said, but you you're saying that nitrates are bad for you, but then nitrates are in plants. And and yes, they are. Um, and I was trying to explain that um when you have a nitrate in in meat, you're having it with protein and that's then converting to nitrous amines in the stomach, which is actually the carcinogen. But if you have nitrates in plants, the polyphenols and the vitamin C in the plant converts that nitrates into nitric oxide, which actually is beneficial. It causes dilation of the blood pressure, brings your blood um your blood pressure down, gives oxygenates your tissues. So it's not it's it's again, the combination. And obviously when you have it in meat, you've got other bad things in the meat like aromatic hydrocarbons and if you've burnt it, you've got smoke or if it's smoked, you've got smoke directly. Um, so yeah, nitrates aren't bad per se. And you've just mentioned, you know, celery, beetroot, pomegranate, uh these are those are particularly rich in in nitrates, healthy nitrates. Uh so if you've got blood pressure problems or if you want to improve your sports performance, those are the foods you should be taking.
Professor Robert Thomas: Yeah, yeah. I'm glad we clarified that difference because it's something I get asked about a lot as well. And the the way you've explained it is um is is bang on. Um there's a lot of talk around uh lectins, uh phytic acid and why they might be bad for you. Um I I I probably get a couple of messages two, three times a month actually about why am I using beans and lentils when aren't they meant to be anti-nutrients and removing thing minerals from your from your um body and and how it's bad for you. Can can you speak a bit on on that topic?
Dr Rupy: Yeah, I mean that I I I sort of locked my way in my office for about two weekends to try to get my head around this because it it is complicated. Um, I I'm I found out I was gluten intolerant, not not celiac a few years ago and and switching off, you know, processed bread, eating sourdough bread. I can now enjoy sourdough bread nicely. Um, but then I noticed um and other people have noticed that, you know, they were getting the same symptoms of bloating and tiredness if they weren't eating gluten, but they were eating like oats, which doesn't have gluten in. And oats has, you know, like other grains and pulses as we've just mentioned, has has lectins and phytic acid, which actually people don't tend to talk about, but you get the same intolerance to those as well. And then you've got the paleo enthusiasts who I um and there's a place called Tarifa in Spain which I love. I go windsurfing and kite surfing there. And there's a there's a friend of mine there called Rowan who's a who's an enormous paleo enthusiast. So he's he's banned anything grains from his diet. Uh and it's true, you know, if if you have an intolerance, it does give you a lift. Uh but these foods, especially the grains, they actually contain, you know, prebiotics which help gut health. Uh and the fodmap people are saying, well, we shouldn't be having beans because it will it will cause gas. And it it and I I figured it out, I think. You know, basically, if you have lots of beans and you're not used to them, and there's data to support this, not just my opinion, you do get wind, you know, you do get bloating. So you instantly feel bad. If you've got a gut which is leaky, it's been exposed to gluten and phytic acid for years, so it's thin, it gets very sensitive. You only have to take one tiny bit of bread and suddenly you bloat up again. Um but if you allow the gut to heal, so if you eat these beans and you eat lots of healthy bacteria rich foods, eventually your gut starts healing and you don't then get the gas and the bloating when you take the beans. So um the what the fodmap is doing is giving you an instant relief because you're not getting the wind and the bloating. But in the long term, my opinion is it's actually making it worse. So um I don't know why there's such an enthusiasm for it. And the same with grains. As long as you're not if as long as you've got good gut health otherwise, introducing some grain grains and beans will actually in the long term improve your gut health. Um so that's my my take on it that uh you know, don't be a paleo enthusiast and don't be a fodmap enthusiast in the long term.
Professor Robert Thomas: In the long term, exactly. Yeah. And I'm glad we're talking about this because it's something I get asked about a lot. I always pre-warn people that if they're going to start, you know, eating uh chickpeas and beans and you know, whole grains and their starting point from the from the start line is a quite processed refined diet, you've got to go slow because you're going to know about it and everyone else is going to know about it as well in your vicinity. So you have to go very slow when when starting a new diet, any new diet really or a new way of eating. Um and and otherwise you'll fall into that camp and you'll you'll be led by certain advocates of different diets and say, well, you had these symptoms, if you take them away, this gets better, ergo, you should follow this way for the rest of your life. And you know, we're all on a continuum when it comes to what we should be eating.
Dr Rupy: Well and it does work, you know, if you say to someone who's not used to beans and they've been taking beans and they're getting bloated and someone comes along says go onto the fodmap, you're going to feel better a week later, but you're not going to feel better six months later.
Dr Rupy: One of my favourite people is Mo Gawdat. He is a dear friend and a wonderful educator in the field of happiness. Having tragically lost his son unexpectedly, Mo dedicated his life to engineering happiness and figuring out what truly makes us happy. In this clip, he explains his understanding of life and death and how he applies that to his own loss.
Mo Gawdat: One of the things that I did want to ask you about and I do want to go into your podcast as well because you've you've had some incredible guests. I'm sure that they have taught you and you know, you've changed perhaps your opinions or perhaps, you know, solidified some of your beliefs before. But one thing I did want to touch on that perhaps we don't talk about enough, particularly in the West, is the the the concept of death and the you know, considering, you know, our current global situation and and this is a topic I think needs more attention. We have to get comfortable discussing death a lot more. And from your own experiences personally, but also your wealth of knowledge across different cultures and how they treat death and and respect death as an inevitable event in everyone's lives. What what advice do you have for for people and and how do you decide to approach this sensitive topic? It is a very sensitive topic and by the way, you know, there is no amount of wisdom you can ever acquire to not feel the pain and the fear. So so I I mean, I I talk about happiness and I share what Ali taught me, but I'll I'll tell you openly every, you know, three to four times a week, I will wake up with a hole in my heart for missing him. It is it's it's just, you know, death is it has a finality to it that is quite painful. But I I want to talk about this topic for from two sides. Uh I I hear that the UK has lost 100,000 people uh to to COVID-19 recent, you know, so far. And hopefully, hopefully not one single life more, but this is what we have so far. Uh around the world, I think we lost somewhere around 2.6, 2.7 million. And um and I have to put things in perspective and I and I I hope again people are not offended by this. I'm I'm 53 years of age, okay? So I was born in 1967. If I was born in the year 1900, by age 53, I would have witnessed World War I, uh the Spanish flu, the Great Depression, World War II, and uh smallpox. Okay? Between them, combined, by age 53, the world would have lost 976 million people. Wow. 976 million people of a population that had not exceeded 1.7 billion at any point in that period. Okay? When you really think about it, that is like one of every two people you know. Now, if you put things in perspective and and and COVID is nasty in so many ways and it's nasty because it puts pressure on work, you know, health workers like you, huh? And and it actually when when my friends, when one of my friends got diagnosed and he was saved by being in ICU, huh? The idea of let's make sure there are not too many people seeking ICU attention so that we we cannot serve all of them and then we'll start losing them. That's noble in many ways. That basically means that by you staying at home and protecting yourself, you're actually saving lives. Right? And and that's a very noble idea to think about. Having said that, in comparison, COVID at the end of last year, I think was the eighth reason uh cause of death, okay? At a 10% of cardiac uh disease, right? And we've survived as humanity with cardiac disease for hundreds of years. It doesn't take the same level of attention to talk about it, huh? You know, and you could say, oh no, no, no, but it's not contagious. Yes, it is with all of the stresses of life. It is contagious in a different way. But at the same time, by the way, there were other causes that are respiratory diseases that are contagious that were higher on the causes of death last year than actually COVID-19. The reason why we're all so worried about COVID-19 is because of the media attention and the political agenda around it. Okay? And because it's a pandemic, it's something we don't know. So there is a lot of fear and anxiety and and uncertainty. If you really think about it, the extent of this, again, I I again, I please don't I don't want to offend anyone, but in reality, if you just let go and say, yes, I'm going to stay home, I'm going to talk to my friends, I'm going to find a way to make my life better for a while, we will win. We won against the Spanish flu with nothing, zero technology. We won against smallpox, 300 million people died of smallpox and we won with with no technologies in the 1940s, 1950s. We will absolutely win this one, but we need everyone to just do it right. Just please, please prioritize. Imagine if that person that you infected was your mother or your lover or your or your sister and say, I don't want that for anyone. And with that, stay home and try to make it happy. And everything will be easy. You seriously. Now, let's talk about death itself. Yeah, yeah, the day before yesterday I interviewed an incredible thinker, a cardiac a cardiologist for 40 years who wrote about near death experiences, an international bestseller sold, I think 300,000 copies of of a book called consciousness for beyond life. Uh Pim van Lommel. And and Pim spoke about the idea of the non-locality of uh of consciousness. That consciousness is not within us. Consciousness is think about the internet. The internet is not on your iPhone, it's not on your smartphone. The internet is received by your smartphone, but it's everywhere. Okay? And so is consciousness. Your life, your your ability to perceive, your ability to to to to comprehend is not within the machine that's called your brain or your body. It's everywhere. This is just the receiver that enables you in this current physical form to receive all of this enormous, enormous consciousness. Now, when you really understand that, and I I don't want to be too complex in terms of physics and and and mathematics, but when you really understand at any level of simplicity, the basics of uh space the space-time continuum and the and the and and theory of relativity, you would understand that time actually does not exist as we perceive it to exist. Okay? That that all of space and all of time, that's this is Einstein's work, all of space and all of time exists in a four-dimensional loaf of bread like structure that is called space-time. Okay? Which basically in physics, every physicist understands that there is no before or after. As a matter of fact, there are case studies that are proven by practical observations where your before could be different than my could be my after. Okay? So if I if an astronaut is approaching the earth at a certain angle at a certain speed, they can they could actually see a world where the world they witness is my my son being born in Dubai in Egypt, okay? My son dying in uh in Dubai as the same moment. It actually would appear to them as a slice of space-time that is the same moment. Now, when you think of that, you have to start realizing that because when Ali Habibi left our world, Ali was very handsome. He was a beautiful, wise, white-shouldered, tall man who uh who would really have that glow to him, something about him, a charm to him. Actually, when he was younger, you know, in in school years, every photograph of Ali is Ali in the middle and six girls from this side and six girls from the other side hugging him. Right? He had that incredible energy to him. Habibi, when he left in the ICU, when he left our world, you looked at that body and it wasn't Ali. It looked like him, it had his features, but it wasn't him. And I know you know that because of your work. There is something that animates that that inanimate object that we call our body and makes it alive. And when that something disconnects with that body, that body is not you anymore. As a matter of fact, I carried him, I put him in his grave Habibi, and and he disappeared. That body completely disappeared. Did you understand that? What disappeared was not my son. What disappeared was the vehicle my son used to navigate this world that is physical. But if you understand space-time, you would realize that the real Ali, the the the real um player of the game that's holding the controller for that avatar that we called the physical form of Ali, the real player was not born before me. He was not born, he he didn't die before me. He wasn't he wasn't born after me. Okay? His physical form was born after me and died before my physical form, but his real essence, like my real essence was timeless. It exists outside space-time. It exists outside this physical space that we live in and it just connects to that antenna, like the iPhone connects to the internet. Okay? If you take any understanding of quantum physics whatsoever and you combine that with a simple understanding of uh of the Big Bang theory, you would have to imagine that life had to exist before matter. Life itself is what creates matter. Okay? We're always alive. Death is not the opposite of life. Death is the opposite of birth. You come into this physical form, this level of the game if you want, through a portal called birth and you leave this level of the game through a portal called death. And life exists before, during and after. Now, when you see it that way, you realize that the only certainty I have, honestly, Rupy, is that one day I will be where Ali is. I don't know what that is, huh? But I have no that I have more certainty of that than I have certainty that I will live another day. And believe it or not, just like my last 53 years passed so quickly, my next, I don't know how many, will also pass. The question is, what will I make out of them? Death does not teach us to think to fear it. Death teaches us to live. To live now, now, I can I can make this amazing until I go and play the next level. But until I play and go and play the next level, by the way, I can guarantee you there is a next a next level. As a matter of fact, this level, if you understand space-time, is so minuscule compared to the actual reality of timelessness.
Dr Rupy: Next is a clip from my podcast with Alexandra Adams, who is quite simply one of the most amazing and remarkable people that I've ever met. Alexandra is soon to be the UK's first deaf blind person to become a doctor. She's an ex-GB athlete in both swimming and alpine skiing, a published poet, and a Ted talker. She's also a lifelong patient of the NHS, having been in hospital for nearly two years as a teenager and having had tens of admissions to intensive care since the start of medical school. The full episode will leave you inspired and determined to take on any challenges. So if you're listening to this for the first time, I highly, highly recommend you go back to that episode that you can find on the doctorskitchen.com and listen to it in full. And in the knowledge of what this amazing person has already achieved, I hope it will allow you to feel a lot more grateful, a lot more inspired, a lot more motivated to tackle any of the obstacles that you might be facing right now. How was your lunch?
Alexandra Adams: It was amazing. It took me so long to but I obviously I just speak so long and
Dr Rupy: I I've never had a guest that's enjoyed the lunch so much to the point where you dragged out the eating. I just enjoying saving every single bite. Honestly, pleasure for someone who's cooked the food who enjoys, you know, pleasing other people through food. It's the best compliment. So
Alexandra Adams: Thank you. Thank you, Rupy. No, it's just it's just and for me, like I was saying earlier, being visually and hearing impaired, like just eating food is just so it's a it's it's so sensual, isn't it? It is like literally every mouthful you really like pay attention to what you're tasting, what you're seeing, what you're hearing, what you're it's just oh, it was beautiful. It was divine.
Dr Rupy: Because I I was I was quite surprised considering you've had so many operations on your gut and uh you've had peg feeding, you've had to have like, you know, a slow transition from liquid diet to something that a lot more with a lot more variety. A lot of people would see eating as like a chore or something that brings back a lot of bad memories, but not so for you.
Alexandra Adams: I'm I was really desperate to get back to to a normal diet, but obviously it was just not knowing how long it would take for the vagus nerve to to repair itself. I mean, I still struggle with some foods, um and I do have an element of gastroparesis now, but it's just it's just being mindful of how I eat, when I eat, what I eat, but still being able to enjoy it. Um so I make sure that I have dinner fairly early, so 5:30, 6:30 rather than sort of late at night. Um and it's the whole sort of little more often rather than like huge meals um in one go, but it doesn't mean that you can't you can't enjoy stuff. I mean, I really did not like ensure drinks. They're just oh god. Nutritional drinks are disgusting and I can just remember actually a few months ago, um we had like a a teaching session at the medical school and they were like, oh, did anyone want to try the ensure drinks? Like they've got all these like variety of flavours. And everyone was getting so excited and there was me in my chair thinking, you have no idea. And like when you have to tell your patient, oh, they're really they're really yummy. Like, you know, I recommend this one. And I'm literally saying it through gritted teeth because actually they are the most revolting thing I have ever tasted. Um so yeah, and actually I do have a garage full of them just in case I have a bad flare up or anything and I'm just like, oh no, but just yeah, the stocks don't go down because I just avoid them at all costs.
Dr Rupy: And for the listeners, just describe a bit about gastroparesis and what that means for you.
Alexandra Adams: So essentially, it just means that I could have, I could eat a normal meal and then, you know, I would be really sick, but it won't be sort of 20 minutes an hour later, it will literally be seven or eight hours later. So as gruesome as it sounds, I could be having chicken for lunch and then sort of at 1:00 the next morning, I could be vomiting lumps of chicken and it doesn't happen all the time, but it's when I have bad flare-ups, um it's just it's exhausting, um and it it kind of makes you feel really giddy as well because your sugars go up and down, like they really sort of yeah, it's and it's quite a challenge because when I'm on placement, you never know when you're going to have a good day or a bad day. Um and then you're thinking, oh, you know, should I should I eat something or should I wait till I get back? But if I don't want to be ill this afternoon. So there's all these things that you have to take into account. Um and sometimes it is really, it's really bothersome, but it's just all a complication resulting from all the surgeries and I've just had to accept that that's happened and just have to live with it really. But like I said, you know, it doesn't stop me from enjoying food, um cooking, eating.
Dr Rupy: And this is why I just think you're going to be the most incredible doctor when you eventually qualify in the next couple of years because you can identify so much with patient journeys. You are clearly eloquent and smart enough to do the job and the day-to-day, but people don't realize that medicine isn't about the ability to suture up a laceration or, you know, perform a surgery or do some other sort of intervention that involves something physical or reading a a lab result. The majority of what I do, and this extends to A&E as well, is have meaningful conversations where you establish rapport and you try and get to the uh sometimes emotional distress as well as the physical distress. And to do that as a doctor requires empathy. And if you've ever been a patient, which you've obviously uh been a patient for a long time and you've had a lot of uh traumatic experiences. I've had that experience as well when I had my own heart issues and stuff. You you understand the vulnerability and how embarrassing it is to be a patient, to be at the end of the bed. I I I've told this story before on the podcast, but one of the most um eye-opening experiences for me wasn't being hooked up to the cardiac uh monitor, wasn't having all the investigations. It was simply uh being wheeled from the cardiac unit to the X-ray department to have my chest X-ray uh through the corridor in the middle of the day. And I was in my pyjamas, I had the porter, I had the nurse with me who had to transport me with the cardiac monitor. And people weren't looking at me. It wasn't like I was being stared at, but I felt like I was being stared at. And that will never ever leave me because I know what it's like to be in the bed at that time. And if you can if you can tap into that as a as anything as a health professional, um you will become an incredible medical practitioner because you understand at a much deeper level what really medicine involves.
Alexandra Adams: Yeah, absolutely. I mean, it it makes you it makes you realize that you are so vulnerable as a patient and you you can't exactly do anything about it because you can't just get up and and go places. You you are kind of you're almost relying on everybody else around you to do things for you when you're so not used to that. Um and I totally when you when you said that going in the corridor and in the bed in your pyjamas, I I totally empathize and actually I have been in the hospital as a patient a lot where I'm a medical student. So I see my colleagues as who then become my doctors, my medical student friends become the medical students who are taking my history. And and honestly, sometimes it can be so oh, just it is, it's embarrassing, but it exposes you to the real world. And I mean, I guess if this again sounds a bit gross, but I remember in one of my ICU admissions, I was literally, I was really delirious, um but it was kind of the the phase where I was gradually coming out of the delirium. So I was vaguely aware of what was going around me. Um but I can remember just having awful, awful runs, awful runs and they just said just go. And I just remember lying in the bed and literally just the feeling of faeces coming all the way up to like, you know, my chest and honestly, if I was with it, I would be absolutely dying with embarrassment. But honestly, I was so ill, I just didn't care. But listening back to it, it's just, oh, it was, yeah. But it makes you realize that, you know, when a patient goes, oh, I really don't want to use a commode, I don't want to use a bed pan, I totally get why. I totally understand rather than they all don't be silly, you know, it's it's fine. You need to be able to sit down and say, look, I've had this really embarrassing experience. I mean, back when I was a patient on for that year and a half, I can remember, I was bedridden for most of the time. Um but I can remember before having an epidural in, I um was put onto a commode and I literally had nothing on, not even a gown. For the listeners, a commode is like a portable toilet you put next to the bed. It's basically, yeah, so it's got like a it's like a chair almost and you just sit on it and and they take the the box away. Yes. Um but yeah, so I had nothing on and the nurse had forgotten to put the brakes on. And so I was literally so weak at this point. I literally heaved myself into this commode and out I go wheeling into the middle of the corridor. I mean, I was on a surgical ward, but at the time, like four out of the five patients had dementia. So I really hope that they don't literally remember what was going on. But for me, with the doctors seeing through the window and everything, and as a young 16-year-old girl, I couldn't have been so more embarrassed. Honestly, it was. And then I needed a toilet break and me being like I said, so I'm so sorry. I'm so colourful. I'm so naive. And literally, I was like, when we get to the next service station, can can I please stop so I can go to the toilet? And they said, yeah, sure. They don't have service stations in Tanzania. Literally. And um so it was another four hours until we stopped and we stopped in this like lorry park. It was not like the usual toilets you'd expect in sort of the Western world. And so anyway, they dropped me off and they pointed me to to where the toilets were. And it was literally this this hole in the floor and there wasn't even a door to sort of shield you. It was literally just kind of like a a barred gate if you like. And anyway, I'm I'm sort of getting used to this whole crouching down thing, but honestly, it was so hard to relax. And I was desperate for the toilet and I wasn't I wasn't wearing a skirt, which is probably the most inconvenient of things. So anyway, I'm I'm squatting for at least five minutes going, come on, come on, I just need to go. I'm desperate. Please relax. And then just as just about as I was going to go, the guy, the driver called, Alexandra, are you okay in there? And literally lost my nerve altogether and literally wet myself and it went everywhere. And I had to bottle out back into this lorry park in front of all these people with a clearly very dark patch like soaking through my trousers. And I had to sit in that that the poor guy's car for like another few hours. So I eventually got on the plane and scaved, but oh my goodness, it was
Dr Rupy: I've come across some studies that a keto diet is the equivalent to having a round of antibiotics in terms of what it does to your microbiota.
Professor Felice Jacka: Yeah. So that's something to always bear in mind. Oh, look, I just came across a new study and I don't know how I missed it because it was published a few months ago now, but it was published in Oslo. It's a really important study. When you look at the ketogenic diet and the the health, you know, what people are purporting it does to to reduce um blood glucose and all of those sorts of things. We really don't know whether that's just because people have lost weight and you get a lot of these health benefits in the short term when you lose weight. This study in Oslo, it took uh more than 30 young adults, healthy adults in the healthy weight range. So they were really healthy, they were nice and slim, doing all the right things and they put them on a keto diet for three weeks. Now, what happened to their blood lipids is just extraordinary, particularly because there was such pronounced variation. So they all got exactly the same food, but LDL cholesterol increased between 5% up to 107%. So in some people, it just went off the scale. Even more concerning, there were two really quite serious adverse events, myocardiopathy. Okay, yeah, yeah. And then and an autoimmune thyroiditis. Is that right how you say it? Yeah, autoimmune thyroiditis, yeah. Two young healthy people within three weeks. In fact, that happened really quickly within a week or so.
Dr Rupy: You can almost understand why that might happen as well because if you're giving an insult to your gut microbiota and that's inherently involved in your immune regulation and you have a patient that has a propensity toward autoimmune disease because of a genetic predisposition, then you're essentially lighting the fire with a keto diet.
Professor Felice Jacka: That's right. And it just blows my mind that people are advocating this as a sort of diet that cures cancer and you know, the whole works. It's it's really I think unethical because at this point, we do not have the data to say that this is a safe thing. Some people may respond really well to it, but others are not going to respond well. And what this study showed was that um some people experienced a really massive increase in their LDL cholesterol, which we know is a profound risk factor for uh heart problems, no matter what the the conspiracy theorists and the diet gurus say.
Dr Rupy: There's so many things that I wanted to chat to you about regarding the immune system and meta-inflammation. We touched on inflammation um earlier when we were cooking. Um but I think you've got a really nice analogy for explaining what inflammation is and what meta-inflammation or low-grade chronic inflammation is and how that relates to to mental health.
Professor Felice Jacka: Yeah, well, I mean, based on what we know, and I'm not an immunologist, um you know, if you if you have an injury or a severe virus, your immune system springs into action. And the little messengers that are part of that whole immune response, these proteins are called cytokines. And I mean, there's a whole lot of different ones. And basically, they run around and make sure that things happen and that you get healed, hopefully, if your immune system's working well. But what you don't want is this those cytokines hanging around over the long term. But what we know is that there are a lot of things in our Western life that really prompt this low-grade inflammation, this systemic inflammation where these cytokines, it's like your immune system is on low-grade alert all the time. And they're things like not having enough sleep and sedentary behaviours and smoking and lack of vitamin D and stress and all of these things. But of course, diet is a really big part of it. We know that a healthy diet that's high in plant foods and whole grains, etc, um prompts a reduction in inflammation and we know Western diets increase inflammation. But of course, inflammation doesn't just happen in your body, it happens in your brain as well.
Dr Rupy: This is a relatively new recognition, right? That inflammation and the cytokines can cross the blood brain barrier.
Professor Felice Jacka: Yeah, yeah. And um I I'm not an immunologist, so I don't want to go into too much detail there, but there's um all sorts of new knowledge coming out of the field that I think's really interesting. Um but basically, you know, the driver of all of this, so we we know about the immune system and its role in prompting depression. And we know this from a whole number of different studies and different ways of coming at the research. And we know that brain plasticity is involved in mental health and that diet influences mental health. But what we now know is that the gut and the microbiota that live in the gut play a key role in all of those things. So they're very, it's very important, it's like the heart of your immune system, your gut. Uh it also influences the health of your brain, the integrity of your blood brain barrier, your brain plasticity, all of these things, um as well as your body weight and your metabolism, etc. Now, it's a very new area and it has to be said that most of what we know comes from animal studies. So we have to be careful in extrapolating too much. And we're also really struggling with the methodologies. You know, like what does this mean? Just because there's a bacteria in there, like what is that good? Is it bad? And then we're finding out that bacteria can do all sorts of different things and sometimes they can be baddies or goodies depending on who else is in the zoo and you know, how they're working together. So it's horribly complicated. But there are some basics that we're pretty sure about. And um the first thing is that the gut bacteria, their primary role is to break down dietary fibre. So the dietary fibre that your human enzymes can't break down, that's their job. And they break down the dietary fibre. So that's in the things like the beans and legumes and plant foods and um all the stuff that we just ate. And when they do that, they produce a whole range of what are called metabolites, many, many different ones and we're only just starting to figure out uh about some of them. The short chain fatty acids have been looked at quite extensively. Short chain fatty acids interact with pretty much every cell in your body through these G protein coupled receptors and they influence how your genes behave. Um they are very important in the immune system and the health of your gut lining, it should have a nice thick mucosal layer. That's really important in uh having good immune health. There's many things that can break down that layer and then you get this what's called metabolic endotoxemia where you get um these pro-inflammatory things getting out of the gut and into the bloodstream. Um but the gut bacteria do so many things. They synthesize vitamins, they synthesize neurotransmitters, they also prompt the synthesis of neurotransmitters. Now we don't know that those neurotransmitters actually get into the brain. We do know that more than 90% of serotonin is actually produced in the gut, but it may not cross the blood brain barrier. But there's neurotransmitters do signal to the brain via the vagus nerve, the gut brain axis. But the bacteria also control how much serotonin is produced by uh the metabolism of tryptophan and they they're in charge of that. So there's a whole lot of different ways by which we think uh the gut bacteria interact with the brain and behaviour and we're just starting to really do the studies in humans to try and unpick all of that. But it's very new.
Dr Rupy: Yeah, absolutely. And I think um a lot of people kind of jump the gun with a few things that you probably mentioned, right? So tryptophan, uh specific types of dietary fibres and a lot of spin-offs supplementation sort of uh practices have come about. You were just telling me before the pod about how you were just at a recent conference and you came across some really interesting research looking at which supplements or nutraceuticals may have benefit and which don't. And you were saying there's pretty pretty thin evidence really for a lot of them.
Professor Felice Jacka: So um a colleagues of mine have done uh just recently a a mega analysis, which is like a meta analysis of all the meta analysis. So it's basically brings together everything we know from randomized control trials about the impact of supplements, nutritional supplements in psychiatry. And pretty much the evidence is pretty limited. Um EPA, which is part of the long chain omega-3 fatty acids, like fish oil, seems to be helpful for people with clinical depression if they have high levels of inflammation, which is about half of people with clinical depression. So EPA, yes, tick, but again, short term, it's not long term, short term. Methylfolate, it's a form of folate, that has some pretty good evidence. And again, it's during the acute phase, it's when people are depressed. And what happens, of course, when you have many different sorts of medical conditions, but including depression, your immune system is activated. So you have more inflammation. And what that inflammation does is it kind of burns up your nutrients in a way. You get this sequestration of nutrients and you you your nutrient levels drop and you also get oxidative stress and that interferes with the um the long chain omega-3 fatty acids in the brain cells because they make up an important part of the brain of the neuronal wall. So that's why I think the EPA seems to be useful because it can bring that back and same with the folate. Um there's some evidence for something called NAC, N-acetylcysteine, which is a precursor. We use it in medicine. Yeah, that's exactly right. And I think again, it's something that's short term, I think it it it has some evidence for efficacy in schizophrenia and bipolar disorder. I wouldn't be taking it over the long term. Right. Okay. Um I think that it uh can break down the mucosal layer. I'm not sure, but that's what I've read and um
Dr Rupy: What's the mechanism by which NAC might be working?
Professor Felice Jacka: I don't know. Don't know. I'd need to look into it further, but um
Dr Rupy: Because in medicine we use it for paracetamol overdoses.
Professor Felice Jacka: That's exactly right. And it's great for that in a short term, but it's not something that uh I would be taking long term. And this is the thing, when you take a supplement, you're not taking it with all the other co-factors and things that you should be consuming. I don't take supplements. I don't actually trust them. Ever since I found out that uh antioxidant supplements, so vitamin C or vitamin E, you take them before exercise and you lose a whole lot of the benefits of exercise because it interferes with this whole really complex processes.
Dr Rupy: Yeah. I remember coming across that actually, uh because vitamin C particularly amongst the um sort of physio or the um personal training community, it's been thought of like a no-brainer after exercise because it's an anti-inflammatory. But what you're doing is blunting the benefits of exercise which lead to ultimately shearing of your muscles and inflammation and it's that it's that little bit of low-grade inflammation that actually leads to resilience of the body over time. Um it's almost like the plant hormetic effect. I'm fascinated by this theory of like, you know, a little bit of bad is good for you in the long run. Um so that's interesting. So no vitamin C or vitamin D.
Professor Felice Jacka: I don't I mean I'll take take a bit of vitamin D in winter time, but I do try and get it from the sun if I can and I'm Australian, so I get to do that.
Dr Rupy: We have we have recommendations to take vitamin D3 now um in the winter months, but as you've experienced our summer in June, it's not always sunny over here, so yeah. I think vitamin D is pretty pretty important for for people in the UK. But yeah.
Professor Felice Jacka: Yeah, yeah. But that's about the only thing that I take. I just don't I've never taken supplements. Probiotics, you know, there's the evidence is pretty mixed and I'd much rather be getting fermented foods into me. And I think fermented foods is really interesting because they've been part of traditional diets forever. There's a lot of misunderstandings about fermented foods. So say if you took kombucha, for example, fermented tea and people will say, oh, but all the bacteria are dead because they've eaten all of the the sugar substrate, they've um and now they've died off because they don't have anything else to eat. So there's no point taking it. Well, actually, that's not how it works. So what happens is during the fermentation process, those bacteria are producing all of these metabolites, so many, they're called biogenics and they are they're multitudinous and we don't even know what most of them do. But um we also know that the bacteria can still have bioactive effects even if they're dead. So I think fermented foods are great for a whole range of reasons. We're really keen to test them in clinical trials and that's what something we're working on at the moment. And also they're just delicious. I love I make my own kefir. I have it every day and I love kombucha. I have it every day.
Dr Rupy: Have you have your own like so you make your own kefir at home with the grains?
Professor Felice Jacka: Yeah, yeah, with the the grains. So simple, so cheap and just so tasty. And then I make smoothies with the kefir. I love it.
Dr Rupy: My husband not so keen. I'll get him there.
Professor Felice Jacka: I've heard of this term uh bandied around actually called psychobiotics, um which are um probiotics that potentially have the impact or can have the impact on on mood. But I think you're right, it's a fascinating area of research, very, very much in its infancy at the moment. Um so at the moment it's just probiotic foods.
Dr Rupy: Yeah, and there is some really interesting data though. There was a fantastic study Bob Yoken's group um published probably about six months ago where they they took and this is to me the most compelling study so far in psychiatry. Patients with bipolar disorder, like serious bipolar disorder who had been hospitalized with mania, when they came out of hospital, they were randomly assigned to get either probiotics or placebo. And then they were followed over time to see how long it would take for them to go back into hospital with mania. And there was a really big difference. The ones on the probiotics took a lot longer to go back into hospital.
Professor Felice Jacka: Gotcha. So that's very cool. But the psychobiotics, so Professor John Cryan and Ted Dinan, great buddies of mine and they're really the world experts, you know, and they've got a great book called psychobiotics, which is all about this. Um but they would say, look, at 99% of the bacteria that strains that they've tested in animal models don't do diddly squat. But there are some that are and I I do think that there's probably huge potential there. It's just that we're not there yet and going and getting some probiotics off the shelf and consuming them is probably not particularly worthwhile unless maybe you've if you've had antibiotics, it's certainly not going to hurt.
Dr Rupy: Exactly, yeah. But I would be getting the kefir and the kombucha and the tempeh and the sour kraut and everything else into me.
Professor Felice Jacka: It's something I actually tell patients whenever I give antibiotics. I was like, look, there's no evidence behind a probiotic supplement. It's unlikely to do any harm. I'd prefer you get it from probiotic foods, but we're just not there yet. And there's so many different variations as well, right? I mean, depending on your genetics, your current state of your microbiota, whether you're dysbiotic or not. Um it's it's almost like the keto diet for some people, it's great. For other people, absolutely deadly. Um and potentiates in some cases autoimmune conditions, which you talk about in your book as well, which I was I was quite pleased to to read about. Um and also one I there was a study that you um you mentioned, it was something that I I wrote an essay on recently. I think it was O'Keefe and colleagues and they did a crossover study um where they took people who were still living in Africa, in South Africa, I think it was.
Dr Rupy: Oh, it's one of my favourite studies. It's just fantastic.
Professor Felice Jacka: And then they crossed over the diet with uh African people of African origin who were living in America and therefore eating a Western diet. And they crossed them over for two weeks and they found profound changes, right?
Dr Rupy: Yeah, that's right. So um you know, we know that people who are living more traditional lifestyles have a much healthier gut microbiome, more diversity, more short chain fatty acids, all of the stuff. And they compared South Africans living a rural traditional lifestyle to African-Americans having the sad, the standard American diet. And of course, their gut looked really kind of awful and had higher levels of inflammation and these markers that we know risk factors for um bowel cancer. But that was the cool thing. They swapped their diets for two weeks and the poor rural South Africans, they're, you know, their gut health went down the toilet so to speak and their inflammatory markers went up, but it got better in the African-Americans. That's so powerful. That's saying in two weeks, you can have profound changes on your in your health by just changing what you're feeding your gut microbes.
Professor Felice Jacka: Absolutely. Yeah. It's incredible that.
Dr Rupy: And so to to summarize, I don't because there's so much information packed in your book. I mean, you talk about uh dairy, gluten, specific diets, you even put the details of the moddy diet that you put in um that you used in the smiles trial. If we were to categorize what things that we need to be doing for mental health, um what sort of things? So we talked about whole grains and and fibre, um which we we had in our lunch today. Um what other things are you looking at? And and fatty fatty fish um uh supplement or potential supplements but
Professor Felice Jacka: Look, I think it's really important to understand that you don't have to get this perfectly right. And you know, I go very much for the 80/20 rule. In Australia, uh average, like teenagers are having on average seven serves of junk food a day. Seven serves. Less than half a percent of Australian children and adolescents are getting the recommended intake of veggies and legumes. Less than 5% of adults. In America, something like 60% of their average energy intake is coming from ultra processed foods. So this is not just a problem of people who are poor or uneducated. It is a massive and on a global scale. So if you moved your diet to be 80% pretty good, you know, you would be doing so much better than the vast majority of the population. And then that still allows for, you know, I love ice cream. Friday night, ice cream time. Um you know, I like chocolate. You know, I'm not super, super strict and it's not prescriptive.
Dr Rupy: You got to give your ice cream recommendation for Melbourne. I I know Melbourne's like a hot bed for new restaurants and great.
Professor Felice Jacka: Yeah, yeah, Messina. Messina. Yeah, so we have a Messina, we have a bunch of Messina in Sydney.
Dr Rupy: Did it originate in Melbourne or Sydney?
Professor Felice Jacka: I don't know, actually. Not sure. But I also love um oh, uh yeah, no, there's many, especially around Carlton, there's and the Italian areas, so much good gelato. I know, I love ice cream. So, you know, 80% of your your diet, you're just going for whole foods and it doesn't have to be that difficult or complicated. You know, porridge for breakfast. Yay. You know, a bit of Greek yogurt with some oats on top and whatever. Yay. Um lunch like we had today, just, you know, good quality sourdough bread, um Ryvitas, whatever. The sorts of recommendations we gave in the smiles trial were dead simple. They were like a, you know, Ryvita type biscuit and a tin of tuna and some sliced salad. Get on with it. That's it's cheap, it's easy, it's quick. I use for that simple diet to have that dramatic effect in three months.
Dr Rupy: It's just extraordinary. So you introduce fibre. Fibre is key. That is number one. Polyphenols, you know, come in all the colourful fruits and vegetables. They seem to be really powerful. There's some really interesting studies showing that if you get rodents and you put half of them on a high fat diet and the rest on a normal diet, the ones who are getting the high fat diet, of course, they get really fat and they put on lots of weight. But if you take a third group and you give them that high fat diet, but you also give them polyphenols in the form of, you know, blueberry supplementation or whatever, they only put on half as much weight. Wow. So it's the only thing that's different and it mitigates weight gain. So you've got to look after your gut. Your gut and I think that makes it easier for people. They get told that they should eat their fruits and veggies and they don't really know why and they think, oh well, maybe one day I'll have a heart attack, but that's off in the future. But if you say
Professor Felice Jacka: No, for people to reduce like the berries, for example, just to its polyphenolic component, so the flavonoids and stuff like that. But actually, you know, it's the fibre, it's all the other parts.
Dr Rupy: All the other things that we haven't even started to measure yet. This is what's so powerful about plants. Um but just this knowledge that if you feed your gut, you're going to be doing good and you don't need to know the detail of which bacterial strain is doing what. You just need to know that your gut bugs need fibre to do what they do. If you don't have enough fibre, they can't do what they do. You just need to know that lots of different types of fibre and different types of plant food help lots of different types of bugs to live there. It's like a zoo, you want this real biodiversity in your gut. My husband and I have just uh written a kids book.
Professor Felice Jacka: Oh, have you?
Dr Rupy: Another book.
Professor Felice Jacka: Yeah, and it's called it's called there's a zoo in my poo. And the idea is that we want to get kids actually going, I'm the zookeeper. I'm in charge of these guys. I got to look after them. And that means I got to feed them the right things. And I think that's true for adults as well. That it's making it very concrete like that is going to be really powerful.
Dr Rupy: That's brilliant.
Dr Rupy: And actually, you can buy the book, There is a zoo in my poo for your kids right now. Finally, my conversation with Rahul was super powerful. Dr Rahul is a neurosurgeon and author of the book Life Lessons from a Brain Surgeon. And our conversation spanned the need for mind wandering and the importance of harnessing creativity, but in our own unique ways.
Rahul Jandial: Even the way you talk in terms of like your mind wandering and the fact that you speak a second language and all these, these are all like concepts that have come out in your book and it's kind of just your book is just like a structured way for you to express yourself. And there are benefits to this, right? There are benefits to daydreaming, there are benefits to um using your left hand. I must admit something, I've actually started using my left hand to text on my phone. I actually use my phone now. Um something I started a few years ago, but then I rapidly just forgot about it. And then once I read your book again, I was like, okay, now I'm going to do that again because that is actually harnessing those new neural connections, right?
Dr Rupy: Right, absolutely. And just on a more fundamental way, you don't want to have arthritis just in your right hand, right? You you want to you got a lot of phone mileage to go. I don't plan to put my phone away, so it's
Rahul Jandial: Yeah, and arthritis will start in your thumbs as well. So Yeah, absolutely. And um I was talking to somebody and not knowing these things or sharing these things in a overly simplistic way has maybe made us not see our real potential. Children, you're this type of personality, you're left brain, it it it closes us. You know, it um it puts us in a rut. And and the key to get out of that rut is inside us, but nobody has explained to us that that is possible. So in the book, we have um extreme examples to show you what I call your top speed. It's up to you if you want to get out of first gear. I'm not here to be preachy and say, uh do this and do I'm not that guy. I just you don't sound puritanical at all. Yeah, I'm actually told I was talking to somebody the other day, I I want to be allowed to do things that are dangerous or hurtful to myself. I just don't want to be misinformed about them. If I want to have a cigarette, I just want it to know and have known from decades past that it was dangerous. If you want to play American football, we didn't do our generation a favour by lying to them that it was just like boxing. But we knew if you go into boxing, everybody knew for the 100 years, well, you get punch drunk and there's dementia pugilist. There are all these words that say you bang your head against the wall or fist too much, it's going to mess up that delicate jellyfish inside. We knew that. And then if you choose it, that's fine. I I I love free will and freedom. I just don't like misinformation. So I just want to let people know, for example, on creativity, um some patients with dementia when their frontal lobe withers, the CEO, the boss, the things behind our forehead, there's two of them, it's a paired brain, it's a left and a right, there's a bridge. When that wears out, they can have dramatic improvements in their ability to paint. What are you talking about, right? So I'm not saying get dementia to be I'm not saying, but that should make people say that is there so there's something that was tamped down. Then you have these case reports of people being hit with lightning and they can do math. And then you have, you know, savants who, you know, might have an intellectual disability and that's in America, that's how we refer in the most respectful way. So if it isn't here, I just want to qualify that for the listeners. That's my most respectful and articulate and nuanced way to to talk about that because I do take care of those patients. They can have certain mathematical abilities released. So they're if the homeostasis in our brains is tilted and it might be not good for you, but there are hidden talents and latent abilities inside us. That is the premise now. Then we talk about, well, I'd like to tap into those on my daily life. Yeah, yeah. I'd like to tap into those if I work for Google or if I'm here in London. And then the book goes into what are the things that people can do. So I love the topic of creativity. I know four people that are wildly creative. Four types of people. Kids. Kids are stuff kids. And guess what? Their frontal lobe is not fully developed.
Dr Rupy: So that that's quite interesting, isn't it? The fact that your frontal lobe isn't fully developed and this is where you harness those sorts of um the imagination, right? The um the sort of creativity. Yeah, you give them a box and they will have a whale of a time. Like I I'm watching my two god sons who are in America at the moment and just the things they come up with and how happy they are and content they are. That's
Rahul Jandial: So let me answer that conundrum. The frontal lobe is not developed and the frontal lobe is also the seat of creativity. But it's the part of the frontal lobe, I don't mean anatomically, the capacity of the frontal lobe, I don't mean like corner X, to uh squash down creativity to be able to go to school, check your emails, get on the tube and check all the checklist part of the CEO component of our frontal lobes hasn't hit maturation. We can also lose that part by getting drunk. I'm not saying get drunk, but that's what alcohol does, it disinhibits. So the inhibition capacity, not location of the frontal lobe isn't there, so creativity is having its way as a kid. Um some writers like to drink and and they feel they write better. Then we're also uh microdosing people feel like they're more creative. Again, that disrupts the frontal lobe from saying, I got to check my emails, I got to get home. Oh my god, I got bills, I got all and it should do that because you don't want to be walking around the park only being creative. You got, you know, you have to achieve the goals of the day to to live, to eat. Um and then the fourth person that has is wildly creative are people with dementia again, frontal lobe is now physically injured. And then what I would posit is, so so we know that creativity is there's greater creativity than we deliver because the homeostasis is tapping it down, okay? Because we've got these examples. But we're all wildly creative in our dreams. And um I love that term you use by the way in the book where um we're all darlings of creativity when we sleep. Yeah. It's incredible. Like We are though, right? Wild stuff going on. Whether we remember it or not. Yeah, yeah. And so then I was writing this chapter on creativity and I just like, you know, I yes, mind wandering is helpful, yes, getting out, walking around is helpful, being playful. But I just didn't feel like that was nuanced and sophisticated enough for for everybody. Yeah.
Dr Rupy: I sincerely hope you've enjoyed listening to these conversations. I can't wait to share another 200 with you all. I have tons of ideas of podcasts and specific health topics, all with the aim of helping you live your best life. Thank you so much for supporting the podcast. Please rate and share it with your friends if you found this episode or any episode in the past impactful, and I'll see you here next time.
