Dr Rupy: Hey, it's Dr Rupy and this is going to be my 2023 wrap-up for the podcast. It's been an incredible year of podcasting. We were at the Integrative Personalised Medicine conference. We had a number of new guests including Johann Hari, Dr Robert Lustig, some passionate, passionate speakers and we have also launched officially on YouTube. So not only can you listen to the podcast, you can watch the podcast in high definition, high quality and we're going to be doing a lot more specific YouTube episodes as well. So do make sure you are subscribed and you hit the notification bell. I have had a wonderful, wonderful time doing the podcast this year. I really hope you've enjoyed listening. We have so many more things lined up for 2024 that I'm super excited about, including leaning in more to the research that we've done for our Doctor's Kitchen app, adding more health goals, specifically women's health and fertility, something that has been asked of us a number of different times. And I just wanted to highlight a couple of conversations that I've had this year that I feel have chimed with you, the audience members, the listeners, the viewers, but also have encouraged me to think about a subject in a new light, whether that be sugar with Dr Robert Lustig for example, or Jessie Inchauspé, focus, the intrusion of digital devices and digital platforms, which is ironic considering we do have our own app and digital platform, although that is really to counter the effect of other addictive platforms. And also the wider context of nutrition, how we choose food. A conversation that was particularly impactful for me was the one with Sheila Dillon and the food programme that has been particularly impactful on my life as well. So I wanted to pick a couple of conversations that we've had, present them to you guys and hopefully give you an essence of the 2023 podcast schedule that we've had in preparation for some incredible guests that we've got lined up for 2024 and subject matters that I know you are absolutely going to love. So first off, we're going to have a snippet from my conversation with Dr Robert Lustig on whether you can be a sugarholic.
Dr Rupy: I want to talk about addiction in a bit more detail here because I'm of the opinion that you can be a holic of all these different substances or behaviours. The traditional description of addiction is that you have withdrawal effects, we definitely see that with sugar. There are people on the other side that have a differing opinion that sugar is not addictive. What are those, those opinions and what are your rebuttals to some of those?
Dr Robert Lustig: So there is a group here in the UK and in Europe called NeuroFAST. And they believe that in fact, the problem is not food addiction, the problem is eating addiction. Well, if that's the case, then there's no specific food that is addictive. Well, what that does is that gives the industry carte blanche to basically put anything they want in. When you look at what they say, first of all, they give alcohol a pass and then they give caffeine a pass. And well, alcohol, caffeine, I mean, sugar is not addictive, but alcohol and caffeine are, but you're giving them a pass. Like, how does that work? They also say sugar is energy and it's necessary for life. Garbage. Where does that come from? Now, it is true that glucose is energy. It is true that your liver can metabolise glucose for energy and so can your brain and so can every other organ in your body. That's true. But the question is, do your organs need glucose? And the answer is, they need it, but you don't have to consume it to get it because your body will make it. It will make it out of protein or fat, process called gluconeogenesis. So, yes, you need glucose, but you don't need to eat glucose. Fructose, the sweet molecule in sugar, there is no biochemical reaction in the body that requires it. It is completely vestigial to all animal life on this planet. And it is a mitochondrial toxin. It inhibits three enzymes that are necessary for mitochondria to work properly. It inhibits AMPK, the fuel gauge on the liver cell, it inhibits ACADL, which is one of the enzymes that helps chop up the fatty acids into two carbon fragments so that they can be oxidised. And also the byproduct of fructose metabolism, uric acid, inhibits carnitine palmitoyltransferase 1, which is necessary to regenerate carnitine, which is the shuttle mechanism to get the fatty acids into the mitochondria for oxidation in the first place. In other words, fructose is a chronic dose-dependent mitochondrial toxin. So, the fact that it has four calories per gram is kind of irrelevant. In the same way that alcohol has seven calories per gram and is kind of irrelevant. There is no dietician on the planet who would call alcohol food. Well, there should be no dietician on the planet that calls sugar food because it's not necessary. It is not a nutrient. Just because it's energy doesn't make it a nutrient. In fact, sugar is not food. What is the definition of food? Substrate that contributes to either growth or burning of an organism. Well, I've just shown you that sugar actually inhibits burning because it inhibits mitochondrial ATP generation. How about growth? My colleague, Dr Efrat Monsonego-Ornan at Hebrew University Jerusalem, head of the Department of Nutrition, has shown that sugar actually impairs linear growth. It impairs cortical growth, it impairs trabecular growth. It hijacks growth. It promotes cancer growth through fermentation, through the Warburg effect, but it in fact actually inhibits growth. So if a substrate actually inhibits burning and inhibits growth, is it a food? In fact, sugar is not a food. Sugar is a food additive.
Dr Rupy: Okay.
Dr Robert Lustig: That's what sugar is. And we have plenty of data to support food additive addiction. So this is where the argument becomes actually not just semantic. Food versus eating addiction. Ultimately, what we're talking about is food additive addiction. And that's one of the things I'm trying to, you know, promote and get across to both the public and to NeuroFAST because they got to get with the freaking programme.
Dr Rupy: And with the, just on that, on that point around food addiction, I think it also comes down to how socially acceptable some of these items are. You know, if you take the glib example of smoking, it was very socially acceptable 60, 70 years ago and it took decades for it to become socially unacceptable. And I think we're still at the early stages when it comes to sugar as an additive.
Dr Robert Lustig: I couldn't agree with you more, Rupy. I mean, smoking went from fashion to filthy habit in 30 years. Okay? Now, how did that happen? And why did it take 30 years? The answer is, we taught the children. The children grew up and they voted. And the naysayers are all dead. This is a generational shift and unfortunately requires a generation to be able to see it. In the fact, we have had four, count them, four cultural tectonic shifts both in the US and UK over the last 30 years. And here they are. Number one, bicycle helmets and seatbelts. Number two, smoking in public places. Number three, drunk driving. Number four, condoms in bathrooms. Each of those was basically third rail of politics 30 years ago. If a legislator had stood up in a state house or Congress or parliament or the Duma or anywhere else in the world and promoted any legislation about any one of those four things, they'd have gotten laughed right out of town. Nanny state, liberty interest, get out of my kitchen, get out of my bathroom, get out of my car. Today, they're all facts of life. No one's bellyaching about any of those. Okay? Oh, we're bellyaching about new stuff, like COVID vaccines. I mean, it's not like we'll ever solve this issue, but those four, they're settled. There's no arguments about it. You see anybody protesting seatbelts today? Lord Balfour in 1980 stood up in parliament right across the street over here, okay, and basically told everybody that seatbelts were an affront against their personal liberty. I mean, let's get real here. This takes a generational shift and we've done it and we'll do it with sugar. We're about, I would say, 10 years into the 30-year cycle.
Dr Rupy: The realisation of our dropping attention spans is worrying and you don't have to ask too many people in your network to realise that this phenomena is not unique. And this conversation with Johann Hari encouraged me to inject a particular activity that I always thought was a waste of time and the antithesis of productivity, which is something that I feel like I'm always aiming for. And it is simply mind wandering. And the benefits of mind wandering are vast. Listening to Johann Hari's latest book, as well as this conversation, has encouraged me to do this practice pretty much every day. I loved this conversation with Johann Hari and this is a snippet talking specifically about our different types of attention. I was fascinated by this book as someone, like many people who are recognising the impact of technology on my own attention, how I feel like I'm constantly flicking around the page rather than following line by line. I was fascinated to dive into this book and dive a little deeper around it. I thought we could perhaps anchor the listener by talking a bit about attention as it is. And you have this wonderful bit actually in the conclusion of the book where you talk with James Williams, the former Google strategist, about attention described as spotlight attention, daylight attention and starlight, starlight.
Johann Hari: Yeah. I mean, I wrote the book because like you, like I'm guessing pretty much everyone who's listening, I could feel that my own ability to pay attention was getting worse. With each year that passed, it felt like things that require deep focus that are incredibly important to me, reading books, watching films, having proper long conversations, were just getting harder and harder. And I could see this was happening to huge numbers of people around me. The average office worker now focuses on any one task for less than three minutes. And for every one child who was identified with serious attention problems when I was seven years old, there's now 100 children who've been identified with that problem. So I wanted to understand what was happening to us. And it's interesting you bring up Dr Williams. Obviously, I used my training in the social sciences at Cambridge University to go on a really big journey all over the world from Moscow to Miami to Melbourne to interview over 200 of the leading experts on attention and focus. And what I learned is there's scientific evidence for 12 factors that can make your attention better or can make it worse. And loads of the factors that can make your attention worse have been hugely rising in recent years. You've mentioned tech. Obviously, there are some aspects of our tech that are doing this. One thing that fascinated me is actually how wide the causes are, that tech is only, you know, it's a substantial part of my book, but it's not the biggest part. You know, the food we eat, an issue obviously very important for your podcast, is hugely affecting our ability to focus. A huge array of factors, the way our offices work, the way our kids' schools work. There's a really big, broad array of these 12 factors. But you've gone to a really interesting one of the things that really interested me that I learned, which is when we think about attention, we tend to think about it in quite a narrow way, as a kind of mild irritant, you know, poor attention problems, right? But actually, Dr Williams, who I would argue is the most important philosopher of attention in the world, argues there's three layers of attention that help us to think about this. I would actually argue there's a fourth, and I know he agrees with this. So the first layer of attention is what we mostly think about when we think about attention problems. And that's what's called your spotlight, right? So your spotlight, you think about the room I'm in now, right? I'm talking to you from my flat. I'm homing in on answering your questions, but actually, I'm surrounded by a load of stuff, right? I can hear, if I zone out a little bit, I can hear the sound of my radiator over there. If I turn my head a little bit, I can see people walking past on the street. I'm surrounded by all my stuff, my books. Somewhere hidden in this room, there's my phone. I'm zoning out all of that and I'm narrowing down to you. So it's called your spotlight because it's your ability to narrow down your focus to one immediate task. And we can all feel that our spotlight is being disrupted, you know. I go to the fridge to get a Diet Coke, on the way there, I get a text message from my friend, I start answering, suddenly I'm standing in the kitchen, I'm like, why the hell did I come here? I come back to my laptop and I don't have a Diet Coke, right? That kind of disruption is happening to us all the time and it's having huge consequences that I'm sure we'll talk about. But actually, so that's mostly when we think about attention problems, we think about spotlight disruption. We don't use that term, but that's sort of what we think about, right? I was trying to get something done and I got disrupted and now I'm not doing it, right? And that's huge. But actually, the next level up, Dr Williams argues, I think persuasively, is even more disruptive. And it's what he calls your starlight. And he says, that's not just your ability to achieve a short-term goal like going to the fridge to get a drink. That's your ability to achieve a long-term goal, you know, I want to start a business, I want to write a book, I want to be a good parent, right? It's called your starlight because when you're lost in the desert and you don't have GPS, you look to the stars and you're like, oh yeah, that's the direction I'm travelling in, right? And he argues it's not just our ability to do immediate short-term tasks that's being screwed with, it's our ability to achieve longer-term tasks as well. If you're jammed up all the time, if you're experiencing these 12 factors that I write about in my book, Stolen Focus, you're going to find it harder to do those longer-term projects, right? I'd say to anyone listening, think about anything you've ever achieved in your life that you're proud of, whether it's starting a business, being a good parent, learning to play the guitar, whatever it is, that thing that you're proud of required a lot of sustained long-term focus. And when your ability to pay attention breaks down, your ability to achieve your goals is diminished, your ability to solve your problems is diminished. You feel worse about yourself because you actually are less competent. And when you start to get your attention back, obviously, you start to feel much better. There's a layer of attention even above that, which Dr Williams calls your daylight. And that's not your ability to achieve a long-term goal like starting a business, being a good dad or whatever. That's your ability to even know what your long-term goals are, to even figure out your long-term goals. How do you know what business you want to start? How do you know what kind of book you want to write? How do you know what it means to be a good parent? To figure those things out, you need to have time to think, you need to have rest, you need to let your mind wander. It's called your daylight because you can see a room most clearly when it's flooded with daylight, right? And he argues we're so jammed up that our ability to even figure out who we are is getting harder and harder, right? He calls it decohering, which is a kind of fancy term, but I think makes some sense that we become less coherent as people because we can't think clearly. And I would argue there's a layer even above that, which I would call our stadium lights. And that's not just your ability to figure out what your long-term goals are and achieve them as an individual. That's your ability as a society. How do we come together, figure out what our collective goals are and achieve our collective goals, right? We can all see that's getting harder and harder. We can't listen to each other. We end up screaming at each other all the time. We're so polarised, we're so angry. So when you realise what seems like a small thing, oh, my attention's getting worse, it's annoying, you realise that problem hobbles us at every stage of our lives. And crucially, starting to solve the problem means that at every level of our lives, we become more effective as people and better able to achieve our goals and solve our problems.
Dr Rupy: Jessie Inchauspé is now a global phenomena and has influenced millions of people to become more conscious about the impact of sugar spikes on their wellbeing. And in this snippet, we focus on her backstory and actually what led her to pursue a career in science and the revelation of how her own glucose rollercoasters were affecting her health. What was your relationship with food when you were growing up and as a young woman and how did that lead to where you are today?
Jessie Inchauspé: Well, when I was a kid, we didn't know much about food in my family. So I had a Nutella crepe every morning for breakfast. My mom had orange juice, Special K with a bunch of sugar on it every morning. And then what happened is that my mother met my stepdad and he had a brother called David Servan-Schreiber, who was one of the leading French doctors who started educating people on the importance of food for health. And back then, you know, I mean, nobody believed that the food you ate could have any impact on your health. So it was quite groundbreaking. But thanks to him, we discovered this whole world, you know, sugar, processed foods versus whole foods, fibre, omega-3s. It was like a, it was really a revelation. So as a teenager, I started discovering this world and I really had an affinity for it. I thought it was very interesting. And then what really cemented my interest in health and the body was this freak accident I had when I was 19. And you mentioned you read my book and in it there's an x-ray of the hardware I now have in my spine from that accident. It was really terrible. I mean, physically and mentally, I suffered a lot, but it taught me at that young age that nothing is more important than health. And so I went on this quest, this journey to try to figure out how do I feel good? Because I felt like absolute crap every single day. And, and over the years, it led me to glucose and now here I am. I feel great and I share the science with other people so they can feel good too.
Dr Rupy: Yeah, I know, absolutely. Tell me about the, the, uh, the accident. Obviously, I know about it, but for the listeners, what, what exactly happened to you?
Jessie Inchauspé: So I was on vacation with some friends in Hawaii and they were like, hey, let's go jump off this waterfall. So I was like, okay, cool. So I jump off of the waterfall and instead of landing with my feet first, I kind of land sitting down. So one of my vertebrae exploded under the pressure just by hitting the water. And so I was walking around with this broken spine, so I had to have surgery where they went in, took the broken vertebrae out, fused it with the top and the bottom ones. And I was in a lot of pain for a very long time. But then physically, I actually recovered really well because I was 19, you know. So when you're that age, your body can heal quite quickly. So in a matter of months, I was totally fine physically. But mentally, all the stress from the surgery, from the accident, the unprocessed trauma, I think, led to this really intense mental health condition called, well, it has a few names, but depersonalisation is the clinical name they gave me for the condition, which is just like very deep anxiety about existing. Depression, brain fog, dissociation, impossible to be alone because I was so scared of just being. And that's what started on me on this journey to try to understand my body. And that's why I went on to study biochemistry in grad school. Then I worked in genetics because I really wanted to figure out how do I heal? It was my number one priority in life.
Dr Rupy: Yeah, yeah, yeah. And so you did biochemistry first and then you did maths. Is that right? Is that was that part of your master's?
Jessie Inchauspé: Maths was before. So when I broke my back, I was in my second year of undergrad studying maths in London.
Dr Rupy: Right. Okay, got you. And so after that, you went to work at a very famous genomics company. What, what was that experience like?
Jessie Inchauspé: 23andMe. Oh, it was incredible. So I wanted to work in the field of genetics because I thought if I can understand my DNA, then I can understand my body and I can figure out how to feel good. The experience was amazing. I mean, the best company, the best people, I had the best job. It was really one of the happiest times of my life. But it did not help me figure out how to feel good because while your genetics are interesting, they can't tell you what you need to do to wake up in the morning feeling good. And that was a difficult realisation I had while I was there.
Dr Rupy: Yeah, yeah. And one of the things that you got experience of was, um, the continuous glucose monitor. That was one of the, you put yourself up for for being one of the guinea pigs. And you very casually mentioned this in the book, but you built your own app to to better visualise what was going on with your continuous glucose measurements. And as someone who's just finished completing building their own app, I know that it's no mean feat to build an app. And you did this, did you do that on your own? Was that, was that just something you just spun up?
Jessie Inchauspé: So let me tell you the the backstory. So while I was at 23andMe, there was this opportunity to try, as you mentioned, these devices, continuous glucose monitors that you need a prescription for in the US. And so I put one on and it completely changed my life forever because finally I was able to see the inside of my body and communicate with my biology in a way that I had been completely incapable of before. And so I learned about glucose and I saw that glucose spikes were bad, that we had to keep our glucose levels steady. And then I wanted to share the science that I had learned with my friends and my family. I was like, guys, look, like this study shows us that if we have vinegar before our meals, we can avoid glucose spikes and feel better. But my friends didn't react to me just printing the studies and showing them the printed pieces of paper. Like nobody really connects to that. So I thought, how am I going to communicate this important information? So I had this idea of taking data from my glucose monitor and turning it into these graphs that I could show people to illustrate the science. But the problem is the app that the device comes with, it's a medical app. Like it's not something you can just turn into easy to understand graphics. It's just raw data and nothing else. So I had to figure out how to extract the data from that app and then to make my own little illustrations. So yeah, I built this piece of software that did it. I took lots of different pieces from the internet. So the concept was you had to, I had to take a screenshot of my daily glucose curve on the app that the device came with. And then I would put this image through a digitiser online that would like extract the data points. And then I wrote this software in this program called R, which I had learned when I was in grad school. And this program then took the data in and made these graphs. And the evolution of that is what you see on my Instagram today. So then I worked with some engineers to like make it into a proper app. But at the beginning, it was running just on my laptop for, you know, a year. Just importing my data and running it. Really startup mode, you know, really like Silicon Valley vibes from my living room. So yeah, I did do that.
Dr Rupy: That's fab. I've so much respect for that because I know how difficult it is, you know, to do this on your own as well. And the fact that you're able to spin it up on by yourself is amazing. So and it's a really cool app.
Jessie Inchauspé: Thank you. And when you really want to do something, personally, if I really want something to happen, like nothing can get in my way. I will make it happen. And so I spent countless hours building this piece of software to make it work. But I was so determined to doing this because I knew this would change the game. I knew this would help people visualise the science, understand it, become interested in it. And that was my objective because the stuff I had discovered was so life-changing. I needed to find a way to make it sexy so I could share it and people could then apply it to their own lives.
Dr Rupy: Absolutely. Yeah. Well, let's dive into that. So why is sugar so important? Maybe we could talk about the like the different names, the the relationship between starch, sugars and and fibre and, yeah, what what just give us a primer on on that.
Jessie Inchauspé: Sure. So the word I use is glucose. And as you know, glucose is your body's preferred energy source. And we get glucose from the foods we eat. So every time we eat something starchy, like bread, pasta, rice, potatoes, or every time we eat something sweet, so this could be fruit, this could be cookies, this could be cakes, whatever. Every time you eat something starchy or sweet, they break down into glucose in your body. Special mention for the sweet foods also break down to fructose, that's a separate issue. But if you eat something sweet or starchy, glucose is going to land in your bloodstream. And glucose is very important. Like we need it to be able to function properly. But the problem arises when we deliver too much glucose too quickly to our body. It's like if you give a plant too much water and it drowns or a human too much oxygen and they pass out, too much glucose creates these glucose spikes and these glucose spikes have lots of consequences.
Dr Rupy: Professor David Nutt is at the forefront of psychedelic research. And on this podcast, he breaks down what these molecules are, the research behind them, and why he believes they have great promise for mental health and beyond, with the caveat that these are still molecules that can be abused. This is a really interesting, in-depth conversation. The full one can be found on YouTube where I interviewed him at the Integrative Personalised Medicine Conference in 2023. It's a fabulous watch and listen. I highly recommend you listen to the full episode, plus his book is phenomenal and I've linked to that in the show notes.
Professor David Nutt: The other thing we've done, and in some ways the most compelling, is that we have looked at the flexibility of the brain after psychedelics. And we've done this in patients and we've done it in healthy volunteers. And you can very easily see it. If you put a healthy person, a normal person in a scanner, give them a psychedelic, the brain becomes much more connected. And that I think is one of the crucial factors in why people get important insights when they take psychedelics. But that increased connectivity persists. Now, with our patient studies, and we've only really done this currently in depression, we're doing it in other disorders, but we've done two depression studies. And in the first one, we we scanned people's brains one day after the trip because you couldn't really ethically put a depressed person in a scanner and hope to get a therapeutic benefit of the psychedelic. I mean, you might get the benefit, but we couldn't justify that. So we scanned them a day after. In the second study, we scanned them three weeks after. And then we looked at the ability of their brains to change their way of thinking, to switch between different thinking states. And in both states, both the day after and three weeks after, the depressed brain was much more flexible. And, and this is really remarkable, the more flexible it was, the better their outcome was at six months. So this is almost like a fingerprint or a measure of the changes in the brain which actually predict outcome in depression. That's very unusual.
Dr Rupy: How were you able to challenge their flexibility in that particular study? What what what measures did you use?
Professor David Nutt: The measure we use is we we look at, you look at the whole brain. Now, let me just give you a little bit of the backstory. There are multiple networks in the brain, depending on how sophisticated your analysis is and how many measures you've got. But I mean, simply, I mean, there are some very obvious ones we can talk about. You know, there's there's a visual system, there's a hearing system, there's a speech system, there's the motor system, there's a feeling system, and there's a thinking system. And there are about three different thinking systems. There's a self-reflective system, there's a system which gets you out there doing things, you know, analysing things. And then there's another thinking system which is about the relevance of what's out there to you. So say there are 10, 10 big networks in the brain. We can measure them and see how rapidly the brain moves between different ones. So obviously now I'm talking, my my auditory network is very active and my word production network is really, really active and my visual network is very active because I'm looking at you and seeing if you're agreeing with me, which is great. And other networks aren't so active. So we can see how readily the brain flips between different networks. And after psychedelics, we can see they flip, it flips more readily. We see these transitions, they're more of the transitions basically. And that's really important because the killer problem in depression is that people, one of the networks, which we call the default mode network, the network which encodes your sense of self, your value, your self-worth, that becomes overconnected to itself and it doesn't connect to the rest of the world. So rather than evaluate your thoughts by say what other people are doing or saying or written about you, you get locked into this internal rumination, this loop of negative thought. We can break that down. We see that psychedelics break it down and it stays less tightly connected afterwards.
Dr Rupy: Yeah. I want to go into the default mode network in a bit more detail, but perhaps before we do that, we can step back slightly and actually talk about what we mean by a psychedelic. What psychedelics we typically talk about from the research point of view, LSD, DMT, etc. And how those are different from other exogenous molecules that we might use. You know, how does it differ from a nootropic, for example?
Professor David Nutt: Right. Okay, so when we talk about psychedelics, most people are talking about what we call the serotonergic psychedelics. So these are drugs which like LSD, like DMT, like psilocybin, magic mushroom juice, DMT of course is an ayahuasca. They target a particular serotonin receptor in the brain called the serotonin 5-HT2A receptor. That receptor is really, it's probably the most interesting receptor in the brain in some ways because it's it's for reasons we don't fully understand, it's massively expressed in the very highest parts of our brain, the parts of our brain which make us human. And that of course is why psychedelics by perturbing those receptors change the very highest functions of our brain. So people think differently on psychedelics, but they can still move their arms and legs because it doesn't affect those, you know, those longer evolved parts of the brain. But there are other kinds of psychedelics and then there are ones like Salvia which produce again a rather similar and disorganised state of brain function, but which are subjectively really quite different and often very unpleasant. And then there's Amanita muscaria, which is the the it's the GABAergic psychedelic, which is we believe is the is the mushroom that Alice took to get bigger and smaller because it it produces distortions of of size. And then of course there's ketamine. Now ketamine is pharmacologically very different from DMT or or psilocybin, but it produces again perturbations of brain function which can liberate people from disorders like depression and addiction. And uh, and currently, of course, in the UK, it's the only psychedelic we can actually use because it's the only one that's a medicine. So, so a lot of our clinical work is using ketamine at present, but but we're hoping in time that the the regulations will change and we'll be able to get hold of psilocybin and maybe DMT.
Dr Rupy: And how do these differ from other molecules like nootropics that people use?
Professor David Nutt: Yeah, so nootropics, nootropics are drugs which promote brain metabolism and brain growth, but they do it in a general way. Whereas psychedelics particularly target one receptor in that are localised on a very special set of cells. And let me just explain why these cells are really important. The human brain has more computing power than all the computers on earth put together. Why is that? Because your brain is made up of about 100 billion neurons and each neuron is a mini computer. And you think, you know, 100 billion times 100 billion, it's an awful lot of computing power. Now, what makes them those individual computers work as a whole are particular set of neurons which are located in the cortex. They're called the layer five pyramidal cells and they pull it all together. So they make all the communications in your brain. And uh, and that is, you know, why we are so clever and you know, we've got the enormous capacities for everything that humans have. Psychedelics particularly target those those neurons. And we don't know why. We don't know why those neurons have got a lot of the 2A receptors. I think it's got something to do with the ability to think differently. I think they, we know that those receptors are involved in neuroplasticity. We know that those receptors mediate the psychedelic experience. We don't exactly know why they're there, but I think, you know, they, the fact that they're there means that even if you, if major things happen to you, even if you're not taking a psychedelic, like for instance, you know, you suddenly discover how to get make fire. I think the encoding of that experience, that that's a light bulb moment. Wow, I've done something fundamental. This is, they will be, it'll be encoded by a whole set of neurons which are controlled by those 5-HT2A receptors. And if you perturb them, then you change the way you think and and that's why you can break out of thinking patterns which are not necessarily very helpful and get into new ones.
Dr Rupy: Are there patterns of use across all these different types of psychedelics that we are seeing are more useful in different scenarios of the patient's diagnosis? So are there certain psychedelics that are more useful for treatment refractory depression, for example, or generalised anxiety disorder or PTSD?
Professor David Nutt: It's a bit too early to say. And the fundamental differences between the psychedelics, but they're more to do with the what we call the kinetics, the time course. So things like DMT, we have to either smoke or inject. It has a very transient effect, maybe 10, 12 minutes. For the clinical studies we're doing with DMT, we infuse it intravenously, lasts about 20 minutes. On the other end, you've got LSD, you know, the trip can last, you know, 15, 20 hours, which makes it quite hard actually to use clinically because you have to have people in hospital. So, but if you get the same level of interaction with the receptors in the brain at the same time with any of these drugs, you do get very similar effects. So at present, it's not clear whether a particular psychedelic would have particular utility for a particular disorder. It might turn out to be relevant, but it's going to take a lot more research, you know, we're very, we're only just starting this in present.
Dr Rupy: Yeah. Because of the legality issues, is ketamine the most studied in terms of the psychedelics that we have research on today for all these different conditions, or are we seeing actually that in terms of the weight of evidence for the other ones, it's it's almost on par?
Professor David Nutt: So there's a paradox here. Ketamine is far and away the most used, but it is the least studied. And the reason for that is I suppose because it's it's kind of less interesting because it's, you know, we the questions that we're asking about ketamine now are being asked because we have done the psychedelic research. The ketamine researchers didn't really, they weren't, I mean, ketamine was developed as an anaesthetic, which, you know, knocks your brain out. People aren't really interested in what's going on in the brain when you're unconscious because you're unconscious. It's only recently that ketamine's been used in a sub-anaesthetic level in order to produce, for instance, an antidepressant effect. And those, it's sort of not been so intellectually interesting. The psychedelic research that has really driven the explosion of neuroscience studies in this field. And now we're desperately keen for the ketamine community to catch up. And in fact, we're beginning to do our own ketamine work because they don't seem to be doing it. So, so we're going to, we're going to have to do it for them, I think.
Dr Rupy: Is there a bit of nervousness because ketamine, I guess, is one of those drugs where it can be abused? I mean, I remember seeing in the GUM clinic when I used to work in Brighton, we had ketamine users and they would come in with all different sorts of symptoms and bladder cystitis and quite, quite severe issues of it.
Professor David Nutt: Oh yeah. Ketamine dependence is a serious problem and particularly as you pointed out in terms of the, you know, the chronic cystitis and requiring sometimes people to have their bladders removed, which is a horrible thing to have to do because it takes years off your life because you end up with kidney infections. But there's another side of that story as well, which is that heavy use of ketamine produces a kind of dementia. It produces a state of apathy and lack of energy and lack of foresight, which is almost either like dementia or a bit like some forms of schizophrenia. And that is when ketamine is used recreationally repeatedly. The thing about ketamine is that you get tolerance to the effect quite rapidly, but you can surmount that tolerance, you can overcome it by taking more. So people might start off taking a quarter of a gram of ketamine and after three or four months, they're taking three grams, you know, a night. And that then really does put the pressure on the brain and the bladder. Now, in clinical practice, ketamine is rarely used more than once or twice a week to start with and then usually it's only it's limited to once a month for for maintenance therapy. So maybe over a year, you might get 15, 20 doses. That's probably not going to cause tolerance. We don't see it cause tolerance and it's probably not going to cause problems. But there are situations, particularly in the US, where there's not much control over who's getting ketamine, where you can doctor shop. You can, you can in theory just keep going to have money, you can just go and see a different doctor a day. And there are cases of ketamine dependence developing from the clinical use there.
Dr Rupy: Sheila Dillon is an absolute hero of mine and having the opportunity to get her onto the show and talk to her about her own food journey was a dream come true for me. Her realisation around food and medicine, touching on her own experience of cancer, her family's experience of cancer was so touching and so raw. And I loved chatting to her about the wider impact of the food programme, which has had a phenomenal impact on my own understanding of food in this crazy, complicated world of not just nutrition, but also how we source food, how we grow food. And her perspective on food, given the vast experience that she has as somebody who appreciates food as medicine, was incredibly validating for me quite early on in my career. And the conversation I had with Sheila was absolutely wonderful. So have a listen to this small snippet as we wrap up our 2023 year of podcasting. When did you get interested into the concept of food and health and how we can utilise nutrition as a means to prevent conditions as well as support treatments and therapy?
Sheila Dillon: Oh, I think it, well, I think there was a sort of background to it, just the way I was brought up. You know, I was still part of that, you know, I'm so, I'm old and I was still part of that culture as a child of, you know, food being used when you were ill. You know, my mother made beef tea. You know, that was, you know, that was just sort of the culture. It was obvious that you know, you could give people food and it would make them feel better. But I think, you know, thinking coherently about it began when there was a study came out and it must have been in the early 90s, which showed that societies with high levels of vegetable and fruit consumption had less cancers. You know, I mean, it seems bleeding obvious to us now, but anyway, this study came out. And I thought, um, well, that's, you know, interesting. It sort of, it fulfils, you know, it says what I think is obvious, but here it is documented. I mean, it was, you know, it was an, um, epidemiological study. And I said to myself, well, what would be the effect then of a diet high in fruit and vegetables with people who'd had cancer who were trying to keep, you know, were trying to keep it off, it returning. So we decided to make a programme, a food programme about that, asking that question. And we called, we rang, you know, we identified the main cancer hospitals in Britain and we, you know, we tried to find people who could talk to us. And we were, we were met with derision. Um, it was considered an absurd idea, completely absurd. And I thought, well, that's amazing, isn't it? I mean, why would you dismiss that as absurd when you'd just come, when you'd just seen this other study? I mean, it was dismissed because it was epidemiological and you know, not double blind and you know, as we now know, those kind of tests are absurd in that world. But anyway, that was really the beginning of seeing, of being, of seeing how people involved in the world of cancer thought it was silly. And then my sister got breast cancer in her early 40s and it was a small cell, you know, it wasn't a tumour. It was small cell, it was considered, you know, um, terminal actually. And she lives in Northern California and you know, she was, you know, very Northern Californian. And she, but she worked in the hospital. She's a an occupational therapist working with people with extreme, you know, bad strokes, AIDS, really. Anyway, she did some research and she decided that contrary to her medical advice, she wasn't going to have chemotherapy. And she had, she had a double mastectomy and, and you know, we were, all her family, you know, mum and dad and me, you know, were just so shocked by this. And she consulted a cancer nutritionist and regardless of what everybody said, including her doctors, which was that she was signing her death warrant, she did it. She didn't have chemo and she did eat, you know, she did do this thing with supplements and, and you know, she's, she's now in her 60s and she's absolutely fine. I mean, as we know, as you know, one case proves nothing, but it was incredibly brave of her because, you know, I mean, they were, her doctors were writing her off, you know, you'll be dead. And so that, you know, made me think. And then I got cancer, goddammit. And, um, I got multiple myeloma. And I thought, am I going to be as brave as my sister? And I thought, no, I'm not going to be as brave as my sister because multiple myeloma, you know, is, is your bone marrow and it's, you know, there's, um, and my husband did a lot of research and, um, I ended up under the care of Professor Jamie Cavenagh at Barts and he was very open-minded and, um, I mean, I've had all the conventional, I mean, I went on a trial and I've had the conventional chemotherapy treatments, but I did try and apply everything that I've learned, um, about the role of food and, you know, the role of relaxation and meditation and all those things. But, you know, it was real, you know, because I didn't ask him how long I'd got, but my husband did and he said, well, you know, it's usually five, about five years and and then it was seven years and, you know, I may drop dead tomorrow, but it's getting on for 11 years now. And, and there's a really excellent book that you probably know by David Servan-Schreiber called, you know, um, what's it called, cancer, God, I can't, anti-cancer. And, you know, that, that puts together what we know. And what I, what I realised when I was doing this for myself, for my own health, my own survival, is that you just have to be intelligent because you have to be thoughtful. You have to look at the animal studies, you have to look at the laboratory studies because there are very few human studies because, you know, A, they're very difficult to do. B, there isn't a lot of money to be made out of discovering that mushroom powder, you know, will help your immune system. And we have a system, you know, we have a medical system. I mean, you were trained in it. It's, it has technical brilliance, it has many marvels, but it has, it's terribly, terribly narrow. And I read about one of the things, I'll, I'll stop soon, but one of the things I'd read, um, when I got sick was about this, this study that had been done at the MD Anderson Centre in Texas at cancer research centre about, um, curcumin, the active part of turmeric. And, um, so I told Professor Cavenagh about this and it turned out he had another, um, of his patients who was taking high doses who actually, I mean, he ended up writing about it in the BMJ. Um, she came back from, you know, when all the options for treating her multiple myeloma ran out, she did this high dose of curcumin and went back to normality. So he says, you know, this needs more study, but, you know, it hasn't been done. Anyway, so when I met you, when that's why we, there was this startling, there was this doctor trained in this, you know, in the system who was saying, look, you know, this, this, all these other elements make a profound difference to, to your chances of recovery, to your chances of not getting these sick, you know, they're not, they're not miracles. You can't eat turmeric and, you know, your cancer's gone. But, well, that's your story, isn't it, Rupy, and you came to the kitchen and talked about this. And, you know, from, from the day, from the, from the week we were making that programme, I can't remember what year, you know, whatever year it was, ringing at a cancer specialist to now, there's been a big, big change.
Dr Rupy: Yeah, yeah. It's, it's incredible how influential the food programme has been to not just the health and food conversation, but multiple conversations, everything from sugar to GMOs to celebrating baking, to the heritage of bread, grains, like all these different, uh, like, uh, spokes of a, of a wheel all centred around food. And that's why I think it's, you know, people's, one of, uh, Radio 4's most successful programmes anyway. But you've really spearheaded a number of things and, and, and I remember that episode so clearly. It was a real pivotal part of my sort of, um, public speaking career, I guess, if you can call it that. The, the, the sort of, um, the picture painted in people's heads of a doctor in the kitchen. I believe it was a rabbi.
Sheila Dillon: Yes.
Dr Rupy: It was Levi Roots.
Sheila Dillon: Rabbi Laura.
Dr Rupy: On the whole show.
Dr Rupy: That is it for 2023. That is our wrap-up of some of the impactful conversations that we've had on the podcast. We've got so many more things lined up for 2024. I can't wait to release more health goals on the app. We're going to be investing heavily not just the app and the images and the recipes, but also videos on our YouTube channel that will be free, plus health goal courses that you'll find on the app. And if you're an Android user, you will be able to use the app on the 29th of January 2024. That we're all super excited about. And a lot more in store that I will wait until 2024 to tell you about. For now, have a wonderful end of the year and I will see you next time.
