Dr Rupy: If you had time to visit a neuroscientist, a cardiologist, a gut health specialist and more, and you asked them, what's the one tip that has the most bang for your buck? I wonder what they would say. Well, today, we're going to dive into this question with our top experts in this summary episode. It's going to be like you kind of walked into your own hospital with a multidisciplinary unit. So listen, we know it can be hard to consume hours and hours of podcast content every week. For example, over the last couple of months, we've generated literally over 48 hours worth of content. And with this in mind, on today's episode, we're drilling down into some of the key takeaways to save you the time and get straight to the expertise that our experts have graciously shared with us all. If you're a regular listener, you're probably going to recognise these familiar voices. Hi, I'm Dr Rupy, I'm a medical doctor and nutritionist. And when I suffered a heart condition years ago, I was able to reverse it with diet and lifestyle. This opened up my eyes to the world of food as medicine to improve our health. On this podcast, I discuss ways in which you can use nutrition and lifestyle to improve your own well-being every day. I speak with expert guests and we lean into the science, but whilst making it as practical and as easiest possible so you can take steps to change your life today. Welcome to The Doctor's Kitchen Podcast. The choices we make every day certainly add up over time and they influence our health and well-being. But with so much evolving research and conflicting advice, it can be really hard to know what actually works. And that's why today, we've put together our top strategies from our favourite experts over the last couple of months on the podcast. And if you're a regular listener, you're going to recognise some of these familiar voices. But you know what? I'm going to go first. I'm going to give you my top tip given that I've just written a book on healthy high protein. And my top tip is to start your day with protein at breakfast. Protein and fibre at breakfast is a magical combination for a number of different reasons. You'll notice that if you do a protein calculation using our free protein calculator on the doctorskitchen.com for example, your protein requirements are a lot higher than are currently recommended by government guidelines in both the US and the UK. I believe these are due to change and I talk about this in my new book, Healthy High Protein as well. And meeting this target across two or three meals per day can be a challenge, particularly if you don't typically start your day with a high protein meal. This is where I think a lot of people fall down. So at breakfast, our typical breakfast foods are low in protein, they can also be low in fibre, and they are high in refined carbohydrates. And if you have this typical breakfast protein or lack of protein picture, it can set you off on a hunger rollercoaster. It doesn't satiate your body's need for protein. And this is why a lot of people suffer with cravings mid-morning. And there's even this industry of snack items called elevenses, because a lot of people recognise that around 10 or 11, after you've had a typical breakfast, you're still really hungry. This is not normal. So, my top tip is to find some high protein breakfast items, breakfast meals, things that you can either make in advance or whip up really quickly. I've got a whole bunch of options in the Doctor's Kitchen new book, the Healthy High Protein book. But my top tip is to go for overnight oats. Why overnight oats? Well, overnight oats you can make the day before. It's super convenient. I literally had overnight oats this morning and it had over 30 grams of protein in per serving. The way in which I've done that is by giving a high dose of hemp seeds, I use cacao, and I also use a collection of nuts and seeds as well. This all subtly boosts up the protein content. If you want to go even more than that, and if your protein needs are higher than that because of the fact that you work out regularly or you are of a higher weight, and that's an ideal weight, then you can boost it using a protein powder if you wish. But the way I would do that is to use an unflavoured, minimally processed protein powder. A lot of these do have additives and emulsifiers in, so you want to make sure that you're getting giving yourself the best protein powder available. And when you mix an unflavoured, minimally processed protein powder in with all those different ingredients that I just mentioned, the cacao, the hemp seeds, etc, then you're introducing more complexity and you're not just having protein on its own. It's that magical combination of protein and fibre and all these wholesome ingredients that actually confer benefits to you. There are so many different overnight oats recipes that we have for free on the Doctor's Kitchen app. So if you want to look at one of those, you can definitely try those just by downloading the Doctor's Kitchen app and typing in overnight oats. You'll also notice that even though oats is in the title, I don't actually use that many oats. I always use jumbo oats or whole rolled oats first off. Definitely do not use the instant oats that can come with a lot of flavours and they can be quite refined, so they do cause a bit of a glucose spike. But I don't use too much because I want to get the benefits of that fibre whilst also introducing other items that are typically high in protein as well as being high in fibre as well. So breakfast protein is an opportunity to meet your protein goal over 24 hours. It reduces your hunger and keeps you satiated rather than falling foul of those typical cravings that you might have after having a typical refined breakfast of cereals or sugary granola or croissants and orange juice. And it also replenishes amino acids as a result of your fast overnight. So you need to introduce more amino acids into your diet first thing in the morning. It helps with those hunger cues, it helps you meet your protein goals, and it's one of the best things I think that has been game-changing for me from a focus point of view, an energy point of view, and ensuring that I don't overconsume calories in the form of snacks as well. So that was my tip. Next, we're going to hear from TJ Power. TJ is a neuroscientist and author of The Dose Effect, one of my favourite books. It's all about improving the quality of your life through the regulation of four key brain chemicals: oxytocin, dopamine, serotonin, and endorphins. Let's see what he has to say.
TJ Power: I'm a big believer in randomly doing press-ups. I like, I have like a press-up addiction and I think it's so good for you. I think like just randomly doing press-ups is ridiculously good for you. I uh, go with laugh because she has to watch this all the time. But our bodies obviously were moving all day. Like I watched this show all about the Hadza, which is this tribe in central Africa. And they move on average for nine hours a day. And I was watching this hunt they were doing and this this guy who was with them had done like 32,000 steps and it was like 2 p.m. So like our body is designed for a hell of a lot of movement. Now obviously just sit like this all day, tapping away, tapping away. And I think just like randomly doing five or 10 press-ups or 20 press-ups, however many you've got in you, is like a really good way to just keep your body active. I also do the same with squats. I quite like handstands as well, so I'll do some handstands. I don't think that's a requirement for your dose. But any kind of physical hard activation is going to get your endorphin system going. And endorphins are magic. They evolved to really help us cope with physical and mental stress. And for our former hunter-gatherer selves, we weren't like stressed by like what's happening politically or how does our bank account look or all this like modern stress, what's going on with our kids, like in terms of their school or something like that. We were stressed by are we going to starve to death or be killed. Like those are the two things that were really stressing us out as a specie. And the one thing that's really in common with those two scenarios is physical action. Like you'd either have to fight for your life or you'd have to try and find food, which again would require physical action. And our brain evolved in a way whereby if we were in stressful situations, our body would move and endorphins would come in and they would remove the stress from our brain so that we were more likely to survive that scenario. So when the bear was chasing you, you weren't like, oh my god, a bear. You were just like running as fast as you can to try and get away from the bear. And in our day-to-day life, obviously we're not running from bears, but we are getting stressed out a lot. And anytime you physically activate the body, so you like do some random press-ups, or you stretch your body a bit, or you go for a walk, or if you can, like do some more exercise than that, then you're activating endorphins and they're taking stress from your mind. They're literally just de-stressing your brain and body, which is really useful because like I'm someone that gets pretty stressed out, like I've got very high standards for myself, and I'm like, what's this, what's that? And if I just know like physically activating my body as often as I can, it's going to help.
Dr Rupy: So any moment, I'm just trying to think about this through the perspective of someone who is has a day peppered with stress, whether that is, you know, a gnarly email you get from work, or whether it's, you know, an issue that you've got with your kids' school or whatever it might be. The sort of antidote to that, or one of them, is to get your body moving, whether it's randomly doing press-ups, if you can do a handstand, great, but going for a walk.
TJ Power: Definitely the handstand is not like a recommendation. That's like a fun thing.
Dr Rupy: Sure, but like, you know, moving your body in a way that's going to suck up the the stress.
TJ Power: When you think about stress, you'll notice that when you feel stressed, you literally feel like a tightness within your body. You feel like a almost like a frustration. A lot of people find that stress also accompanied with like almost anger. Like you almost feel like annoyed at whatever that piece of information was. And we then like, whenever we were stressed, like we would physically like release it from our body by running or whatever it might be. Whereas now we just like consume the stress, swallow it, and our adrenal system just has to swallow all of that annoyance. And then we want to turn off the stress, so then we head for the quick dopamine. And then it's like, okay, now I'm scrolling, I don't feel stressed at all because I'm like watching random shit on Tik Tok. And it's like, but all that stress just like stayed all stagnant in our body. And if we can try and have the concept of like, I need to release this. And you see this like big time in kids. Like when kids get stressed out, they literally like physically act out. And that's because their body instinctively knows it needs to move. It needs to like, if you get really annoyed, you literally want to punch a wall. And it's like our body accompanied that feeling with hard physical action for hundreds of thousands of years. And now it's like we're getting so much stress into our mind and then we're just like taking it in. So having an idea of like, I need to get this out of me is a really good framework. And if something really stressful happened, like going for a walk and getting outside, or like it can be movement in your home. And then if you had the opportunity to do a workout, like for me, I typically will do my workouts later in the day because I know like work will be stressful. And if I can try and get rid of it in the evening and like get it out of me, like I literally imagine it's like stuck inside of me and I need the endorphins to like come in and be like, oh, let's get rid of this. Then I think that's super powerful.
Dr Rupy: You know what, it just it made me think of something that my wife gets me to do when the weather's a bit better at the end of the day, we always go for a walk and we're like phones away and all the rest of it. And we just sort of like decompress the the day. And I think before that, and I think a lot of people will resonate with this, you know, we we tend to swallow our stress and store it within us. And what I'm hearing is we can distract from that stress through dopamine hits on social media or comfort eating, emotional eating. Or we can release that stress, discharge that stress through what what sounds like physical activity.
TJ Power: Definitely. And there are a few alternative ways as well that you could get this endorphin system to activate. Singing, for example, is so good. And like, we've all had that moment of like singing in the car thinking like, I could actually win the X Factor, even though you're terrible at singing potentially like I am. But the singing again provides this like physical activation of the body. And like if you were to cross compare like listening to music, humming to music, or really going for it when singing, you'll notice you feel best when you just really go for it and you sing if you were to compare them against one another. And that's because it's going to release these endorphins. So singing is another magical way. And sometimes I'll have like had a stressful meeting and I'll get in the car and I think, oh, the last thing I want to do is sing. But I'll just like put some songs on that I know I know the words to. Gradually I'll like ease into it. And then eventually I'm singing so much that like because I'm so focused on trying to get the words right, I'm like not thinking. So my brain's having a rest from that worry and it's releasing this chemical and it's chilling my body back out.
Dr Rupy: Got you. What's your go-to song?
TJ Power: If I really need it, there's this song called Spirit Bird by a chap called Xavier Rudd. He's like some Aussie dude. And uh, that can solve any problem for me. That can really get me feeling. I might listen to that today actually. Not in like more of a celebratory aspect. It's a it's a powerful one.
Dr Rupy: Mine's uh, Don't Stop Believing.
TJ Power: Yeah, I mean that that would be endorphin hell. Yeah, yeah, yeah. If you can get some dance moves in there as well, like they're going to be firing hard.
Dr Rupy: Thanks so much, TJ. Next, we have a world-leading preventative cardiologist, professor of public health with more than 30 years of experience in this field. It is cardiologist Professor Kausik Ray. He also leads multiple global trials for novel therapies. Let's see what he has to say. I like this concept of return on investment because I kind of think about it in the same way of smoking pack years. So the amount of exposure you have to all of these these insults. So whether you've allowed a persistent raised cholesterol from your 20s all the way to your 50s because in your 20s you're like, I don't really need to worry about my cholesterol. That's a later on down the line thing versus having it treated for a longer period of time. So you're basically giving yourself a higher exposure and increasing the probability of it lodging into the arterial wall. Am I correct in thinking?
Professor Kausik Ray: Yeah, absolutely. And and the thing is also that um, the the age side of things is not to be underestimated in terms of the benefit. So the best way to think about that was with a with a couple of analogies. So a lot of people will talk about how many people did you have to treat to prevent one event, so-called number need to treat. Well, there's a variable there and that is what was the risk. If there isn't much risk over the next three to four years, even if something's beneficial, the gains are going to be small. I mean, you know, you need to be at risk. So if you drive, a seatbelt's beneficial, period. But the chances of it saving my life are going to be more if I'm driving every single day at 70 miles an hour, rather than in a cul-de-sac once a week where the maximum speed is 20 miles an hour. So that's the relative and the absolute. The relative benefit is the same in both scenarios. The absolute is different. And and I think that the the issue that we have is that people think about having to have symptoms before they've got a problem. So you need a lot of narrowing of your blood vessels, whether it's your legs or any or your heart, before you complain of chest pain. You know, supply and demand phenomenon because the body's been able to adapt and cope and accommodate up to a certain level. But that process was going on decades before it shows up. And the worrying thing is that about 50% of people, the first presentation is with a sudden death because of a heart attack or a heart attack that doesn't kill you. You go into hospital, you open up the blockage, but actually unless you deal with the problem that caused it in the first place, you're going to come back at some or the probability is you're going to come back.
Dr Rupy: Thank you so much, professor. Next, we have Dr James Kinross. He's a consultant colorectal surgeon specializing in the gut microbiome and he's written one of my favourite books on this subject called Dark Matter. I come back to our earlier point. Like if you're a well healthy person, I would argue it's much better to have a balanced food intake that is diverse and has a food matrix. So microbes in your gut, they need the the mechanical structure of food. It has value. And this idea that you can recreate that through a powdered form is incorrect. Like how the the the ingredients that you take and the way you cook and prepare food has a profound and important impact on your microbiome. And I would argue it's much better to have control of that and you'll end up with a healthier gut than to take these powdered foods. And the problem is is that the people that consume massive amounts of these powdered foods are the people that least need to take them, right? And invariably, you know, in my clinical practice, they're young men in their 20s and 30s that rock up in my clinic and they go, well, I've got bloating and you know, I can't poo properly and I've got abdominal pain. And then of course for them, the use of these powders is so habitualized and so normalized, they don't even see it as being part of the problem. So then what you've got to do is take a really super detailed history and then and then explain to them maybe these things aren't quite so good for their gut. Lo and behold, you stop it, everything gets better. And what we're discovering is that these powdered products have unintended consequences on the microbiome. So you might be taking them for the best of reasons because they've got prebiotic fibres in them, because they've got, you know, a bunch of, you know, um, well-established, you know, ingredients that have benefit. But actually, I was looking at this study on on a study of casein and whey protein supplements, right, in powdered form. Actually, you just get these big blooms in the virome. So the viruses in the gut just bloom out.
Dr James Kinross: Wow.
Dr Rupy: And we don't know what that means. Like we just don't understand the long-term consequence of that. It might be that actually it's having these um, unintended pro-inflammatory changes in in the gut. And so, so before we talk further about that, maybe we should just define exactly what we mean by the virome because I think a lot of people might have heard of bacteria in the gut, but they don't actually appreciate that there is also the virome, which is bigger, isn't it?
Dr James Kinross: Yes, fair point. So, so a microbiome describes all of the microscopic life forms in an ecosystem and all of the things that they need to sustain their health. So, um, that doesn't just mean bacteria. It means it other kind of ancient but distinctly different microscopic organisms that look quite a lot of bacteria but which are not called the archaea. It looks like um, viruses. So these are kind of non-self-replicating, they're not technically alive um, forms of DNA or RNA. And we have lots of different types of viruses in the gut. And some of these viruses are called phage. And what phage do is infect bacteria. Okay. All right. And they are hugely important in the gut because they have a really big influence on how particular kingdoms of bacteria, you know, grow and dominate and live in the gut. We also have eukaryotes. So eukaryotes are multicellular organisms. And this is where it kind of all gets a little bit, you know, weird because you've got multicellular organisms like worms and nematodes and these sorts of things that have their own guts with their own gut microbiomes living within your gut and your gut microbiome, right? So you've got, you know, microbiomes within microbiomes. And all of these microbes are living in this dynamic community where you've got kind of trophic levels of food. So you've got, you know, big bugs eating small bugs, right? And they're, you know, and they're eating smaller bugs and they're and they're in this constant dynamic relationship where you have keystone, you know, organisms, much like any other ecosystem, and you've got equivalents of your kind of carnivores and your herbivores, right? And they're they're existing like this. So there's this dynamic interaction between these different forms of microscopic life forms and they are constantly interacting with your gut and your immune system and they're constantly producing small molecules as they interact with each other that are having a further impact on your gut. So it's this like wildly complicated system. This wildly complicated ecosystem. And what we're just doing is dumping a bunch of powder on it and just expecting it all to be okay. Like it's madness, right? So, so of course there are unintended consequences of it because you have system complexity. And that's why like the microbiome is so important in understanding like individual health and personalized healthcare because it's just so variable between people. Um, and so I would argue that, you know, taking these like my oh god, I don't want to be too like every time I name a brand, I get into trouble. But like like these like Huel. God, it upsets me so much. Like this idea that we're not sponsored by Huel, so feel free to talk about it. This idea that like we're just eating out of plastic containers in our lonely lives in our offices, like it I don't know, it just seems so regressive.
Dr Rupy: I know, yeah. Yeah. And I think um, the what you described there, the the the sort of I have a lot of friends actually who you know, have parties and they also have IBS and they text me and they're like, what do I do? I'm like, how many protein powders are you having? What what else are you having every single day? What is habitual for you? Because it those are usually the culprits that explain your symptoms. And the way you've described it in terms of the study looking at whey and casein and how that blooms the virome and you just don't know what what the the downstream consequences of that are, that actually brings it to life for folks, I think. Because when you start disrupting that food matrix and maybe we should step back and and define what we mean by the food matrix, the the complex 3D nature in which regular whole foods exist naturally. And when you break that down, you're essentially pre-digesting a lot of food that your microbes would have had to work towards and therefore, you know, you're you're leading to a bloom of of of other microbes that down the digestive tract.
Dr James Kinross: But the the structure of food also means it has a set of chemical and physical properties that have health benefits irrespective of the microbiome. So they absorb toxins, they absorb bile acids, they help you absorb vitamins, they help you absorb essential nutrients, right? So there's a key part of this that's got nothing to do at all with the microbiome that actually just you just need it and you need it in your gut. And then it's super important. But but I think it also comes back just to kind of take a step back, just sort of reflecting on what you were saying. Like I think we've just we've become we've got a very warped sense of what health norms are. So for example, like a lot of young people, you know, are obsessed with the gains and they want to be in the gym and they've got this idea of what physical health is, right? And to them, physical health means muscle gain, it means muscle mass, and it means maybe aerobic fitness, it means this sort of fitness. But but that is quite different from gut health, right? That is not the same thing, right? And you need to understand that if you're following an extreme nutritional intervention, and to me, an extreme nutritional intervention is sustaining yourself on powders, then there will be unintended consequences for your gut and they will not necessarily always be healthy. And here's the kicker. Those things will not manifest themselves for 10 or 20 years. So you will be fine tomorrow. You'll be fine the day after. You might get a bit of gut bloating, you might get a bit of IBS. The consequence comes when you've been doing that in a sustained way for a really long period of time.
Dr Rupy: Thank you, James. Keeping on this theme of the gut, we've got Dr Emily Leeming. She's a microbiome scientist at King's College London. She's a dietitian, former chef as well, which is what I absolutely love, and author of Genius Gut, the life-changing science of eating for your second brain. Let's see what she would say is one of the most important things that we should be thinking about through the lens of our guts.
Dr Emily Leeming: So I talk a lot about what I call the BGBGs. So I think you talk about BGs.
Dr Rupy: We talk about BBGs.
Dr Emily Leeming: Oh, BBGs. We're talking about BBGs. Um, it's all the same thing. It's just a different uh, order of uh, of the letters.
Dr Rupy: Order of the letters.
Dr Emily Leeming: Um, so yeah, so I'm like 70s boy band, you know, Saturday Night Fever. Um, so yeah, so B G B G S. So for me, I don't know if you have to check what your one is. So beans, greens, berries, grains and whole grains, and seeds and nuts and seeds. Gotcha. And so of the beans, whole grains and nuts and seeds, they tend to contain about three to four times more fibre than most fruits and vegetables. Oh, wow. So actually, when we're thinking about adding in fibre, if we can think about having the BGBGs and particularly the whole grains, the beans and the nuts and seeds, they're just easy, simple add-ins that we can be really thinking about to kind of meet that 30 grams of fibre a day or even just get an extra five grams. Like that five grams has so many more health benefits or so many health benefits. So I can of that could be having um, you know, a jar of uh, so I keep a jar of mixed nuts and seeds by the kettle. So if I make a cup of tea, I can have that as a snack. Um, I really like flaxseed and chia seeds um, because two tablespoons is about five grams of fibre. And you can easily add that, you know, I joked I kind of add that to my breakfast. Um, you can sprinkle it on roasted vegetables. You can mix that in with so many things. Maybe you just want to put it in your salad dressing. Um, that's a really nice easy add-in as well. And I think it's just having again, it's like this variety of of different foods that are just going to make your meal taste really delicious and be great for you and your gut as well.
Dr Rupy: Yeah, I I completely agree. Uh, ours is BBGs, but we we don't do it from the perspective of fibre alone. It's more like just nutrient density. So beans, berries, greens, seeds and nuts. That's it. And so it's, you know, it's got a collection of fats and all those different plant chemicals and greens that are anti-inflammatory. We should be getting more greens in and that would negate the need for you to have to supplement with magnesium because it's got loads of magnesium in anyway. Um, so yeah, ours is slightly different. But it's all the same. Um, you mentioned a couple of ingredients there, avo, rye, dark chocolate, all favourites of mine, flax, chia, pretty much have those every day. Some of the push that we get from recipes where we utilize these ingredients, particularly for those who are new to this game of looking after their gut health and increasing fibre is the expense. What do you say to to to people who would rightly say, look, you know, I can't even find chia in my local store or I've looked at the rye bread and it's like three, four times the price of the plain white farmhouse bread.
Dr Emily Leeming: Yeah, so I think I totally hear you on that and I think it's really important to always think about, you know, what's possible and what's achievable for an individual. And I think really berries are a really great place to start because actually you don't have to have them fresh. You can get the mixed ones from the frozen section. Um, beans are really affordable. Um, you know, you get the canned ones. If you're not really a huge fan of beans, actually think about peas and edamame. Well, edamame a bit more expensive, but even just your humble, you know, garden pea is like great source, packed with fibre, packed with protein. Um, you know, buy if you can only buy the bulk pack of of um, nuts and seeds. Um, you know, peanuts, great. You know, just get that, you know, whatever's kind of on, if something's on sale, you know, try and stock things up. I'm a huge fan of um, also making things when I cook in bulk and then using that leftover so I'm minimizing food waste because I think that's also a key thing. And then making sure you're keeping stuff in the freezer as much as possible. I have so many frozen fruits and vegetables in the freezer. It's like ridiculous. Um, because it's great. Like and also like I don't want to be paying for fresh, like, you know, when it's not in season and it's like twice the price. You know, I'll just put it in the microwave. So like cherries are my favourite. I'll just, you know, put it in the microwave or like cook it into something, you know, if it's like porridge in the morning. Um, so there's lots of simple kind of, I guess, kind of less kind of fancy sounding foods that are packed with fibre. You know, it could be that you're getting pearl barley, which is, you know, a grain that maybe me being from Scotland, that's a very common one. Uh, you know, you'd add to your.
Dr Rupy: I use pearl barley all the time. I love it. Yeah, it's got a lovely chew to it. It's like a real nutty flavour as well.
Dr Emily Leeming: Yeah, it's something like, you know, growing up we'd be kind of putting into kind of broths and things. Um, and you get the lentils again, really affordable. Um, you don't have to like, I think a great thing about red lentils, you get the dry packs, you don't have to soak them or pre-cook them and you just bung them in things. Um, so if I'm making rice, for example, I'll put red lentils in the rice. So I think all there's just so many affordable options that are out there, I think that hopefully can and I talk a lot about price in the book as well.
Dr Rupy: Yeah, yeah, yeah. I think price is is one of those areas where fibre can really win, um, because you don't need to spend a huge amount of money on supplements to increase your fibre intake and actually the cheapest options in the supermarket are often the highest in fibre and the highest in in nutrient density and you're getting that collection of not just fibre but all the other chemicals that you find in in whole like grains and uh, pearl barley and stuff. Pearl barley is literally one of my favourites. We make that all the time.
Dr Rupy: Thank you, Emily. So next, we have Louisa Nicola. She's a neurophysiologist and human performance coach. She is passionate about getting people into the gym and she's also founder of something called Neuro Athletics. It's this elite human performance consulting firm that provides top-tier education and coaching for the world's highest profile athletes and executives, ensuring that they achieve peak performance. That's something that I want to achieve. Let's see what she would say.
Louisa Nicola: Exercise is the elixir for brain health. Now, my advisor, I'm doing a body of work right now, and my advisor, Dr. Tommy Wood, keeps telling me, stop saying that. I'm like, I won't. And at the end of probably every post I put on social media, it is exercise is medicine. This is fundamentally the most important thing you can do for your overall longevity and your brain health. If we cut exercise up into three categories, we've got aerobic, we've got resistance training, and then we've got neurocognitive training. All serve a benefit. So, aerobic training, what is it? And this is the first ever studies that we had, and that it was because when you put mice, you know, we we first experiment with mice before humans, when you put them on a wheel, it's just much easier than to have them push weights. 1960s, that's when we first realized. And Marion Diamond did this, she got two groups of mice, split them up. One group was just the sham control, and what she did was she put them in a in a box, in a shoe box where they didn't have what she called an enriched environment. Dark, didn't have many, the mice didn't have many friends, many things to do. Then the other ones, she put them in an enriched environment. They had wheels, they had little steps, they had friends, sunlight, exciting times, right? And over the course of six months, that's when she found that the mice in an enriched environment improved cognitive scores, they improved gray matter, white matter, and that then burst what we know now as aerobic activity is good for your brain. So, what does it do for your brain? So I'm talking about long-distance running, right? In your zone two. Zone two is typically classified loosely as around 65% of your maximum heart rate. When you can sustain it for around 90 minutes, or maybe 60 minutes, right? What are we doing? Well, when we're running, we are releasing these hormones, right? One of them is called BDNF. Sure you've heard about it because the 90s were all about BDNF. Brain-derived neurotrophic factor. What that is is it is a growth factor for the brain. And that's what Marion Diamond found. She found that when we produce a lot of this, it acts as fertilizer, if you would, for the brain cells. Basically, it goes into the brain, it goes into the hippocampus specifically, and it helps with the growth and proliferation of new brain cells in the hippocampus. That's what it's responsible for. So we get a big boost of that. It's really great for also depressive-like symptoms. So this is why you feel great when you exercise because you're getting a release of these neurotrophic factors. That runner's high. That runner's high. You're also doing another thing which I think is is not spoken about enough and this is getting into more of the exercise physiology. You're getting something called cardiac remodelling. Cardiac remodelling. Yeah. So, think back to med school, right? You've got you've got your cardiac system, you've got your your heart, you've got these chambers that come out of, you know, you've got this massive artery, it's called the aorta. You've got so many other things happening. What's your heart, what type of muscle is it? It's just like the muscle in your actual legs, right? So you when you train it, it remodels itself. And we have a study actually from Dr. Ben Levine, he's a cardiologist, turned sports cardiologist. Wonderful study, right? What he did was he took a group of he took 50 53-year-olds or 53 50-year-olds, right? He subjected them to two years of maximal aerobic exercise. So this is when you're going into your VO2 max. So around 80 to 95% of your maximum heart rate. It's a super strenuous. Super strenuous. Like hit training. Like running. Okay. I wasn't I'm not aware of the exact protocol, but they were reaching that strenuous state. Got you. What he found, and he took 3D models of the heart, he did echocardiograms, he did everything to to really look at the heart, right, of these 50-year-olds. After two years, and he subjected them to four hours a week of maximal exercise, which is a lot. That is a lot. That is a lot. And I don't actually don't suggest that, but this is this is just what happened. Over the course of two years, he reversed the age-related decline in the heart by 20 years. So these 50-year-olds now had a 30-year-old heart. Gosh. Wow. So what does that mean? Well, that means that as we age, many things happen to our cardiac system. One thing is we get stiffening of the arteries. Unfortunately, and this is probably why you advocate, I I guess, for um, lowering cholesterol, right? We we don't we want those arteries nice and we want blood to be able to flow through them. That's the first thing. So we get stiffening of that. With your heart, you've got a left and a right chamber. And the right chamber gets all of our deoxygenated blood, and the left chamber actually it expels blood to your your organs and your muscles when you're exercising. We get something called left ventricular hypertrophy. So the the the left ventricle becomes a bit smaller and stiffer. And so he actually reversed that part of it. So therefore more blood was able to pump through the heart.
Dr Rupy: Keeping on the theme of exercise, we have Kieran Chopra. Someone I could talk to about muscle health and metabolism all day long. He is a sports and exercise physiologist working with both athletes and non-athletes, providing tailored programming to optimize performance, but also improve healthy aging as well. Let's see what some of his top tips are. What is the ideal amount of time I should be looking at to sort of get the maximum benefits of this this training?
Kieran Chopra: Yeah, so it it truthfully depends on your time commitment levels. A very basic level is something like 30 minutes is a good starting point. Uh, if you can do longer, great. It's going to provide additional benefit. But if you can just start off doing 30 minutes of that intensity of exercise where, like I said, it's challenging enough where you're starting to get that respiratory rate up, but not too much so that you're not able to maintain a conversation. So start off with 30 minutes and then as the weeks progress, try and do 35, 40, 45. And then once you feel like, okay, I can do 45 minutes of this intensity, drop it back down to 30, but let's just turn up a tiny bit. So whether you walk a little bit quicker, you cycle a little bit harder, that's that progressive overload that tells our body, I'm not used to this and I need to do something to improve my body to tolerate this a little bit better. So our body's adapt and that's how we kind of gradually see the adaptations that we need.
Dr Rupy: Great. So I I love this. So if your time commitment is only 30 minutes and you're able to do this, I I like this measure as well because it contextualizes it for the individual. So some people, if they're on a bike, for example, and I like doing a bike because I can see the wattage and I'm I'm sort of data driven in that respect. If I can maintain a wattage of 120 watts, um, that gives me an idea of like where I'm at. Um, if I can maintain that wattage for 35, 40 minutes, great. Before going into past 60 minutes, your suggestion would be to drop back down to 30 minutes and then increase the wattage ever so slightly, all the while being conscious that I should be able to breathe in that gear two, that in through the nose, out through the mouth, and maintain somewhat of a broken conversation if I was to try and chat with someone.
Kieran Chopra: Yeah, exactly that. So I mean, you can you can go when I'm programming for people, it would be, let's say 30 minutes up to 45 minutes. If you feel like I can dedicate a bit more time, we'd go from 45 minutes to 60 minutes. If you feel like you could do even more time, you can go from 60 to 75. It really doesn't matter. But once you find that range that you say from a time commitment perspective, the max I can commit to this is maximum, let's say 45 minutes. Cool. We'll start off with 30, work our way up to 45, drop back down to 30, but increase the exercise intensity. Work our way back up to 45 minutes, drop back down to 30, increase the exercise intensity. And that's my way then to progressively overload somebody in terms of their cardiovascular activity.
Dr Rupy: Great. Okay. And this is great because, you know, this could be brisk walking for some people or it could be like a a real sort of intense cycle on a white bike. So again, choose your modality of steady state exercise and try and commit at least 30 minutes. If you've only got two exercise periods in a week, which is very uh, relevant for me right now considering I've got an eight week old. So this is this is great. Um, okay, so that's one of my exercise appointments for the week. Uh, what would be the other thing that you would recommend if I've only got two exercise opportunities to improve my VO2 max?
Kieran Chopra: So that's going to be your long steady state cardio. The other one then is going to be doing some form of high intensity interval style training. Um, this is going to be the one that is much tougher. You're pushing your body to higher levels of intensity. Um, but it's something that really drives a significant amount of adaptation in quite short periods of time. So, as I mentioned, it's really helpful when we do do a VO2 max because we can then dictate exactly what that intensity is. If you're not able to know what that is, again, get yourself on a bike or a treadmill and get yourself to a point where you're doing primarily mouth-to-mouth breathing, really pushing yourself, but not to a level where you feel like, okay, if I do this for longer than 30 seconds, I just can't maintain it. You should be able to do this exercise intensity for at least two to four minutes maximum. Um, but it should be pushing yourself to a level that that is as far as I could go from a duration perspective. Um, so again, we'd start off with something like two minutes on at this exercise intensity, then two minutes off. And that two minutes off, we'd like to be active recovery. So you could be, let's say, if you're doing it on a bike, you'd cycle at a quite high intensity, and then we drop it back down, but still keep our legs moving to keep that kind of blood flow going and try and start getting rid of that lactate that we might have produced um, during that exercise. But we'd then do that for multiple repetitions. So we might do that for two minutes on, two minutes off, and we might do that for six repetitions. So it's 12 minutes of really hard work and then 12 minutes of of essentially active rest. And that means that once a week, if I can do 12 minutes of exercise, of really hard exercise, I can get phenomenal benefits from it.
Dr Rupy: So you make it sound so easy, those 12 minutes.
Dr Rupy: Thank you so much, Kieran. And remember, if you're interested in the full-length episodes of all of these podcasts that we are taking clips from, you can find them in the show notes as well. Just click on your podcast player and you'll be able to find them. Next up, we have Dr Anita Mitra. She's one of my closest friends. She was involved in the delivery of my son, Raphael. She's an NHS doctor specializing in obstetrics and gynaecology, and she appears online as the Gynae Geek as well. She's also author of Dealing with Problem Periods and The Gynae Geek. Fantastic books that I highly, highly recommend. Let's see what she has to say.
Dr Anita Mitra: I think that it's probably because we're a bit more able to talk about it in society these days. I it still is a huge taboo and it's a real problem. But I do think that we are a little bit more open. I don't know, I'm also probably in a little bit of an echo chamber. Yeah, yeah. Um, but I think that we are just starting to hear, you know, so much about people can't go to work, people can't look after their families, can't, you know, go and do sports, go to social occasions. And you know, there's so much data out there about how much is lost in terms of earnings, um, per year, the the cost of the to the economy of problems with periods. But there's so many costs to people's lives that you just can't put a figure on. And that to me is the most important thing.
Dr Rupy: This is really interesting, right? Because you're privy to this not just because you are in the field, women's health specialist, you see women every single day of your clinic, but you're also on social media, you've been on it for years now, and you're literally getting DMs every single day about these issues. And actually you're collecting information using the medium of social media as well. Tell us a bit about the study that you did on the back of the surveys that you collected a couple of years ago.
Dr Anita Mitra: So first of all, this is all your fault because you are the one that said to me, Anita, you need to get on social media. So, um, no, I mean, jokes aside, you've really, really supported me and I'm really appreciative um, about it because, you know, I think it is really important to have the voice of a doctor talking about women's health on social media. Um, and there, yeah, it just the number of messages I get really gives us an insight into the fact that there is a huge problem when it comes to gynaecological health and the fact that people aren't getting help. Because obviously, whilst I'm honored that people want to contact me and want my opinion, it just shows that they're not actually getting the help that they need from the healthcare system, they're not getting the answers that they need. And, you know, there's staggering statistics from the, you know, the the data that was collected by the government to show that, you know, the proportion of women that aren't listened to or don't feel listened to um, during a healthcare consultation. Um, and so, you know, the fact that someone has to open their phone and find a person who they've never met before and ask them for advice really shows the sort of the scale of the problem. Um, and, you know, I think that it is important that we do put reliable information out there on social media because there is a lack, even now, you know, the problem years ago was much worse, but there is still a lack of really reliable, engaging, evidence-based information online because that's where people go for their their health information these days. And I actually see that day-to-day. Unfortunately, often related to the misinformation that people have gained through social media. And that's why I think it's really important that, you know, there are a really good number of healthcare professionals these days using social media to put out, you know, responsible content. But also, I think it's important to say that it doesn't replace having that one-to-one individual consultation with a doctor because, for example, you might find somebody on social media and, you know, I'm really grateful to all the patients and people who are, you know, experiencing problems out there who talk about it on social media because I think when it comes to gynaecological health, because it is still, you know, a taboo, we often don't know somebody who's been through it ourselves. We probably do actually, but they just haven't spoken openly to us about it. And so it can feel really isolating. So then when you go online and you find someone and you think, oh gosh, there's someone, you know, similar to me, she's going through it too. Okay, maybe there is hope. And I think that there is definitely a huge community spirit that you can feel on social media in the kind of patient group. And so that can be really helpful. But also sometimes what you see, you know, is applicable to that person who you're following, you're watching their journey, okay, they have that medication or they have that operation. There are reasons why that might not actually be suitable to you as an individual. So that's why it's really important to to have that one-on-one.
Dr Rupy: Thank you, Anita. And from one close friend to another very close friend of mine, Dr Rangan Chatterjee. He is an NHS general practitioner, an inspirational speaker. I've just seen him live on his tour, the Thrive tour in London. He was phenomenal. He now hosts Europe's biggest health podcast, Feel Better, Live More. He's author of six Sunday Times bestsellers. And he has something very special to say, something that I've been incorporating as often as I can, and it really, really does make a huge difference.
Dr Rangan Chatterjee: Whilst I acknowledge we're all unique and we've all got different lives, so what might work for one person may not work for somebody else. If I really had to say that there's one practice, a daily practice that I think everyone would benefit from, there's no question for me. In the current age in which we live, the most important practice I think for most people each day is a daily practice of solitude. I I really believe that with all my heart. A daily practice of solitude doesn't need to sound scary. It can be whatever you want, right? It can be breathwork, it can be meditation, it can be journaling, it can be having your morning cup of coffee in silence, not looking at your email and Instagram at the same time. A revolutionary thought, I know. Right? That that qualifies as a daily practice of solitude because the problem, Rupy, is, right? And it and it sort of refers to something I said earlier in this conversation. We're living in a world now where we're being bombarded with information from the outside. If you wake up and the first thing you do is start consuming information, emails, social media, uh, podcasts, even good quality information. And that's a key point. Even good quality information, let's say like your podcast or hopefully my podcast, right? You're still consuming from the outside and you've lost the opportunity to start listening to what's going on on the inside. You will never change your life for good in the long term unless you start listening to the signals that your body is sending you. Your body is very, very powerful. You know, interception is a term that we're seeing more and more scientific literature around. Right? Interception is you can almost think about it like our sixth sense, the ability to sense what's going on inside your body. You know, how's your breathing? What is your heart rate like? You know, all these things, right? And there's really good studies on interception, right? There's a couple I I write about in the book. There's one here. Um, there was a study done uh, at Sussex Medical School with autistic individuals who had symptoms of anxiety. They were able to significantly reduce their stress levels by training, by by getting training to be more aware of the signals from their own heartbeats, right? So I'll just I'll just read what the summary said in in that study. After just six sessions, 31% of them recovered completely from their anxiety, compared to only 16% in the control group. Right? That's just by being more internally aware. There's also lots of uh, research now on um, people who suffer with drug or alcohol abuse, right? Uh, previous people who've had issues with addiction, right? And actually those who get this internal mindfulness training, they relapse less. They have less uh, rates of depression, right? So it's it's very, very powerful. But I I I feel it kind of speaks to where we're going wrong as a society on this kind of big picture level. We think all the answers to our life are on the outside. More knowledge, more reading, more blogs, more podcasts. Hey, listen, I'm part of that world, right? This is my sixth book. I release a weekly podcast, right? So I'm part of that. But I want people to know that you've got to listen to that information, right? Put it through your own filter and then go, is this information right for me? Right? There's a case study in chapter one of the book I'd love to share with your audience, Rupy, because I think I think your audience is obviously very interested in health, they're interested in nutrition, right? So there's a common um, there's a common bit of advice these days online about having 30 different plant foods a week. Now, I'm not saying that there is a problem with that advice. I'm saying that that advice, I don't believe is for every single person. No piece of health advice I've come to the realization works for every single person in every setting. And if we look at this through the lens of our reliances, I believe, Rupy, that many of us now are overly reliant on experts. Now, I say this as a so-called expert myself. There's a certain irony there, right? So I, like you, am a medical doctor. I've got an immunology degree. I've got a specialist in general practice qualifications. I'm now a professor at Chester Medical School. Right? I've got all these qualifications. But I can still confidently say that I cannot know for sure to the person who's listening to this right now, what is the best approach for them in the context of their life. I can't. I can give them frameworks and principles to think about, but ultimately only they will know what is the best approach for them. So for example, I don't know if you get this Rupy or not, right? I realize, let let's think about this through the lens of nutrition. Because people are getting confused out there with all the advice. Right? They're getting really confused. So people will say, you need to get your advice from experts. Okay. It sounds reasonable. But let's just play that out a little bit. Today, you could have an expert, and I think we've both had Chris Palmer on our show. I haven't had Chris Palmer yet. You haven't had Chris Palmer. So I've had Chris Palmer, right? I think Chris is a great psychiatrist, Harvard Medical School. And Chris came onto my show to talk about how he has found a ketogenic diet can in some instances be very helpful for people with severe mental health problems, like bipolar or severe anxiety, whatever it might be, okay? And he will present published research and case studies to support what he's saying. And then I may also have a couple of months later, a different expert, another expert with the right credentials, another medical doctor, who might come on and say, actually the evidence shows that it's a whole food plant-based diet that you need for your mental health, right? And they again will present published evidence and give you clinical case studies. So I would then get people in my DMs on Instagram saying, hey, Dr. Chashi, I'm listen, love your podcast. Uh, I kind of like what they both had to say, but I'm confused. I don't know which expert I should trust. And I believe in 2025, that is not the appropriate question to ask. I don't think it's the most useful question to ask. Instead of asking which expert should I trust, I think the more helpful question is, why do I no longer trust myself? Because both of those experts can be right for some people, but they're not going to be right for everyone. And I think we've missed this. I know it's I think it sounds quite obvious when I put it like that, but I think we're all walking around or many of us trying to find what what is it? What is the truth? What is the perfect diet? No, it's not that. It's this. No, it's not that. It's this. It's like, well, wait a minute. Maybe there's no one perfect human diet that works for every single person. And you know, let's go our culture, Rupy, for a minute. Traditional Indian medicine, Ayurvedic medicine, or even traditional Chinese medicine that has been going for thousands of years, they've always recognized that actually different people have different constitutions and require subtly different approaches. I'm not against science. I think science is absolutely fantastic. But I think one of the problems or one of the traps we've fallen into is a belief that the scientific method is going to teach us what is the perfect diet for all of us. And like you, Rupy, I believe there are some common principles that we need to apply, you know, generally as much as you can, minimally processed foods, you know, generally food that helps you balance your blood sugar, right? Trying not to consume excess sugar. Yes, all these things I think are great guidelines. But I think my clinical experience really informs my view on this, which is I've seen people thrive on low-carb diets. I've seen people thrive on vegan diets. I've seen I've seen people thrive on paleo diets. I really have. And I've come to the realization that there is no one perfect diet for everyone. And in that in the chapter one of the book, I I share this story about someone, a patient I saw, right? She was very health-conscious and she had consumed podcasts and blogs and she had heard a very prominent gut health expert say that you have to have aim for 30 different plant foods every week. That's what will give you a really healthy gut microbiome. Now, again, I'm not um, I'm not at all trying to criticize that advice. I'm I'm trying to make the point that not every piece of advice works for everyone. So she tried her best. She was stressing out. She was trying to introduce these 30 plant foods into her diet. She was struggling a little bit. She was getting bloated. She thought, okay, maybe I'm doing it too fast. Let me slow down and do it gradually. Whichever way she tried it, she didn't feel good. Her gut didn't feel good. She would get constipated, a bit bloated. And she felt like a failure. This is a really key point. Right? This is why I'm so passionate about this idea. If we follow an expert's guidance and we don't succeed on it, we never think that they're the problem. We think that we're the problem. We think that we're a failure. Oh my god, I couldn't do it. Guilt comes in, shame comes in, which never leads to changes that last. Right? So for her, when she came in to see me, I said, listen, no one piece of health advice, no matter how good, is going to work for absolutely everyone. If you're open to it, would you like me to try and help you figure out what is the right approach for you at this point in your life? She goes, okay, sure. Over a period of about six weeks, we realized together that actually at that stage in her life, and again, that's a really key point, she did much better on a lower carb type diet where she had about five to 10 different plant foods a week. Right? And I did all her blood tests, right? Everything looked great. Her HBA1C, the average blood sugar marker looked really good. Fasting insulin looked good, her triglycerides looked good. Like, I'm like, you're feeling good. You're having a whole food unprocessed diet and your blood markers look good. I don't think you need to feel like a failure that you're not getting 30 different plant foods a week. I think things are going just fine. And I think it's a really, really important point there for all of us, myself included, and all your listeners, Rupy, which is listen to the information, right? Listen to experts like you and me. I'm not saying ignore us. I'm saying the balance has shifted too much where we actually now we ignore what we feel and it's all about what the experts says. And so in some of those DMs, I said, hey guys, listen, what those two experts that you heard on my podcast, why don't you for four weeks try Chris Palmer's approach, right? And pay attention. Right? So we talk about interception, it's a scary term, right? We can look at it another way. Pay attention. Pay attention to how you feel. What's your energy like? What's your sleep like? What's your bowels like? What's your gut like? How's your bloating? How's your focus? Okay? Then for four weeks, try the other diet and pay attention to those same things. You will very quickly start to build up a picture of, actually, you know what? At this stage of my life, that one's suiting me a little bit better than that one.
Dr Rupy: Thank you so much, Rangan. And I really do hope you enjoyed today's episode of clips from the last few months of podcasts. We have so many podcasts, and if you loved this episode, let us know. Reach out to us on Twitter, click the link in the bio to give us feedback. We always listen to your feedback. And if you enjoyed it or you want specific themes, let us know. We can always dive into the library of podcasts that we have and take out some of the juiciest bits for you. Until next time, I'm Dr Rupy, and I will see you here on the Doctor's Kitchen podcast.
