Dr Rupy: Someone who's who's able to say I don't know is actually someone who's say practicing safely. If you come across someone online and says if you just do this, then this will happen, you know instantly red flags. Welcome to the Doctor's Kitchen podcast with me, Dr Rupy, where we discuss food, lifestyle, medicine and how to improve your health today. Now, this podcast was meant to be a supper club podcast with three incredible guests talking about three individual themes, eat, motivate and inspire. Obviously with the current pandemic, it was completely impossible to do a supper club or arrange this, and what was meant to be this truly immersive experience where you get to eat food and watch live conversations with some of my guests, was pivoted to a Zoom conversation where we had 20 people who posed some of their questions before the live event, and then watch me do a 30 minute podcast talking about opportunities for growth post pandemic. I really do hope you like this episode. It's really me sort of distilling some information and opportunities I think for us to do better post pandemic and what we can learn from this tragic incident. If you want to join future live podcasts, then do sign up at thedoctorskitchen.com newsletter and we will put out when we're going to be doing a live supper club where you can eat, meet some of people who who probably share fellow ideas about food and medicine and also just connect with a grander audience as well. I really want to do something in the live space because I think some of the best interactions I've had with people who follow me and people who also inspire me are just doing Q&A sessions and meeting each other in person. So if you are interested in that, then sign up to the newsletter. That's where we'll be posting out initial tickets and stuff. And yeah, I think it's just a good opportunity to meet everyone too. So the podcast, like I said, the first half an hour is just me chatting and the second half is live Q&A from guests who who were on the podcast with me. And we talk about everything from plant based diets, supplementation and everything in between. So nothing specifically related to COVID, but lots of general lifestyle tips anyway. I hope you enjoy it. Give us a five star review or comment as well if you want to hear more of these and I will be sure to post those. First of all, thank you so much for joining me for the first live podcast that I've ever done. So what I wanted to do with this podcast, it's kind of changed actually over the last couple of days, which is why I didn't really put a theme or anything to it because as everyone is aware, the world is changing in so many different ways. So I thought what I would do is give you some thoughts about how I see nutrition and medicine going forward in a post pandemic era. And I'll talk for about 20 minutes or if I run out of steam maybe before then, or maybe a bit more. And then I've got a list of questions that people have submitted before this. We'll try and get through all of them. I'm not too sure if I can get through all of them because there's quite a few questions. So apologies if I can't get through to yours. All right, so I told you about what the kind of podcast that, oh and by the way, this is the kitchen studio. I'm at home. I'm actually cooking something at the moment. Hopefully it doesn't mess up whilst I'm on the podcast with you guys. And at the moment what I've been doing a lot of is a lot more clinical work. So for those of you who have no idea who I am or the Doctor's Kitchen, which I'm sure is a couple of you, I'm a general practitioner. I trained as a GP over five years ago. I've been in medicine for about 11 years now. I also do emergency medicine. And my clinical role has increased over the last couple of months. So usually I'm fortunate to work part time, two to three days a week, because I run a nonprofit, culinary medicine, which is teaching medical students the foundations of clinical nutrition as well as how to cook. I am, I also am doing a masters in nutritional medicine, which fingers crossed is going to finish later on this year, pandemic pending. And I run the Doctor's Kitchen, which is podcasting, recipes that we put on the newsletter every single week and developing a digital product that will hopefully demystify how to eat for certain issues and personalise nutrition for you without having to spend hundreds of pounds on nutritionists or appointments or or the sort of the hassle of looking through the web and trying to figure out how to best eat for yourself. So we're going to try and simplify that process. And that kind of stems from my own personal experience suffering with something called atrial fibrillation, which is where your heart beats exceptionally fast and irregularly. And I had to go through the process of being a patient and trying to figure out how best to look after myself because unfortunately, it wasn't something that I learned in my conventional medical degree at Imperial. Imperial is actually doing a lot better now. And in fact, I'm involved in their lifestyle medicine course, which is being delivered to all first year and second year medical students and it just started this year, this academic year. So things are changing and we can talk about that a little bit later because I think that relates to one of the questions that we had here. So considering some of the podcasts that I've put out over the last couple of weeks, I'm kind of pivoting the topics of discussion around yes, eating to beat illness and eating to manage conditions and prevent illness from occurring in the first place, which is essentially what my second book was all about. But pivoting more toward the wider determinants of health. And what do I mean by that? Well, it's about creating and cultivating communities that allow health to thrive. It's about the discussion around how financial security is something that we need to really consider using our lateral thinking hats, putting our lateral thinking hats on, to essentially allow a health and well being to thrive. It's also about the environmental question as well, which has never become more apparent to us most recently because we're witnessing what it's like to actually have lower amounts of pollution and what the benefits of that might be as well. So my question and what I'm going to try and cat hand my way through this evening's discussion is the question of how we cultivate community that is able to look after itself effortlessly and how we can essentially grow and use the teachings that or the experience of what is such a tragic scenario at the moment to better ourselves going forward. And the key determinants are financial, environmental, societally, culturally and from a health and resilience point of view. So I want to, if you if you're an avid listener to the podcast, then you can switch off for the next five minutes because I'm going to talk about an incredible podcast I did with Professor Guy Standing very recently, just a couple of weeks ago. I reached out after I've come across his work a couple of times, but I reached out a couple of weeks ago and I said, you know, I'd love to talk to you about the the notion of universal basic income. And for those of you who don't know what universal basic income is, it's a non means tested financial contribution to every member of a population or a citizen of a country. So what that literally means is if yourself, your child who's over the age of 18, your neighbours, everyone got a fixed nominal amount regardless of their employment status, their wealth status or anything. And it can be anything between 50 pounds and 200, 300 pounds per week, depending on what that country can afford. And whilst that sounds like a wacky idea and something that doesn't seem to wouldn't seem to work on the face of it, and I was a massive skeptic before, actually looking at how you can A financially afford that using current schemes that we have at the moment and better taxation. And the potential benefits of that was enough to change my mind on the whole subject and actually consider it. There've been some interesting experiments done in controlled environments in rural India. And I believe Spain is going to be experimenting with UBI, perhaps in a smaller population rather than the whole nation. But I think this is something important. And the reason why UBI is potentially, UBI being universal basic income. The reason why I'm personally talking about that is because financial security improves psychological health as well. Financial security isn't just about the money in your pocket and the ability to spend on luxury items. It's also the ability to nurture your yourselves from a nutrition point of view, but also improve your overall well being and having the financial resources to do that. Not everybody is going to spend that nominal amount on healthy food, as I would love to nourish them toward and some people might spend it on alcohol and tobacco because this is there are no conditions on this nominal amount. However, those who are interested and those who do have the nudges and the behavioral change motivation are therefore able to engage in health promoting behaviors. Now, it's a lot to get your head around, but I think one of the books that I would highly encourage people read is Guy Standing's book. It's called the eight giants. And it's about the parts of our society that we need to try and manipulate and try and improve. And it it goes across oppression, precarity, rather, and a whole bunch of other subjects. So I think financially, we can grow out of this tragic scenario and it's not through just taxation changes. It's not through better welfare system. It's actually rethinking it from the ground up and just seeing what can happen if you give people security, literal security, and you elevate everyone to a basic level of income. And this is something I didn't actually recognise enough of. Inequality and measures of inequality over the last 60 years have increased exponentially across the most industrialised nations. You'd think that wouldn't happen. You'd think it would be the opposite. But actually, if you look at data from Europe, data from the UK, data from the United States, overall, the rich are getting richer and the poor are getting poorer and more destitute. And we're seeing for the first time in decades that the life expectancy, particularly of women from a lower socioeconomic strata has actually reduced. And that for me is just not acceptable whatsoever. So not to catastrophize, but I think it's something that we should be be really thinking about. Something else, so moving on from financial, I think um, I had a conversation with another person I'm a huge fan of called George Monbiot, who you may have heard of. He's a he's a prolific writer. He's writes for the Guardian, a whole bunch of other portals. And we talked about how we can harness intrinsic values of human kindness to foster better well being society and how what we're witnessing over the last couple of months is better cooperation, which is it's hardwired in our neurobiology and there's a lot of evidence for this as well. And what we need is a structure, a political structure that essentially emphasizes this and encourages this via a number of different means. The prevailing political narrative of being an individual and rising to the top through by any means necessary is actually something that is very and is the antithesis of what our evolutionary history is. Putting it this way, we wouldn't have survived in the wilderness had it not been for the cooperation within communities. We would have looked after each other's children. We would have hunted and gathered together as a community. We would have moved according to the seasons as well, as a unit. And we would have had to protect ourselves from predators on an ongoing basis. And that's something you can't do as an individual. So the notion of individualism is it doesn't really strike a chord with how we are evolutionary adapted. And in the context of our evolution, we are but a fraction over the last 10,000 years. We've developed over hundreds of thousands. So this is something I think again is to do with the political and I don't want to talk politics the whole evening this evening, but I think this is something that breeds inequality and I think we can be better humans and healthier humans as well if we change the the constructs of our of our society using that. And I highly encourage you you listen to that podcast when it comes out. Going back to more something that's I think a little bit easier to conceptualize when it comes to health and well being is the environment. And now the environment has had what I think is a really bad PR campaign. The climate change, global warming, call it what you will, even though it is so catastrophic, which is what something could happen over the next 10, 20 years, even though we've witnessed what it's like to see forests burning for months on end, it lacks immediacy to how our lives are on a daily basis. I'm sat here in my kitchen, I can get food from the supermarket, it doesn't affect me. Whereas now, we actually understand what living in a desperate situation can look like. Now, this isn't a desperate times for us by any means. Yes, there is a, you know, a pathogen that we're trying to deal with. We're lucky that we've actually had some of the changes to our freedoms essentially to try and and reduce the the viral spread. But on the grand scheme of things, the climate change is going to have drastic ramifications on our on our well being and our and our ability to to thrive and grow as a as a population. And so this is kind of like a turning point for us to rethink about rethink what we believe about climate change and the environment. And and what I believe could be the starting of a generation of children that know what it's like to live in a an era where your freedoms are are completely collapsed. And so the immediacy that climate change doesn't provide has now been provided in the form of something like what we're seeing at the moment. And that this is where I think we can potentially use our current situation as a as a hook as to what could happen with climate change. Even though they're quite different things, what we're witnessing, I think is is something that could be parallel to that, but it's probably worse if I'm honest. And whilst pandemics could have occurred anywhere in the in the world and the global scale, this could have started anywhere. This could have started in the UK, could have started in America. There are plenty of opportunities where virulent pathogens could could break out. It doesn't always have to come from the far east or because of wet markets or anything. And I've talked about that on a previous podcast as well. And lastly, culturally and from a health and resilience point of view, I think a lot more people are definitely cooking at home, which I I'm I'm loving seeing and I think it's wonderful to see how many people are in their kitchen and how many people are actually learning to cook, those who hadn't had the time or whatever reason, that's completely understandable as well. But what I've seen is a shift from just baking, banana bread, which I've done as well, and and making cakes and cookies and all that comfort food to actually, okay, how can I use this as an opportunity to not just learn the basics of cooking, but also how to eat properly for health. And I think this sparks a cultural shift in resilience because what we're seeing and what I've seen certainly from the work that I've done in my own hospital and getting involved in intensive care is the propensity towards worse outcomes with COVID-19 are there where you have comorbidities like high blood pressure, cardiovascular disease, obesity, metabolic issues, all of which are in part mitigated by your lifestyle and your diet. And I think there is a almost like a a light bulb moment going in for lots of people's heads. And I think again, lifestyle related issues lack the immediacy effect in the same way climate change lacks that as well. I'll give you an example. When I explain to someone in primary care that they have high blood pressure, they can't feel it. They can't in the majority of cases, you can't feel it. You you can learn about it, you can understand that it raises your risk of stroke and cerebrovascular disease, cardiovascular issues, etc. I can explain to them that it might lead to kidney issues, eye problems, etc. But if it doesn't affect you in that moment, then you're less inclined and less likely to make the behavior changes unless nudged appropriately. And I think this is something that a lot of people are clicking because there's genuine fear about what's going on right now. And I think this could be a cultural shift for a lot of people. By virtue of being here, of you guys being here, I'm sure this doesn't apply to you guys anyway. But I I've I've noticed that in patients and and people talking to me and engaging with me on social media that perhaps wouldn't have in in the past. So I think there are some potential good things to come out of that. The other thing, again, linking it back to our our health and our food landscape is rethinking what healthy eating looks like and actually creating a resilient population. And this comes down less about the individual, although it is intrinsically linked, but more at a political and population level. There's been tons of campaigns about reducing sugar consumption in children, trying to tackle obesity, trying to tackle a whole bunch of other determinants of health, but one one in particular is sugar. And I think people have really lacked the understanding of just how bad sugar is. Now, I'm not an anti sugar person. I don't believe that, you know, you should throw away your brownies and cookies and stuff, but I think we also need to appreciate that sugar in its various forms can be addictive. I've written a recent essay on this very topic and we were lectured as part of my master's program by an incredible neuroscientist from Imperial College Healthcare Trust. And the the arguments for why sugar in particular can be an an an addictive substance or have parallels with substances of misuse are pretty convincing. What I would say, rather than going to the science is to to understand whether something is an addictive substance or not, you need to compare it with known substances of addiction. And what the characteristics are are compulsion, withdrawal effects, so those are both physical and emotional, as well as tolerance effects. So that's where you need an ever increasing dose of a certain substance to have the same desired effect. And we don't have human trials for this at this point with with sugar. But there's a lot of animal and preclinical data that states that it lights up certain reward pathways in your brain that mirror that of a number of different substances of misuse. And that isn't to say it's as addictive, but certainly on a spectrum of substances that could have addictive like tendencies, it's certainly on there as well. The the added issue with sugar is that it is it's part of feeding and we are hardwired to engage in activities where we seek out things that have sweetness and certain flavors and that's why the sugar fat combination can be quite compelling. And just to to give you an idea about about what why sugar is particularly difficult to compare to substances of misuse is that the the neurological reward, the emotional limbic system, as well as your your decision making prefrontal cortex, sort of triangulate to determine what your feeding decision is. And that will lead to decisions about chronic overeating. And not to blame the neurocircuitry and the impact of sugar on this circuitry alone, but certainly it does contribute. And when you combine that, that sort of innate need for sugar with a food environment which is littered with the stuff to be frank, it's no wonder we have a population that is suffering from a number of different issues. And it's not just obesity. There is a there is a huge number of of patients that don't have overt obesity at all, but they have an unhealthy lifestyle. So that's all I really want to talk about this because I think I want to speak to a neuroscientist on the show and talk about addiction in a wider context, what the comparisons are and whether they are fair comparisons. But I think going forward out of this pandemic, it's something that we really need to address because in a sense, one of the reasons why the US is postulated to have such a poor outcome is because of the prevalence of chronic diseases, lifestyle related illnesses that are in part related to the number of sugar sweetened beverages and the poor food options as well as food deserts that exist and hit the the most vulnerable populations in the country. So I want to get off my sort of milk crate here and and and stop talking at you guys and instead engage you guys because I think I I do a lot of lectures for corporates and and in a medical education position as well. And I think the the best outcome or the the best sort of interaction is is by doing a Q&A and actually trying to tailor what I can tell you guys to to what you actually want to hear. So I've talked a bit about the different sort of financial, environmental, societal and cultural changes that we can see coming out of COVID and the pandemic and and why sugar addiction and and post pandemic medicine can be a lot more appreciative of the lifestyle issues. And I think that's definitely going to come to come to a hill after this. Hello. Hi.Fiona: So you had a question that I've got on my thing here. I understand that certain microbes in the microbiome can enhance the body's barriers to pathogens. What are these barriers and how can I optimize their function through my diet? Is that correct?Dr Rupy: Okay, great. So the microbiota is your population of microbes that live in and around your body, largely concentrated in your gut. And it contains mostly bacteria, but it actually also contains viruses and fungi and nematodes that live harmlessly in your in your ecosystem, in your ecosystem. If I could suggest one way to improve and nurture this microbiota, this this population of microbes, it's to increase your amount of fiber and variety. The reason why I say those two things is because A, fiber is drastically low in our consumption across the UK and and most industrialized nations to be fair. The minimum requirement is 30 grams and we don't even hit that. And from an evolutionary perspective, we would have been eating a lot more than that. We would have would have been eating upwards of 100 grams plus. Your microbes thrive on different types of fiber. They will create things like short chain fatty acids like acetate, propionate and butyrate. And those short chain fatty acids are involved in metabolism and energy production, but they also nourish your digestive tract as well. So when your question pertains to, you know, how do you how do you enhance your body's ability to to bar itself from pathogens? That's one of the ways in which it does that. An appropriately nurtured microbiota as well is better able to perform its function, which is inherently immune. So it's part of your immune system. Your immune system is is everything. And and there's a podcast I've done with this where we talk about this in a lot more detail with Dr Jenna Macciochi, who's an immunologist from University of Surrey. So those are the main things. The other thing is variety. Now, I I like to try and draw a comparison with microbes in your gut and bored children. They they need constant entertainment and they need variety of sources of of fibers and and different plant materials. So you want to try and vary your your eating habits. And that can mean like trying a new ingredient per week. So that that's those are two ways in which I I would try and nurture your microbiota.Fiona: So would that be all mainly plant based?Dr Rupy: So I I would say it's heavily plant based. Whether you choose to go 100% plant based or not is your decision. I personally choose largely plant based around 90% and I think that's that's perhaps the best way for people to eat more generally. But if you choose to go fully plant based, that's completely up to you as well.Fiona: So I kind of try to, it's just trying to find the variety of things, but I guess it's like you say, just introduce one thing a week.Dr Rupy: Absolutely. And I like the TED talk that I that just came out, even though I did it like five months ago, is all about that process of just eating one more. Can you eat just one more at every meal time? And can you if you want to go a step further, can you vary it every week? And you'd be well on your way to improving your microbiota. And and there there's studies that show that people who have a refined carbohydrate diet, which is full of junk food, after two weeks, they can completely change what their microbiota looks like at a taxonomic level. So, yeah, that there's there's loads of ways in which you can improve it and and diet's one of the best ways.Fiona: Brilliant. Thank you.Dr Rupy: No worries. No worries. You go for it.Lucy: What's your question? Well, I'm curious as to if you have one really go to ingredient or food flavouring that you couldn't be without. And so my question is, if you were on a desert island and you could only be guaranteed one food to cook with along with whatever you could forage for, what would it be?Dr Rupy: Oh, amazing. That's that's such a good question. It's very up for the Doctor's Kitchen. So one food flavouring I couldn't go. Can I have a blend? Am I allowed a blend of spices? Yeah. So, yeah, I I would go for za'atar. It's like my my favourite spice blend and there's loads of different varieties. There's a Palestinian variety that I'm currently eating at the moment. And it's just this gorgeous, if you don't know, it's a gorgeous mix of marjoram, oregano, cumin, sesame, a little bit of chili and heat. Sometimes it comes with sumac. And I think I would definitely have that because whether you're eating a root that you found in on a desert island or whether you've got some beautiful seaweed or something, za'atar just seems to marry with everything. It makes it a lot better. So that's probably what I would have for you.Lucy: Brilliant. I I've made it from your book, so I I know what you're talking about.Dr Rupy: Brilliant. That's so good. Thanks so much for your question. Really appreciate it. Thank you.Maya: I feel like that last question was really fun and really good and mine's just going to be a bit like, but I do think it's quite an important one. So I'm going to read it because it was quite word for word, but as someone who's curious about nutritional health but not yet qualified, I often spend a lot of time reading information and advice from various professionals, experts, books, etc. And I find a lot of the time it's quite conflicting and quite difficult to digest. And it's really difficult to decide, you know, what's right, what's wrong. So what's your advice on that? Because if you're naturally curious and I'm actually studying nutrition at the end of this year for three years and you know, I'm almost like trying to set myself up to to that point. It's like, what do I believe? What do I read and what, you know, it's really difficult to to make a decision sometimes.Dr Rupy: It's a it's a really good question and it's something I get asked a lot, you know, what is the best diet? Who do I listen to? How do I know they're qualified? Yada yada. And I think there are a few things, a few little hacks that I use to try and validate whether someone what someone is saying is is true and whether I should even be entertaining listening to them. Credentials don't always mean everything. So even though I say credentials, like whether they're a doctor, whether they're a registered nutritionist or a dietitian, etc. It doesn't mean everything. It just means that up to that point, they've done enough academic work to get that credential. But you always judge, you should always judge people by what they're saying, whether they can back up their arguments with science or not. And if they actually caveat what they're saying, if there isn't science. So if I'm asked a question and I'm not aware of the science behind it, I always say, I don't know, because someone who's who's able to say, I don't know, is actually someone who's say practicing safely. If you come across someone online and says, if you just do this, then this will happen, you know instantly red flags, instantly red flags. The other thing is brandishing general advice for an entire population is just never going to work. And unfortunately, it's kind of what public health England have to do, a whole bunch of other health boards across different countries have to do. They're in a rock and a hard place because they're trying to give general advice to the entire population without really recognizing that you yourself are an individual and your needs might be completely different. And that's why I don't really have a plate or anything. It's just I have principles of healthy eating, largely plants, lots of colors, fiber, quality fats and and eating in time. And I would say, you know, those those apply for the majority of people, but some people might thrive on a ketogenic diet or a low carbohydrate diet or a vegan diet whereas others might not. So I think we just get the basics right and then find your your way thereafter.Maya: So how do you, sorry, I'm just going to carry on that. But how do you, you personally and I guess some of your sort of colleagues that are in this sort of limelight, try and challenge that? Because I think, you know, nowadays you can be an influencer and you could be a nobody. And it's so, you know, I work in that industry as well, so I understand how how, sort of toxic it can be when there's like wrong information put out there and there's almost like a group of people like yourself like trying to make that positive change and then you've got another group that could be even bigger and more influential. So how do you kind of put, how do you face that challenge? Because it's it must be really difficult.Dr Rupy: It's yeah, it's a really good point. And it's there isn't a straight answer I can give. It's like rather than trying to focus on being bigger and shouting other people down, I just stick to what I know and hopefully the word of mouth through pragmatic means will just influence a lot more people. You know, for example, the whole five a day message is something that I'm fascinated by was started something like in the 1980s, I believe, in America. And it's so pervasive. If you ask anyone on the street, they'll know how many fruits and vegetables you're meant to be eating? Five. But we don't do it because we need some other means rather than just information. But that's the way I think we're going to actually educate people. Simple, actionable tips that people can take on board and ways in which to recognize, you know what, someone's telling me to eat whipped cream and drastically reduce that. It's unlikely to work. So that's that's my two cents on it. We just have to keep on going.Maya: That's cool. I think simple is definitely the key and yeah, I think that's it's a really good advice. So thank you.Dr Rupy: No worries, Maya.Danny: So my question is on probiotic foods and so you know, kimchi, kefir, all all that stuff. And so we know they're super good for you, but is there a way to have them to kind of maximize those benefits? Like are they better with breakfast, dinner, with meals, without meals? How how are they good to kind of consume?Dr Rupy: Great, great question. So probiotics is this like huge burgeoning field and just to clarify for everyone, there are three main buckets that I like to put these in. So there's prebiotics, which are non-live substrate or fibers that essentially feed microbes in your gut or even outside the gut as well. There's probiotics, which are live bacteria, but sometimes they're they're not always live. They can actually be inert or dead and you'll just have like the bacterial cell walls or the fungi cell walls and they'll still exert beneficial effects on your microbes. And you have something called synbiotics, which is a combination of pre and and probiotics. And that essentially sends the microbes on their way and then gives them like a packed lunch to go with it as well. And synbiotics is sort of the reason why I describe synbiotics is because that's kind of the way you want to think about taking probiotics. It's not just taking a small teaspoon essentially and putting it in the ocean of microbes that is your digestive tract. You've got to feed it as well. And that again pertains to the principles of healthy eating. So largely colors, lots of plants, variety, and lots of different types of fibers. So beans, nuts, lentils, legumes, if you can tolerate that. And when I say that, I mean like always go slow if you're new to sort of this way of eating or you're drastically changing your diet. In terms of time of day, I'm not aware of anything specifically that says you have to take it a certain times, but I think pragmatically, it would be best to take it at the end of a meal. So you're actually and not on an empty stomach. So you're actually introducing a lot of those fibers, those those microbes with fiber as well. I'm aware of a company that states that you should leave 10 minutes between having your probiotic and then eating food or vice versa. But I'm not too sure of the science to back that up. I hope that answered your question. And if there's a really good book to, if you're interested in in gut health in general, there's a few books that I have on the website that I recommend. And then Megan Rossi's eat yourself healthy is a fantastic resource for a lot of people.Priya: So, um, briefly, um, I got diagnosed with a kidney condition about, um, 11 years ago. And it's inflammatory based. It's called, um, IgA nephropathy. And I've done really well. I've maintained my kidney function all this time. Um, but I just, um, I am vegan. Um, so I have over the last 11 years made a lot of changes to my lifestyle. But I just wonder what more, especially with the prevalence of inflammatory diseases out there, what I could be doing, um, what more I could be doing. So, yeah.Dr Rupy: Yeah, that's I mean, first of all, congrats on making all your lifestyle changes and improving your condition if you found that. I think that's brilliant. There are lots of renal specialist dietitians out there as well who give a lot of resources out there. So I'd definitely hit up the BDA website and try and figure out if you don't already have one yourself. I'm assuming you don't.Priya: I don't actually, no.Dr Rupy: Okay, fine. So I would I would certainly do that because there are dietitians that spend their entire professional lives just focusing on renal conditions. So IgA nephropathy is a renal condition as you said, Priya. In terms of improving inflammation that is based on on that kind of condition, I'm not aware of anything that would add to that. There certainly isn't evidence based for that. Vegan diets are generally really good. The reason why is because you're actually reducing the overt protein content and that can actually lead to a damaging effect if you're having that in excess. And it's quite unlikely that you're going to have excess amount of protein in your diet that could be worsening your condition. So even if you have a low animal protein diet or a vegan diet, then that's usually a good first step. Hydration and all the other things that I think you're aware of. But in terms of optimizing it further, there isn't anything that I can think of off the top of my head without looking into it a lot more detailed. And I and I would highly recommend you speak to a BDA registered dietitian that is has a specialist interest in renal disease.Priya: Cool. And so one thing I am doing is I am, I don't know if you've heard of Vivo powders, those um, Vivo powders? No. Oh, yeah, those they're um, vegan protein drinks and they've got like a broad sort of spectrum of all the amino acids and everything like that. So, so, um, as you mentioned having a low protein diet, that is the protein powder is something I actually do take on a most daily basis. So do you think before I speak to the the dietitian, do you think that's something I should continue in the interim or?Dr Rupy: That's a really, really good question and I think that's one that you need to speak with a medical professional or a dietetic professional on a one on one basis so they can look at and the reason why I say that is because before even answering that question, I would want to do a seven day food diary to find out just what your diet exactly looks like and whether there is a need for you to be supplementing with protein at all. With certain disease states, there can be protein losing issues where you actually have to supplement with amino acids, similar to that kind of drink. But that's why I would I would I would hesitate to even entertain that question on this. I would I I I would certainly say that you need to speak to a specialist one on one.Priya: Okay. Cool. Thank you.Dr Rupy: All right. No worries.George: Nice to see you.Dr Rupy: Good to see you, George. What's your question this evening?George: My question was pretty similar to the one before, so I'm going to ask a slightly different question. How important do you think it is to include organic foods in your diet, in particular when going for meats and milks and eggs? How important is that wild fish?Dr Rupy: Yeah, it's a really good question. So it's interesting. My my thoughts on this, I imagine are going to evolve. So primarily, my mission at a population level is to try and get more plants on plates, trying to get people to think about the basics of getting nutrient dense ingredients on your plate in in the first instance. And that's the primary issue that we have, I think. Whether you choose to go organic is kind of like the extra 10%. There isn't good evidence based to say it has a lot more antioxidants or a lot more phytonutrients. There are some marginal increases in benefit. But the real issue is pesticides and herbicides and whether that has a negative impact. Overall, the consensus is that they're much the same and it doesn't have an effect. But I think there's going to be a lot more evidence to come out that it probably does have an impact if not on our own ecological system, certainly on the environmental system as well. And I'm going to be doing a sort of a discovery of myself and educating myself on this subject, the more I I interview other people who are experts. There is a podcast I've already done with Karen from the Happy Tummy Company. If you're interested in that, then I'll definitely listen to that one as well. Meat, animal products, I think the main issue for me is the sourcing of it and if it's produced with the with the welfare of the animals themselves. I do not support things like caged, caged chickens. I you won't find me going to a local doner kebab or like any of that, any any point where I can't at least qualify to myself that this is as best produced a product as possible, organic, etc, etc. Like it it's just a no no for me. So it means that I I'm largely plant based when I eat out as well.George: Cool, great. Thanks a lot.Dr Rupy: Thanks, George. Appreciate it.Vanda: So my question was, basically I'm vegan almost for years and obviously when they say you go vegan, sometimes your skin could react badly. And um, since then it's improved for me, obviously four years, but I'm still having problems and I wonder, do you think if the vegan diet doesn't work for everyone or I might be missing out on something? Like my diet is pretty balanced and healthy, so I just wonder if if it's just not working for everyone or.Dr Rupy: Yeah. So so from at a I'll answer that question at a at an overall level rather than an individual level. So the question being, is a vegan diet appropriate for every single person? The the vast majority of people, I think people can thrive on a well balanced, well portioned vegan diet. However, there are certain people that may not thrive on a vegan diet for a number of different reasons. If they are definitely following it correctly, there are certain issues. So omega 3 is the long chain omega 3, not the short chain that you get from walnuts and chia and a whole bunch of other sources. The long chain omega 3 is virtually impossible to get from a purely vegan diet unless you're having algae and seaweed and all that kind of stuff. So I'd I'd always recommend getting omega 3 and that can actually have an impact on skin quality as well because it's involved in the fatty acid synthesis and reducing inflammation, etc. Vitamin A. So you get loads of pro vitamin A from things like butternut squash and kale and a whole bunch of other sources. But the conversion of vitamin A differs from person to person. And depending on your genomics, you might actually lack the ability to change that from pro vitamin A to retinol, which is something that you get pre-formed in animal products. There are a couple of other examples of the same sort of issue across the spectrum. And if you have enough of those potential single nucleotide polymorphisms, then it can coalesce into something that leads to a problematic vegan experience. And this is why I think it's always really important to think a bit more intuitively about your body, whether you're thriving it, whether you enjoy it. And if there are ethical reasons, then of course there are ways in which to mitigate this with appropriate supplementation. But if you feel unwell or anything, then A, you've got to see your GP and B, I would have a one on one with a nutrition specialist who can go through your entire diet seven days and just see, you know, where things might be lacking as well.Vanda: So you would suggest maybe to try a vitamin A supplement because I'm do I do take omega 3 like in an algae form. So you think it would be useful to supplement with vitamin A then?Dr Rupy: Not necessarily, no. That's not what I'm saying. I'm talking at a at a general level, so I can't give you individual advice about that. I'm just saying that there are some pitfalls with a vegan diet. You know, it can include a whole bunch of other things that you know, B12, choline, a whole bunch of other issues that you know, can can can present themselves as as a medical problems. But yeah, so I'm sorry, I can't say just take a vitamin A supplement and you'll be fine. It's like it doesn't work like that, unfortunately.Cheetal: Hi yeah, how are you?Dr Rupy: I'm very well, thanks. What's your question this evening?Cheetal: Thanks for doing this. My question was, um, when I was recovering from chronic fatigue, when I was recovering from cancer, um, I was recommended a smoothie which I took and within 21 days, the smoothie actually made me feel better because when you're suffering from chronic fatigue, the whole idea of cooking and eating healthy is just not something you'd be able to do. But the the the the smoothie recipe which I was given while I was at college just, I don't know whether it was the the the smoothie or just the fact that I was doing something for myself, but within 21 days, I did feel a lot better. Is there any such recipe that you have, um, to to make you feel better?Dr Rupy: Well, first of all, I think your story is amazing. I always love hearing about how people have overcome illnesses or, you know, feeling unwell, chronic fatigue in your instance and and you know, particularly after cancer as well, can be particularly harrowing experience. And I think there's a lot of misinformation out there too. If you've had a positive experience with having a smoothie or a drink or whatever for 21 days as a supplement to your diet, that's amazing. And I would, you know, I'm really open minded as to why and how these can have impacts, even on the psychological level like you said, you know, it might just be the fact that you're able to look after yourself using a nutritious drink. I personally don't have many recipes in terms of smoothies with that in mind. But there is a really interesting smoothie if you are interested in one that has been formulated by a, I think she's a clinical geneticist, her name is Rhonda Patrick. You you'll find her her her smoothie online. If you just look up Rhonda Patrick smoothie, it's literally got everything you can imagine put into it. And the reason why is because she's formulated it to have all the necessary micronutrients needed for a fully functioning. But it's a really big smoothie. I I'll warn you now, it's like a lot that you put in. But that's that's the one that I could say like hand on heart, someone with a proper science background has actually formulated to contain a lot of the nutrients. The other thing I would say about smoothing and and juicing in general is that I tend not to do that. The reason why is because and it's different for everyone. So, you know, for for yourself, for example, I can understand why it would have been beneficial because you're allowing your body to absorb something, particularly if you hadn't been having good nutrition prior to that. But it breaks down a lot of the cell structures and increases the uh the intake of of glucose straight into your into your cells if you're blending fruits, for example. And that can mitigate against some of the benefits that you find in whole vegetables and it macerates the fiber as well, which slows down the digestion, which is basically how we're naturally um developed to to to take in food. So that's just the one caveat I'd say, always be mindful of that and and don't go too overboard with the juicing and smoothing.Cheetal: Okay, perfect. Thank you very much.Dr Rupy: I wish you well, Cheetal. Thanks so much for joining this evening. Bye bye now.Carol: My question was in relation to eating for hormone balance, especially for a woman. And I know you've maybe touched on some of the issues already. Um, I suppose I'm thinking about on a plant based diet about pesticides and how that impacts on your hormones, um, environmental toxins.Dr Rupy: That's a really good question and I get asked this a lot and so with female hormones, it's a very complicated subject and one that I think is going to take a lot more sort of time, but I will answer your question about what you're alluding to there, which is xenoestrogens, essentially synthetic estrogen mimicking molecules that you find in pesticides and herbicides and some other synthetic chemicals and also personal care products that can interfere with the estrogen receptor and lead to potentially increased risk of um uh excess hormones, whether that be an increased risk of cancer or an increased risk of um if you're premenstrual then you can have excess bleeding, menorrhagia, etc. So the best thing I could say is A, isolate what could be xenoestrogenic in your in your diet. And B is fiber. So fiber is something I've talked about on a previous podcast, but it's one of the most effective ways in which you can actually remove estrogens from your body. A lot of people who are constipated because of having lacking of fiber are losing that ability to safely remove excess estrogens in multiple different forms by just having a poo every day. And it sounds very simple, but a lot of us are constipated. It's something I see all the time. The other thing is, so other than fiber and having making sure that you're having adequate amount of fiber, is actually having lots of different types of greens in your in your diet. So spinach and and kale, but particularly the cruciferous brassica vegetables. So the things like rocket and cauliflower and cabbage, because those actually contain certain micronutrients and phytonutrients that support the detoxification processes in your in your liver. So there is nothing that you can consume that detoxifies you. However, there are things that you consume that support your natural detoxification mechanisms. There's phase one and phase two in your liver, for example, and that relies on things like riboflavin, B vitamins, and yes, even some phytonutrients, in particular indoles and sulforaphane that can that can aid that process. So those are the two things I I I tend to talk about. If you're interested in the subject, as I am as well, I'm doing a full podcast on menopause and eating with with women's hormones in mind with a with a doctor who's a specialist in um uh in in pre in menopause and primary ovarian failure as well. So definitely look out for that. It's going to be released in the next couple of weeks and we we talk about two hours on the subject.Carol: Brilliant. Thanks.Dr Rupy: I hope that helped in the meantime. Okay, great. I think I'm going to take one more question, guys, and then I know I've gone over and I've tried to get through everyone. So, uh, Carol Devine, I think I don't think I've asked your, I don't think I've answered your question. I'm going to wrap up there, guys, because I've been talking for about an hour. Thank you so much for for joining this live podcast. It's I wish I could do this in person with you guys. And and when we do do it at some point in the future, just make sure you're subscribed to the newsletter, thedoctorskitchen.com, and we'll post when we're going to be doing a Q&A, a supper club, um, and all that kind of jazz. Um, and it will be, yeah, it'll be great to see some of you guys there. I'm so sorry I couldn't answer everyone's question. Um, but uh, but I really do appreciate you guys turning up on a on a random Tuesday evening to to listen to me whittle along. So I really do appreciate it. I'll try and get back to some people in the comments as well. And um, yeah, thank you so much for your attention and thank you so much for the support as well. I really do appreciate it. Stay safe, stay indoors, hug your family members, but no one else. And uh, remember you can stay emotionally connected even if you're physically distant right now. So remember to to text your friends, uh, do a video call and uh, and tell your loved ones that you love them. Take care everyone and uh, and have a safe evening. Bye now. I really hope you enjoyed this week's podcast. I know it was different to what I had imagined, but we will be doing something in that live space where we do a supper club, three courses of meals, get to watch me and some guests live on stage, ask questions live, and also meet fellow followers as well and people who have the same sort of like mindedness about lifestyle medicine and the wider determinants of health as well. Sign up to the newsletter, thedoctorskitchen.com if you want to be first in line for tickets to that as well when we do it on Zoom, digitally or actually in person. And um, and also sign up if you want recipes every single week. We send brand new recipes every single week to everyone on the newsletter of which there are thousands now and we are a growing community and it's super exciting to see that too. I will catch you here next week.
