Professor Robert Thomas: But what COVID is perhaps changing the goalposts here is if you say to someone who's overweight, has a poor diet, you say, come on, you need to try to change because you will avoid the risk of chronic disease in 20 years’ time, they may not be so interested. But actually, with COVID, what it's showing is people who have these comorbidities are more likely to get a fatal illness now. So actually, COVID, you know, a horrible, terrible catastrophe that might actually be getting people thinking, well, actually, maybe I need to be changing now, not to prevent a disease in 20 years’ time, to prevent a disease which could happen next week.
Dr Rupy: Welcome to the Doctor's Kitchen podcast. The show about food, lifestyle, medicine, and how to improve your health today. I'm Dr Rupy, your host. I'm a medical doctor, I study nutrition, and I'm a firm believer in the power of food and lifestyle as medicine. Join me and my expert guests while we discuss the multiple determinants of what allows you to lead your best life. I'm delighted to welcome back Professor Robert Thomas to the show. You may remember that we spoke with Professor earlier this year about oncology and how he encourages diet and lifestyle during treatment of cancer as well as after treatment and the evidence base behind that. His brilliant book, Keep Healthy After Cancer, which is something I linked to in the show notes. But today we're going to be talking about something that may be perceived as quite controversial. Can you eat for COVID? Now, I want to make it clear at the start that we're not talking about replacing treatments that we have for COVID-19 in the hospitals with food or singular supplements or singular foods in their entirety. What we're talking about is the foundation behind why certain people might have a worse outcome of COVID-19 when they come into contact with it. But also, we're going to be talking about his current trial using food supplements and probiotics as an addition to conventional treatment and exploring whether that has any elements or any evidence of improvement in severity or reduction in the complications associated with this disease. It's something that sounds very controversial on the outset, but I think that's because as allopathic doctors, we are used to using drugs and pharmaceuticals alone, rather than exploring other things that we should really be paying a lot more attention to, particularly as more and more people are becoming used to the idea that a healthy lifestyle and a foundation which lessens the likelihood of comorbidities can improve outcomes with this particular virus, but also other conditions as well. On the show, we talk about his current experience of COVID on the ward and how that compares to earlier in the year. His latest trial using food supplements, as well as how they went about choosing what types of foods to put in a pill form, the formulation of the product with industry, the confounding that is likely to be picked up, and but what the potential results could mean for medicine going forward. His experience of conducting the research and just how long it took to get ethical approval, as well as why lifestyle modification and the prevention of comorbidities has to be the foundation before we start adding supplements to the list of interventions as well. I think you're going to find this a really useful podcast. Professor is a pleasure to speak to. And I also cook him a very easy recipe that is full of prebiotics and polyphenols, things that he talks about. And as someone who is a self-confessed can't cook, won't cook, I think I converted him with this recipe. You can check it out on YouTube, but for now, onto the podcast. All right. Thanks so much for coming into the studio.
Professor Robert Thomas: You're very welcome. I'm looking forward to it.
Dr Rupy: The reason why we're doing the second podcast is because I really wanted to teach you how to cook after the last time we chatted. I remember you saying you're not much of a cook, you can't cook the same kind of meals that I can cook. So this is really a challenge for me to try and teach you something that you can, you know, cook for your family afterwards.
Professor Robert Thomas: I think it's a bigger challenge than you think actually. First of all, I'll never be able to cook like you can cook. But I can't even cook at all is more the point. I know a lot about food, I have to say, and about nutrition and what's in it, but I just don't have your knack, I'm afraid. But I'll be proved wrong at the end of the show.
Dr Rupy: Okay, brilliant. Brilliant. I'm glad. All right. So the first thing's first, we're going to be cooking a Greek style bean stew. It's got cinnamon, honey, oregano. We're going to finish it off with feta. Um, and it's, you can also make it with orzo if you want to make it a little bit more heavy. We're going to keep it quite light with just some chopped tomatoes and some really good prebiotic vegetables as well. First thing's first, turn on the oven to 200 degrees centigrade and make sure you've got enough space for it, and that's it. And then we're going to do some.
Professor Robert Thomas: First thing is to buy an oven.
Dr Rupy: You don't have an oven?
Professor Robert Thomas: Not yet. We're waiting for one. So yeah, so there will be one shortly.
Dr Rupy: Surely. Okay, fine. Well, this is quite versatile because you can put it on a hob.
Professor Robert Thomas: Okay, good.
Dr Rupy: You do have a hob?
Professor Robert Thomas: Yes. Yes. So the first time we talked about healthy living, a lot of the stuff that you've talked about in your book, keeping healthy after cancer, keep healthy after cancer. Um, today, I think I want to talk a bit more about gut health in particular. This is something you have a strong interest in, as well as some of the studies that you're doing with regard to COVID. And um, and also about sports performance, nutrition, and some other things that you've clearly got done a lot of reading around. So, um, but how are you doing first of all with the whole COVID situation and and still being a consultant on the medical wards?
Professor Robert Thomas: Yeah, well, um, as you know, I'm a consultant oncologist, so that's affected oncology quite a bit. We've had to shorten radiotherapy regimens. We've had to think twice about starting people on chemotherapy. Um, and you know, it's it's the the saddest thing is that some people have delayed uh presenting. So in the last few weeks, I've seen quite a few young people actually with with tumours without COVID would have presented probably two or three months earlier. And that's going to affect their prognosis. It means they're more likely to need chemotherapy and have all the effects of that. Um, and of course, the hospital's been super busy. So we've all been dragged, like yourself, been dragged up to the medical wards and covering A&E and things. So, uh, but fortunately, the uh, the unless we get a second peak, the peak seems to have gone. We've only got uh four patients at the moment in in Bedford, one of the hospitals I work in.
Dr Rupy: Yeah.
Professor Robert Thomas: Um, so uh, yeah, and I do, as you know, I do a ward round most mornings to try and pick up patients who want to go into our study.
Dr Rupy: Yeah.
Professor Robert Thomas: Um, which we can talk about more later if you want.
Dr Rupy: Well, let's talk about that actually, because I'm I'm fascinated by the study that you're doing. Um, and also, you know, taking the opportunity to promote it as well. I think that'd be brilliant.
Professor Robert Thomas: Yeah. Um, well, it's quite clear from the data so far, without sort of blaming people for catching COVID, which is the last thing we want to do. But if you look at something like the New York data where 15,200 people died, uh, you know, very tragic. Of those, only 99 didn't have a something else wrong with them. So obesity, heart problems, diabetes. Um, and of course, you you don't want to blame people for having those illnesses, but we know over a long period of time, um, what you eat, uh, and how much exercise you do, etcetera, and your lifestyle choices, uh, do strongly determine whether you're going to get those lifestyle related disease. So, taking that as a sort of basic hypothesis, we're thinking, well, if someone gets COVID, although, you know, we can't reverse time and sort of, you know, once the diabetes set in, but could we do something with nutrition, um, to improve their immunity, inflammatory status within the time frame where we affect um, the the natural course of of the disease. Uh, of course, we don't know that, and that's why we need to do a study. So the hypothesis is, if you if you get people and give them um phytochemical rich foods, you know, foods with lots of uh aroma, um, colour and and taste, all things you cook with, we can change their gut health with a targeted probiotics. We could reduce the dysfunction in inflammation and reduce the course of the illness and hopefully improve outcomes. So that's that's what we're that's what we're currently doing, randomizing people to a placebo or that intervention.
Dr Rupy: And just taking a step back with regard to the likelihood of adverse outcomes with COVID if you do have comorbidities. What is the, what what are the different mechanisms of action as to why you're more at risk if you do have comorbidities like high blood pressure, obesity, etcetera?
Professor Robert Thomas: Uh, well, there's twofold. One is if you have problems with your heart and lungs, when you have a a terrible virus like COVID, it puts enormous strain on those. So if you're if you're weak to start with, you're more likely to get uh fatal consequences. Um, but I'm more interested in the chance of actually um getting a severe form of COVID, because we know many people get COVID and just have a temperature for a few days or a bit of a headache. And those, that's what I'm trying to look at. Why are those people um less affected? And I think gut health, my opinion is gut health has a lot to do with that. Uh, as we'll talk about in this program, there's lots of issues which affect, adversely affect gut health. Um, and we have, you know, millions, trillions of bacteria in our gut, part of the microbiome. Those form or stimulate the immunity. So if we have a bad gut, you have a dysfunctional immunity, which means you have lower immune surveillance, so you're more likely to catch an infection, and you have higher chronic inflammation, which means your reaction to that infection is dysfunctional. So, um, for example, you could overreact to the virus and cause the uh, cytokine storm, which is the thing which really affects the lungs and and is actually ultimately fatal. You can get uh really bad diarrhoea, which many people are getting, which can, you can lose electrolytes, etcetera, which can also be fatal. Um, so that's that's the, so if you start off with a poor gut health, you're more likely to catch COVID and get a severe form of it. And when you've got it, you're more likely then to overreact to the to the inflammation, uh to the virus and create this excess inflammation and you get these exudates in the lung, which which which are the fatal form.
Dr Rupy: Yeah.
Professor Robert Thomas: And that's a bit way, a bit the the main study is the hydroxychloroquine and that's an out of date malaria tablet. And that's looking at ways to dampen down uh excess inflammation. It's the same sort of pathway, but I I strongly believe food would be even more powerful, but harder to prove and harder to control in a study, to be honest.
Dr Rupy: Absolutely. Well, that's why it's it's great that you're doing this in a, you know, in a way that meets the scientific rigor with the randomization. And what what what exactly are you putting in the uh in the intervention arm?
Professor Robert Thomas: Right. So, uh there's two interventions. One is a uh a mixture of lactobacillus probiotics, which has been specifically made uh for the trial called your your gut plus. Um, and we're not trying to emulate the whole gut microbiome. I mean, there's be pretty hard. Trillions. Yeah, we need a tablet the size of this room. And I mean, there's trillions of different bacteria as you know. Um, and there's new strains being discovered every week. So it's an uncharted passage, excuse the metaphor. Uh what we're trying to do is just just support the gut with uh butyrate forming bacteria. So these are the healthy bacteria or um the bacteroidetes type bacteria, which the they're anti-inflammatory. Uh they produce, they they metabolize polyphenols into butyrate. Butyrate feeds the gut health. Uh they are, they they are an antidote to carcinogens. Uh they they restore gut integrity. So they make the gut healthy. And if the gut's healthy, you have a healthier immunity. So it's the, so the first part is uh just to top up your um probiotic intake. Uh the second intervention is a polyphenol rich food, whole food supplement. So these aren't chemicals removed from foods. They're just foods which have been concentrated and put into a pill. So it's just boost your intake.
Dr Rupy: Okay.
Professor Robert Thomas: Uh and we looked actually at the SARS, the last SARS outbreak. There's a lot of data from China and the Far East, India, where they've looked at which foods have direct antiviral properties.
Dr Rupy: Oh, really?
Professor Robert Thomas: And there's there's surprisingly quite a few, and not just for SARS, they was looking at herpes and uh HPV. Um, so one of the, one of the ways these foods work is they can have direct antiviral properties. The other way they work is they can um regulate an appropriate inflammatory response. So they improve the immunity and then they avoid this excess inflammation, which is also important. But they have lots of other benefits which we can talk about for hours. Um, so the intervention is a series of polyphenols, which we just looked at the trials which were published over the last five years and we sort of picked uh the best bet basically. And we looked at foods in different categories. So there's no point having ginger and turmeric and, you know, it's really the same polyphenols. So we've got things like camomile tea, um, aloe vera, turmeric, pomegranate, uh green tea, which uh are packed full of these really healthy polyphenols. And we're combining that with a probiotic and comparing uh that against placebo. So half the people in the trial, I'm afraid, are on placebo, which we don't know who. And the other half is in that intervention.
Dr Rupy: I want to talk a bit more about this polyphenols, particularly from the different types of foods that you just suggested. But let me introduce you to my set of polyphenols for this recipe. Exactly, yeah. So we've got um, just to keep you up to speed, as you've seen, I've done it exactly the same time as we've been chatting here. Uh, there's chopped leeks and chopped celery. You can chop. Yeah, good. Good right answer. I've also put the stalks of the parsley in here as well, because you you it's got fibre, it's got those polyphenols as well. You want to put those in. Two, because we're we're cooking for about six people here. Your your kids here as well. Um, we've got some white beans, two cans of white beans, and then two uh cans of chopped tomatoes uh that I've just put in here. I've added some seasoning and a little bit of chilli flakes with some black pepper. And now we're going to go in with the spices. So I'm hitting it pretty hard with about a tablespoon of oregano. Cumin. Do you have you don't have any pet hates or anything like that, no? So we got about a teaspoon or so of cumin. I usually do it by eye, but I'm doing it like this just to show you how easy it is. Yeah. I hope you're taking notes. I'll send you the recipe afterwards. A stick of cinnamon. So cinnamon goes in. Three sprigs of rosemary. Again, pick it up from any supermarket. A couple of bay leaves. I keep these in the freezer, so you know, you can use them whenever. So those have just been taken out for a little while. Um, I'm going to add about two tablespoons of balsamic vinegar, just to add some acidity because you want to kind of balance the flavours. You've got loads of sweet flavours coming from the tomatoes and the honey that I'm about to put in. Um, so you always want to balance sweet and and acidity. Um, and just about a tablespoon or so of honey. You don't need to add the honey, but I find that it it just really balances the meal and I think, you know, part of the flavour, part of the enjoyment of food is making sure you've got plenty of flavour in there as well. I'm going to add a tiny bit of the uh hot water, just to help everything come together and just give a little bit of liquid. The other thing that you can add to this meal is um orzo, um so that's like a dried pasta, which kind of looks resembles kind of like rice. Um, if you didn't want to add orzo, you want to add something a little bit more high fibre, you could add something like a rice pea pasta or you know, other sort of whole wheat pastas, those are absolutely fine. I'm going to add a little bit more hot water, and then this goes in the oven and we're going to continue our podcast whilst I'm quote unquote cooking.
Professor Robert Thomas: And you'd add it at this stage, the pasta or rice.
Dr Rupy: I would add it at this stage. Everything goes into one pan. This is sort of, this is a a three two one meal. So it's um, it's an adapted recipe from one of my three two one uh recipes from the new book that's coming out in January 2021. Um, and it's it's literally this simple. Because most people suffer, I mean, you work on the wards at the moment, you're, you know, the last thing you want to do when you come back home is cook like a massive meal that's complicated. It's got like two or three pans on the go or whatever. This is the kind of meal you want to be able to cook.
Professor Robert Thomas: Absolutely. You're making it look very simple.
Dr Rupy: And it is it is simple. It is simple. Trust me. Pop this into your oven at 200 degrees centigrade that we've already pre-warmed. And this goes in for about 20 to 25 minutes. And that's it. And then I'm just going to put a timer. So that's 20, 25 minutes. We'll we'll check it at, let's say, uh, about, let's say 35 minutes past the hour. I'll take it out and let it stand for about five minutes. And then we're just going to garnish with the rest of the parsley leaves and a bit of feta, some aged cheese for some probiotics. And that's it.
Professor Robert Thomas: Brilliant. Looking forward to it.
Dr Rupy: Good. We're going to stop for a second whilst I clear this down and then uh we can get on with the rest of the podcast.
Professor Robert Thomas: Okay. Great. Well, we're going to talk a bit more about the the research that went into as to why you put those particular um ingredients into the intervention. But also you want to mention the ingredients that I just put in there.
Dr Rupy: Yeah.
Professor Robert Thomas: And the and the talk about both of them.
Dr Rupy: Yeah, yeah.
Professor Robert Thomas: Okay. Well, um, well, the theme of today is gut health as well as other things. Um, and there's various ways you can promote gut health. So, um, I would like to split it up into uh, it's not as simple as this, there's two types of bacteria. There's the good bacteria and the bad bacteria or friendly and unfriendly. Uh, other people call it pro-inflammatory or anti-inflammatory. The official name, if I can get it right, is bacteroidetes are the good ones and uh firmicutes are the the bad ones. But anyway, um, so if you have foods with uh bacteria in, so you mentioned the feta cheese, that's fermented. So that will have a lactobacillus type friendly bacteria. We're going to put that in afterwards. But actually, it's the prebiotics, as you know, which uh determine a lot of the of which bacteria are going to grow and which aren't going to grow into your gut. So you put leeks in, uh an allium vegetable, and they are full of uh prebiotic soluble fibres or fermentable soluble fibres. And what they do is, well, there's a number of things. First of all, they uh, they are metabolized into butyrate. So they get polyphenols, which we'll mention in a minute, and they metabolize polyphenols into butyrate. Now, butyrate feeds the healthy uh gut, so it feeds the gut. And uh in return, other uh healthy bacteria feed off butyrate as well. Um, they actually, so if you have more healthy gut growing, healthy bacteria growing, there's not enough room for the unhealthy bacteria or the pathogenic bacteria to grow. Um, some of the, um, are you putting mushrooms in there? You're not putting mushrooms in there.
Dr Rupy: I could put mushrooms in there. A really good way of adding mushrooms to it would be if you use the dehydrated mushrooms, because they have a lot more flavour and it preserves a lot of the polyphenols and the the um, I forget the name of them, the ergogenic acids, I think they are. They're a novel antioxidant that you find in different types of mushrooms. And you get loads of different types as well in a in a pack. So, trompette, girolle, chanterelle, all those different ones.
Professor Robert Thomas: Yeah, they I mean, lots of those foods you've got contain natural antibiotics, particularly the mushrooms. And it's a strange quirk of nature that those antibiotics, not like the ones we're taking, they actually tend to kill uh the firmicutes bacteria, the bad bacteria, but they don't kill the good bacteria. So they preferentially encourage the good bacteria to grow. And when you've got uh a good ratio of uh good to bad bacteria, that improves gut integrity and there's all sorts of things which you get from that.
Dr Rupy: Yeah. Oh, but there you go. So, I mean, the prebiotics that we add to our food, um, I think a lot of people would prefer to use a supplement because it has sort of a medicinal feel, you know, the fact that you're purchasing something that's usually quite expensive, um, without really laying the foundations for something like that to work. And I think, you know, making sure that people are aware of uh the importance of the allium, the umbelliferous vegetables, all the different types of of high fibre items as well to ensure the probiotics that we have naturally in our food, as well as the ones that we might take in supplemental form, are going to be doing the job.
Professor Robert Thomas: Yeah, yeah, exactly. Uh, and I I, you know, I actually think that the prebiotics are probably more important than than the probiotics, although in a British society, we don't tend to eat much bacteria. I mean, if I was in Japan last year and there's loads of fermented foods and in Korea, there's kimchi, even in uh Eastern Europe, there's lots of fermented foods, um, pickles, sauerkraut and things. Um, we do have yogurt, but a lot of the yogurts we see in the supermarket aren't actually live yogurts. So if you want to boost your bacterial intake, you know, look for the live variety or mature cheeses. Uh, kefir, you're seeing more and more now. Um, but it's the it's also the the prebiotics, the the beans, uh, the well, the legumes, which are beans and seeds, uh, onions, artichokes, um, chickpeas, those sort of things. They are packed full of uh prebiotics, but also packed full of uh phytosterols, which reduce cholesterol, uh phytoestrogens, which have anti-cancer properties, particularly the hormone related cancers. Um, but many people avoid those foods because, you know, you take a, you've got white beans, which is a great prebiotic. Uh, if you're not, if you haven't eaten beans for a while and you eat beans, you know, you get a bit bloated, you have gas. But it's very obvious from the data uh that if you have beans as about a quarter of a cup of those sort of foods a day, you don't get that bloating and gas. You only get it at the beginning when you're not used to the their intake. So it's you have to get past that barrier and start eating them regularly and then then you really reap the benefits.
Dr Rupy: Yeah. And and going back to the list of foods that you added to your intervention, um, you mentioned green tea, camomile, uh, what what what was the um, do you do you know the full list is or are you allowed to or is it proprietary information?
Professor Robert Thomas: Yeah, it's quite an extensive list, so I can't often remember. Uh, so what what we did, um, as I said, we used the probiotics, which I've just mentioned, mainly the lactobacillus because they're the sort of safe, safest ones. They they are metabolized, uh, they metabolize polyphenols into butyrate, which feeds the healthy gut. So that's that was the choice of that. We didn't want a probiotic supplement which had hundreds of different bacteria, which we're not really sure about. Certainly didn't want to put anyone at risk. We went for a safer option. Uh, and we made sure it's strong enough. It had 10 million, 10 billion colony forming units. So it's quite a strong one, but it's a safe variety. So on the food capsule, which as I said, is just simply whole foods and it's a convenient way to boost your intake. We'd never say it's instead of eating food like yours. But it would boost your intake, particularly if you take it say with with your breakfast at a time when a lot of British people don't have a lot of polyphenols, you know, they tend to go for white toast, sugary jam. Um, and we looked at the ones which had prebiotic properties, so they're going to promote the growth of the bacteria, but also full of polyphenols, which are, uh, which have enormous health benefits. Um, so just to run through those quickly, we've got the the they they regulate inflammation. So they reduce excess inflammation and they improve immune surveillance. So they just make your immune system to run more efficiently. They affect the oxidative enzymes. So they encourage the formation of oxidative enzymes when we're under attack. So, unlike vitamin A and vitamin E, which are direct antioxidants, and they you can actually overdo it with those. You can have too much oxidative uh capacity. Uh these just encourage the appropriate oxidative response. So it avoids oxidative stress, which is carcinogenic and damaging for all sorts of systems in your body. So we chose the foods which had most of those. And as I said, it was uh green tea and turmeric are always up high on the list. Uh uh we had some pomegranate and actually camomile seems to be high in a type of polyphenol which has direct antiviral properties.
Dr Rupy: Okay.
Professor Robert Thomas: Uh and same as pomegranate. And those uh polyphenols have been shown to reduce viral replication and reduce the ability of the virus to penetrate into a normal cell and shred. So when when a virus is going into a normal cell, they sort of attack it, they replicate and they shred viruses back into the bloodstream. So the hypothesis is it could stop the infection of a cell, stop the damage of the cell and stop it spreading.
Dr Rupy: Wow. And and looking at the list of foods that you you put into this supplement, was that on the basis of observational studies um for people consuming those foods and having less likelihood of uh worse outcomes with the initial SARS outbreak? Or were there a collection of both observational and some intervention studies perhaps done in India and China?
Professor Robert Thomas: Um, yeah, I mean, there's a lot we don't know about these foods and uh, most of the data from what I've just talked about come from animal and cell line studies. Um, and then uh on the other side of the coin are observational studies. So if you look at a population which eat more of these foods, they tend to have a lower effect from viruses and other chronic conditions. Um, but the the amount of evidence from, you know, class A studies, double blind randomized trials is is lacking. And that that's why we wanted to do this trial. Uh, you know, why why are there so few double blind randomized studies is is difficult to explain. The conspiracy theorists say that because these are not uh uh you know, you can't there's no intellectual property around them. You can't sort of uh trademark turmeric, etcetera. So even though it's in a capsule at the end of the day, these things can be easily be bought over the counter and be made by multiple different people. So there's no sort of protection from a drug company to or no incentive for a drug company to do them. Uh, but in our trials, you know, we just want to get the information out there and then people can make their own own choices.
Dr Rupy: And choices, yeah. And is the aim to have a commercial spin-off from this collection of different ingredients or is it just for public information about the impact of perhaps having these in your normal diet?
Professor Robert Thomas: Um, well, I mean, research is expensive. Um, and uh, you know, we we got donated the probiotic from your gut plus and uh, so that was probably about 20,000 pounds with the probiotic we got free for the study and no doubt the company who's making it will want to sell it. Um, but, you know, they're not, they're not uh, you know, they're not particularly unique. There's a lot of different companies could make the same sort of thing. Of the food capsule, again, they're they're not, there's no intellectual property around them. I suppose for the company who uh supplied it to us, if the the trial does turn out to be significant, uh they would get a bit of a head start and no doubt they would be selling it. But we get, we get the products for free and uh, you know, so it's it's a two-way situation. It's another sort of way of of funding studies because we're not going to get grants from drug companies. We're not going to and we could try to go through the sort of 150 page application forms for for money and you know, that's going to take a year. And for this study, we didn't have a year. It already took four months to get through the ethics committees and the MHRA.
Dr Rupy: Even now?
Professor Robert Thomas: Yeah, I mean, that was fast track. Wow. Normally it takes well over 18 months to get a trial through. Um, so the fast track is even a little bit slow for us. Because we only we the the number of patients coming through is less and less, which is good, of course, but it means we're we're going to be much slower getting the answer for this for this study.
Dr Rupy: Do you think there's scope for people becoming sort of um uh social scientists in this era where, you know, people could, like you said, purchase these food supplements uh themselves, enroll themselves in the study, have a positive uh test for COVID and actually document their symptoms, their if there's recurrence, the severity of the symptoms, etcetera, over a period of time and you can actually map out whether people who took the intervention had positive benefits or not.
Professor Robert Thomas: Um, well, it's with a clinical trial, you have to really control everything because what you don't want is uh you want objective data. So and you need independent statisticians to come in and analyze your data for you. And even then with COVID, we started off thinking, oh, it's going to be a temperature and a cough. But actually, it's not. It's as you know, it's it's diarrhoea, it's extreme fatigue. Um, it it's very and we have to use validated questionnaires. So we've had to go back a few times and do trial amendments to like we've got fatigue now is the main end point. Um, because that seems to be the most common symptom. Wow. Especially as uh people who've had say the disease, the peak of the disease a month ago. Um, but if you start, you know, that that is a that is a problem if people um hear what I've said about the ingredients, they go out and buy them. Yeah. Uh, you know, they they're healthy things. They're not going to do any harm. Um, but we don't know they they work and we really need to know the answer because if they if they do work, we could we could expand that information across the world. We could then do further studies sort of homing in to which of those ingredients has has the best benefit. I think with food to have a mixture of a lot of things is always better. And otherwise you go down the the drug route, don't you? Taking out one chemical. Um, so it it's an issue and and one thing we've noticed with recruitment is when we start mentioning the word probiotic, people are very unhappy to be randomized because they've they've heard the benefits of probiotics. They've taken antibiotics when they've had their COVID. Their gut health is probably all over the place. So they're thinking, well, actually, I want the probiotic. So actually, we're doing another, uh we're doing another trial amendment. So both groups will actually get the probiotic.
Dr Rupy: Oh, really?
Professor Robert Thomas: And we're randomizing the other food. The reason, scientifically that's less robust because you've given both interventions, but it means that we can give something positive to the patients in the trial and they can start seeing a benefit. Um, because people are reporting benefits post COVID to probiotics actually. So they we're that's going to be, I think from next week, which is um, you know, second week in August, there'll be uh all having the your gut plus and they'll be randomized to the the food supplement.
Dr Rupy: Wow. That's super interesting. I mean, already you're going to have to gear yourself up for being um not attacked, but there's a softer word for that when, you know, your food supplement contains a list of so many different ingredients. Like, well, the scientists will will in me will say, well, how do you know it was the camomile instead of the green tea or whatever? And how do you know it's a combination rather than just the mushrooms doing all the work, sort of thing? And I think we're always going to have to deal with that when it comes to nutritional science, but I think the more money we invest in preventative measures and management measures using simple lifestyle and and dietary means, the better the outcomes for for most people. And I think this extends as you as you've been talking about for a number of years now into oncology as well.
Professor Robert Thomas: Well, as you may know, we about five, six years ago, we did another similar study using a supplement which had broccoli, green tea, turmeric and pomegranate. And we looked at men on active surveillance for early prostate cancer. And we had exactly the same questions. Uh, so we we didn't want uh to extract one chemical. That's we wanted the opposite of a of a drug trial. Uh, and that study was highly significant. In fact, it showed a 64% reduction in the rate of PSA progression in men with early disease. And that resulted in a very significant difference in outcome. It stopped people going on to radical interventions. Um, and uh kept many people on active surveillance. Um, and then when we presented that to ASCO, the world's biggest cancer conference, uh, you know, all these questions came, but we were actually very pleasantly surprised because every year they get 10 papers to be the the the most important papers for that disease for prostate cancer in the plenary sessions. And we were invited to be one of those. Of course, it upset quite a lot of people. You know, there's 44,000 oncologists from around the world and obviously a lot of them are sort of paid, you know, supported by drug companies, etcetera. Uh I don't want to say there's a big conspiracy here, but uh you know, um you know, I had to sort of fly economy and stay in a B&B down the road while they were in the five star hotels. Anyway, no no bitterness there. But, you know, there was a lot of people saying, how do you know which one works? I said, well, look, it's probably the combination. It's the same way in diet, you know, you have to uh and each of those, they said, well, which is which polyphenol? I said, well, in turmeric alone, there are 120 different phytochemicals. In green tea, there are hundreds of different phytochemicals. All we know is from the uh cohort data, the laboratory data, we know that these foods have definite medicinal properties. Uh and we know that if you we now know from that trial, if you boost them, uh particularly as I say, taking them in the morning and lunchtime in times of the day you wouldn't have them normally, we know they have beneficial properties. And I think there's loads more trials waiting to be done on that sort of thing which will show a benefit.
Dr Rupy: Do you think there's scope and this is really high level thinking here, and I'm thinking with my sort of like public health obesity strategy hat on, where if there is a clear benefit to be determined by increasing polyphenol concentration of people's diets, even if that means with supplementation such as the one that you described in the intervention for the pomi-T, as well as the one that you're doing right now with COVID, do you think there's a rationale for the government to be subsidizing polyphenol rich supplements to people's diets? As we can't always be relied on, and myself included, to eat well every single day.
Professor Robert Thomas: Yeah, I mean, obviously the number one message is to eat well. And like yourself, I try to make an effort. But if I'm exercising a lot or uh, you know, I've had a stressful day, I will definitely take some extra supplements. Or on the probiotic side, I will if I'm going on holiday, um, with different water or different types of foods, I will definitely cover myself with a probiotic. If you've been in hospital or taken a course of anti, but there's lots of indications. You should never take a probiotic daily if you're otherwise well. There's no evidence for that. But there's many situations where they would help. So yes, I I, you know, it was beginning to get to a situation, I know Norfolk and Norwich, for example, were giving probiotics for people before they were admitted to hospital because there's evidence to reduce the risk of uh clostridium infection. There's a a new strategy run by the Royal College of Anaesthetists called the prehabilitation program where they're looking at people coming into hospital, uh and they're mainly talking about exercise, um, to try to sort of reduce the risk of thrombotic events. But I think we I was on that committee and I was trying to sort of introduce maybe that's an opportunity to sort of try to really change people's diet, even if it's only for three or four weeks, to really arm them with the polyphenols and the right bacteria to reduce the risk of uh adverse events, reduce the risk of infection. And actually, um, going forward, you know, I think if you can change the environment in the body around say a cancer, you start getting changes in that cancer. So if you do get any cells spreading off at the time of surgery, they're maybe less likely to form roots and metastasize. But that's all in the sort of research domain at the moment.
Dr Rupy: Yeah, because from my limited understanding of cancer research, a lot of it is reactive at this point. We spend the large majority of our money on um medications, toxic drugs, surgery, which all have their place massively. But if you ask me, I'd rather try and prevent myself from getting cancer in the first place. And my understanding of how much we spend in preventative medicine is less than 5% of the total NHS budget, which is very, very small. And there's a lot of evidence that we can prevent a lot of these things if we start early enough. And also detect as well. So, yeah, I think that definitely needs to.
Professor Robert Thomas: It does, but the problem is, um, preventative interventions haven't been particularly successful. So, uh, yeah, I mean, we know from uh World Cancer Research Fund, WHO, Cancer Research UK, who've done very clever statistics that about 50% of cancers, um, could be avoided if we led a healthy lifestyle. Uh, the others, um, you know, I'm not blaming people for getting cancer, some people live the life of an angel and still get it. Uh, but also there's there's some evidence that if you have a healthier lifestyle and you get the cancer, it's going to be later in life and perhaps less aggressive and more amenable to being cured. Um, but, you know, you tell a, you know, you tell your your teenage kids uh to eat healthy because they might get cancer in 20 years' time, it's sort of falling on deaf ears really. Um, you know, so that that's why they're not investing more, I think, because it's it's not changing behaviour. And it's getting people to change their behaviour is is the hard bit.
Dr Rupy: Absolutely, yeah. I think there's definitely a motivational element of, you know, investing now and uh with a payoff later, but it's also about um, I think looking at the wider determinants of health. It's something that I've come to realize throughout my six years of working as a general practitioner. It's easy for me to arm people with the information. It's harder to appreciate the uh other determinants, time, uh financial insecurity, um stress and all the other things that will predict as to whether they're going to be able to cook one of my meals uh every day, um or, you know, whether they're going to fall into old habits or going to be, you know, uh susceptible to the advertising from the junk food industry.
Professor Robert Thomas: In in your books, which I've read are fantastic, and and certainly in my mine as well, what we we're talking about preventing chronic disease through through diet. So we know, we talked about cancer, but 50% of them could be prevented. But actually things like arthritis, heart disease, premature aging, Parkinson's disease, stroke, these are all, you know, related to chronic inflammation and gut health and they can definitely be uh the instance can be reduced. We're not going to get rid of them, but when you get them, it's going to be, you know, a much older age and a less severe form. Um, but what COVID is perhaps changing the the goalposts here is if you say to someone who's overweight, has a poor diet, you say, come on, you need to change because you will avoid the risk of chronic disease in 20 years' time, they may not be so interested. But actually, with COVID, what it's showing is people who have these comorbidities are more likely to get a fatal illness now. So actually, COVID, you know, a horrible, terrible catastrophe that might actually be getting people thinking, well, actually, maybe I need to be changing now, not to prevent a disease in 20 years' time, to prevent a disease which could happen next week. And, you know, obviously, you can't, you know, become from obese to normal overnight, but actually, a lot of the evidence shows it's the process of changing is more important. So you can be, you know, overweight but but still quite healthy. So if you change your diet and you exercise more, that can start changing your gut health, it can reduce your estrogen levels before you start seeing a reduction in weight. And this is why I try to say to the patients, you know, don't be despondent that you go on the scales and you only see a little bit. The process you're doing is improving your health before you see reductions in actual weight.
Dr Rupy: Yeah, yeah. I as harsh as it sounds, I I think COVID has really brought to attention the importance of healthy eating and that motivational element of it having an impact tomorrow. Uh is something that is kicking a lot of people into gear. And I think everyone's motivations are different. You know, some people are motivated by money or time or aesthetics. I think most of us are motivated um also by fear as well. And again, as harsh as it sounds, the fact that tens of thousands of people have died in this country alone and we're witnessing this on a global level, it has sparked a lot of fear and I think a lot more people are motivated to to do something about poor health habits that we all have, you know, we're all, you know, privy to it.
Professor Robert Thomas: I hope so. I'd I'd like to see, you know, the evidence for that coming through that people are changing their lifestyle. I mean, without criticizing the government, I mean, it's been a very hard process for every government in the world. I find it a little bit odd looking at the data, which is very obvious, you know, it's all published. The New York data is fantastic. Uh the Chinese data is coming out. This this issue with, you know, over 50 have to lock down. I mean, it's you just go on to the Chinese publication. Age is irrelevant. Age is just a correlation that you've got something else wrong with you. The data shows very clearly you can be in your late 80s, but if you've got no comorbidities, you have no more risk of COVID. It's not an age thing. It's it's a disease thing. And you can be in your 30s and 40s and have lots of problems, which is going to increase your risk. But it's only till recently they've started saying, oh, let's get on your bike, let's do more exercise. You know, this is a great opportunity. We know that smoking increases your risk of the lung damage. You know, there should have been campaigns saying, you know, stop smoking. There are some countries, Italy, for example, have banned smoking, I think.
Dr Rupy: Oh, really?
Professor Robert Thomas: I'll have to verify that story because I was only told by an Italian. But uh, but you know, some countries are saying, look, you know, we know that excess alcohol, we know that smoking is bad. Uh, use this as an opportunity as well as a as a as a risk. Um, but, you know, I I think it should be a step further. You know, I think there should be, okay, we don't have grade A evidence yet, you know, the trial I'm doing is trying to get that and there's some others around the world. But, you know, it's not going to do any harm saying to people, come on, instead of five a day vegetables, you should be doing 10 a day vegetables. You should be, you know, trying to exercise every day, keeping your weight down if if possible. Vitamin D, again, we need more evidence and I was very surprised that the there was an official thing saying, um, an announcement saying there's no evidence that vitamin D influences COVID. But, you know, at the end of the day, many people in Britain are vitamin D deficient and we know there's hundreds of other benefits of vitamin D. And even if it could possibly be relevant, it's a cheap thing you can take over the counter or just go and take your shirt off and lie in the park for for half an hour, you know, so I think we should be concentrating more on that without blaming people, of course. You know, we last thing we want to do, but just encouraging people to change.
Dr Rupy: On that note, I'm going to serve up this meal, which is definitely polyphenol rich and I hope that you're going to enjoy it.
Professor Robert Thomas: One thing I try to tell people is not to snack between meals. So I've had my breakfast at 8 o'clock, so I haven't had anything since. So I'm definitely hungry.
Dr Rupy: Do you intermittently fast at all or just have an eating window of?
Professor Robert Thomas: I I don't. Um, and I'm not saying the data's not okay for that. Um, if you look at the 5:2 diet, you know, Michael Mosley, who's actually shares the same publisher, so I should encourage that. It's all very good. If you actually look at the data, I mean, the the best data is the overnight fasting. Um, if if you can go 13 hours overnight, um, and extrapolating from that, I think, you know, having your breakfast at 7:30, 8:00 and then eating nothing till 1:00, I think that that leaving your stomach to empty, um, actually makes a, you know, letting your insulin pathways die down. You know, having food in your stomach all the time is is really unhealthy. It's it's not good for the amount of carcinogens in the food. It's not good for your gut enzymes. It affects your PhD and it's, you know, your your system's in overdrive all the time. Just giving it a rest and uh is is my take on it.
Dr Rupy: It's one of the recommendations I I give to patients to really think about, you know, just that simple act of giving yourself a bit of a rest um overnight and, you know, like you said, if you if you're constantly eating, your gut's never having a rest. And it does need a little bit of a break. Let let's let's get you eating. I want you to try.
Professor Robert Thomas: Well, I I had breakfast at at 8:00. It's now 2:00, so I've had. You're probably ravenous.
Dr Rupy: Okay, so this is uh the Greek style beans. You can imagine taking this to the table and then doing the feta and the parsley at the table. But I'm going to serve it for you right in a bowl, so it's easier. I'm sure you don't want to just dive into this.
Professor Robert Thomas: I I can I can smell it. It smells really nice.
Dr Rupy: No worries. Good. Okay. And obviously just dodge the uh the parsley and the big stick of cinnamon. But I mean, one of the reasons why I cook like this is um, not only because of the health benefits and and you know, the uh um the the impact that can have, but it's um it's for the enjoyment of food as well. I mean, that's why my recipes sort of skip through different um uh different cultures and cuisines. It's a way in which we celebrate different absolutely cultures and stuff and yeah, share food.
Professor Robert Thomas: And and you know, um, I hear from patients sometimes and friends, you know, I I I don't want to live till 100, you know, I prefer to enjoy myself. But you say, well, we're actually talking about things which are more enjoyable than white bread with plastic cheese on, you know, it's uh um it's it's it's a strange quirk of nature that that foods which are healthy, yeah, uh generally taste really good as well. You know, it's it's an all win situation.
Dr Rupy: And I think it's like about retraining our taste buds as well. If you are sort of um of that, you know, if you do like the white bread and plastic cheese, which I I refuse to believe over a long term, you know, you can like learn to enjoy flavours very gently. You don't have to go straight into the. Okay. Tiny bit of seasoning. And there we go. Oh, let me give you a spoon.
Professor Robert Thomas: Oh, wow, look at this. It might be a little bit hot, so maybe.
Dr Rupy: Yeah, you'll be fine. You just give it a blow and then you'll be okay.
Professor Robert Thomas: Well, it looks fantastic.
Dr Rupy: Good. Smells really nice. I hope your kids enjoy it as well.
Child 1: It's really good.
Dr Rupy: It's good? Yeah? Great. What do you think, Dad, could make that for you?
Child 2: No.
Dr Rupy: I'm going to prove to you he can. Honestly. He's definitely going to be able to make that.
Professor Robert Thomas: I've been taught. I'm going to do it next week.
Dr Rupy: She doesn't look particularly convinced.
Professor Robert Thomas: I think you're wrong. I think I'm going to be a cordon bleu master chef after this.
Dr Rupy: Definitely. Thanks for the tap on the shoulder.
