Dr Rupy: Welcome to the Doctor's Kitchen podcast with me Dr Rupy where I'll be discussing the most important topics and concepts in the medicinal qualities of food and lifestyle. Today I've got the absolute pleasure of inviting a really good friend of mine, Dr Oyan Panja, who is a general practitioner, a super generalist, and he's really on a mission to essentially heighten people's awareness of just why generalism is so, so important. He's a lifestyle medicine enthusiast. He's also co-founder of Lobe Medical. And we're here to talk about eating for our mind and for our brains with specific regard to neurodegenerative disease. And the first time I've heard Oyan was on TV because he's previously been on TV. He used to do something called Street Doctor. And but he has a very nice way about him, the way he speaks on the radio and you're going to hear his dulcet tones. And honestly, they're so relaxing.
Dr Oyan Panja: Right, the pressure is on now.
Dr Rupy: Just relax and listen to him. He's I'm very, very pleased to have him on the pod today as you can tell. And we're going to be giving you some nuggets and at the end we're going to round up with some tips to eat for brain health and we're going to explain exactly what we mean. Do you want to just give us a little bit of an introduction to yourself and just how busy you are as well because you are a full-time GP.
Dr Oyan Panja: Yeah, it's a tough gig actually and I think people realise this because although the papers would make out that we earn millions of pounds a year, no one wants to do it anymore. And there's a good reason for that and that is that you can never turn anyone away. It is for all comers and the stuff that comes through a GP's door, not just patients, but also the amount of wrap around work around it, which is demeaning called paperwork, which makes it sound very unimportant, but it's very important stuff. I mean, I said to a friend the other day, I often get 100 letters to read a day. 100 letters and I start that at 7 o'clock at night at the end of my day of seeing patients. I don't know how long it takes you to read 100 letters that all have an action where you have to concentrate. And if you don't concentrate, you start dropping balls and things go wrong. But I still love the job. It's in my DNA and as you said earlier on, super generalism, it's a sort of a made up word, but I think you need more and more people in today's society to join up the dots and connect, make connections in order to keep people healthy. We're losing that sense of global overview as the world moves further and further into specialisation. So yeah, my job is full on but I love it. And as I said to you off air a minute ago, once a week I think actually, I could easily go and do something else, but it's like groundhog day and at the moment I'm enjoying it.
Dr Rupy: You know what, the patients keep you going, don't they? And you have those cases where you've actually made a massive difference and that's what reminds you why you're looking through all these letters at 7:00 p.m. And the variety is just insane. One minute you're trying to look after someone's mother who's disabled and you need to organise a wheelchair or someone else who's worried that they've got cancer and then at the same time you're being pestered about doing some paperwork that is important to that person, but it's really not a priority.
Dr Oyan Panja: Exactly right. And and I think the other thing is is that a lot of people don't know what GPs do. From where I'm sitting, you get the feeling that everyone just comes to the doctor all the time, but actually a lot of people don't. And if you don't need primary care services or access to the GP very often, you don't really know what it is that we do. I think a lot of people think we're just machines that refer people on. That's not true. Only 10% of people get referred on. 90% we manage ourselves. And we get very good at holding in inverted commas, holding patients who are depressed or effectively you're doing lots of different jobs as well as you can. So you're part counsellor, you're part physio, part dietitian, dare I say it, although we're not because we're not experts in those fields, but you're doing what you can whilst they're waiting for a referral or or occasionally, as you said, you put some interventions in and actually that person gets a lot better and I'm seeing that more and more and that's why I'm such a champion of this this super generalist approach.
Dr Rupy: Exactly. And I think that 90% figure is something that resonates very well with this podcast that we're doing today because brain health and preventing dementia is something that a lot of people don't realise you can actually do using lifestyle approaches. And I want to make sure that this isn't in the realm of experts. This isn't just something that only cutting edge researchers know about. This is something that we can introduce to our patients as general practitioners.
Dr Oyan Panja: 100%, you know, and I think the brain, in many ways is the master organ. It sits above everything else. And what we've learned in recent years is that when it comes to non-communicable disease, so this is stuff that you don't catch from other people. We're not talking about colds or TB or malaria. This is stuff that arises from within, painful joints, headaches, memory loss. These are all symptoms that people come in with. Actually, what we're finding and I know you know this very well, Rupy, is that all the interventions are very similar, and if you look at ways of keeping your blood pressure under control or keeping your brain health optimized or preventing diabetes, actually the tools are the same. And if you do, if you work on one, you'll find that all the others get better. And I think that's the power of this and I think not only should every clinician know a bit about this, but the public at large should know about this and we need to increase awareness about it.
Dr Rupy: Yeah, even though we're talking about brain health today, you'll notice there's lots of similarities and the similar sorts of things that we will talk to patients about for their blood pressure or for cardiac health or for their diabetes. And that's a really nice metaphor to just how interconnected we are.
Dr Oyan Panja: Yeah, I think interconnected is exactly the word. I mean, it's interesting as well because when you've got the patient in front of you, you're going from symptoms to, it's almost like one of those things where you zoom in on, if you had a magic camera and you zoomed in on their brain or their joints to the molecular level. And I think this has been for lots of reasons, partly because we're so punch drunk busy as doctors and partly because we've fallen into this medical model of quickly dealing with something efficiently that works and drugs can do that, although they don't actually treat the underlying cause of a symptom. But if we take brain health for example, and you actually, let's go really deep. So let's forget the person just for a second and what symptom they've come in with. But if you take the actual cells in the brain, the neuron, they need three things. They need glucose, which is a type of sugar, they need oxygen, and they need stimulation. Those are the three things that effectively preserve brain health, to cut a very long story short. But how do you get the person in front of you to improve those three things? That's a good sort of starting point in a way. And of course it's through lifestyle. So, when I say glucose, that doesn't mean you can just go and eat cakes because it's a glucose is a very specific type of sugar that the brain uses and actually if you eat cakes, it will make the wrong type of sugar and that will be bad for the brain. But essentially it's to do with making sure that you exercise more, making sure that you eat the right foods and the timing of meals and also making sure that your brain is active and that you're stimulating the brain by doing lots of brain activities. So it's quite simple. I mean that's a long story cut short, but that's the kind of way that I think doctors ought to be thinking.
Dr Rupy: Yeah, and I think that's a really nice framework to start off talking about all these different elements because, you know, glucose as you mentioned, that's a really important topic. We talk about other things that can improve the oxygen levels to the brain as well as brain stimulation. I think a lot of people don't realise that stimulating the brain in different ways improves those connections, those synapses, the different neuron connections that we have and the brain is actually quite plastic. It's quite moldable.
Dr Oyan Panja: Absolutely. Yeah. And plasticity or neuroplasticity is the ability of your brain to handle stress in some ways, whether that's biological stress or emotional stress so that the neurons don't get killed off because they're dying all the time. As you and I are sitting here, our brain cells are dying, but...
Dr Rupy: But I'm also being stimulated as well, so...
Dr Oyan Panja: Yeah. But um, I know that sounds a more morbid thought, but actually what stops them dying, what makes them die quicker, if you and I had a massive heated argument now, that would kill off a lot more neurons than us having a nice chat. And if you're, because your blood pressure goes up, your cortisol level goes up during this episode and that affects your blood sugar. And while we're on the topic of blood sugar actually, it's interesting to mention that someone who's diabetic is actually several times more likely to have memory difficulties and some kind of neurodegenerative brain condition. And that's not as a scare tactic, that's just to show how much how important sugar control is.
Dr Rupy: So you've had some experience with dementia patients and utilizing some of these concepts that we've just been talking about in clinic, right?
Dr Oyan Panja: Absolutely. Yeah. And it came from a trip that I made with Rongan. He always comes up, doesn't he? Somewhere. And um, he's here but he's not here. And um, so he and I went to California to spend some time with Professor Dale Bredesen who I know you know his work and Dale is actually a neurologist. So hardcore brain researcher who for many years had done studies on animal studies really looking at Alzheimer's. And for years he thought he could come up with a drug that just cleaved the amyloid protein. So basically just a quick recap, amyloid is a type of protein. So all neurodegenerative brain diseases, Parkinson's disease, Huntington's career and Alzheimer's disease, one feature they have in common is something called protein aggregation. So proteins build up in the brain. So in the case of Huntington's, it's the protein's called Huntington. In Parkinson's disease, they're called Lewy bodies and in Alzheimer's they're called amyloid plaques as we know. But you and I probably have some amyloid in our brains, but it's sat there not doing anything. And then suddenly there's a switch that activates it. And then the amyloid starts making these tangles called tau tangles and that's when memory starts to decline quite quickly. So Dale, after all, 30 years of research, came to the conclusion that actually he wasn't going to invent this drug and it wasn't going to cleave the amyloid protein in one part. But what he did discover was that actually if you modified lifestyle factors, that not only can it prevent dementia, but it can reverse people that have already got the label of Alzheimer's. So this is the stuff of fantasy. I mean, imagine someone rocking up saying, hey guys, I've found the cure for Alzheimer's.
Dr Rupy: It's met a lot of skepticism as well from traditional neurologists because they're like, this is absolutely impossible. We've been studying this for decades and we haven't made this link and we have all these other medications. It's quite revolutionary, isn't it?
Dr Oyan Panja: Very much so. And I think Dale, what he points out is the medication plays a role, but he analogizes it to a roof with 36 holes. If you plug one hole, it's not going to keep the rain out. You need to plug about 30 or so. And the drug plugs one of them or maybe two of them. As we were talking earlier, the lifestyle changes that he recommends are very similar to those for diabetes, for high blood pressure. And what I loved about his work because it was all too much for us really because we went there and we were blown away by A, his intellect and his passion, but B, that the science is very technical at that sort of top level that Dale operates on. And we needed to bring it back to the consulting room so we could actually help people, in the real world, but you know what I mean, in the 10-minute appointment world.
Dr Rupy: It's like another hurdle that we have to deal with in the NHS, yeah.
Dr Oyan Panja: But what was interesting about Dale's work, he classified these patients into groups. So type one of, one type of person that he found that has Alzheimer's, he called inflammatory. So this is a group of people who tend to be inflamed. It might be, they tend to typically be men who have gout or they have elevated markers in their blood for inflammation. Then type two he describes as trophic. And trophic is a word that means growth. And often this group are women, particularly after menopause where there's a withdrawal of their sex hormones and that sometimes accelerates memory loss or other vitamins and minerals like B12 for example that are lacking. The third group were called toxic. This is a very unusual group and we don't learn about this sort of stuff at med school. And these are people who either genetically or for some other reason cannot get rid of toxins very easily from their body. So say I had a gene mutation that meant I couldn't my liver wasn't working as well as yours and we sat in this room and it was full of mold. By the end of the day, I may have a very bad headache and feel terrible because I'm not getting rid of the toxins. So that was another group. And the fourth group he calls glycotoxic or sweet, which are the people who are diabetic. And often as you know and a lot of people listening to this will know that Alzheimer's is often called type three diabetes because and again going back to sugar control and how the brain becomes resistant to insulin. So I love that model and I think that made it much easier for us to apply because you've got a starting point in terms of diet, exercise, brain stimulation and going back to that thing at the very beginning about the neuron, glucose, oxygen, stimulation, how are we going to get there? And that's a great starting point really.
Dr Rupy: Yeah, I mean he's absolutely fascinating. His work and his landmark paper I think that came out in 2014 looking at a small group of patients with phenomenal results. Very simple lifestyle changes. It was getting them to meditate, exercise, use some targeted supplementation, but mainly concentrating on food being a healthy, colourful, largely plant-based, almost Mediterranean style diet. It's pretty phenomenal the results.
Dr Oyan Panja: It is really. And I think, the DASH diet, the MIND diet, there are lots of these diets around, but they all predominantly, there are some common messages in all of them. And I think one of them is the power of whole foods and avoiding refined and processed foods because that processing just does something in terms of increasing, for example, the way that you handle sugar. We know that if you're eating fruit, for example, which has sugar in it, because fruit contains fiber, your body handles it differently and it doesn't cause the insulin spikes that say a bar of candy might. So that processed stuff is not good. So whole foods is definitely one of them. And also fats and and healthy fats. So I don't want to get into an argument about fats because I've got to stress, I'm not an expert on nutrition, but this knowledge is out there and I think what I'm trying to get across is how do you apply stuff that you read to the person in front of you? And that is to do with starting with where they're at, tell me what you eat every morning and every lunchtime and at dinner time. And then you start with them there and then share the science with them and tell them about how great omega-3s are.
Dr Rupy: I think what you just quickly told us there is actually something that I use in clinic quite a bit. That 24-hour recall because straight away you have a snapshot of how this patient is generally eating. What do you have for breakfast, lunch, dinner? What do you drink and what do you snack on? Those are simple things that I do in clinic in 45 seconds, you can get a really nice snapshot. And then you can have a targeted approach like, okay, well, let's change your food so they're a little bit more whole or let's add a few more vegetables here and there. You don't need a nutrition degree to make those changes. And I think it's really important that GPs shouldn't be shy of making these very reasonable suggestions, but obviously use registered dietitians, nutritionists where appropriate.
Dr Oyan Panja: Absolutely. And I would love everyone to have access to a dietitian or a nutritionist, but there isn't the facility or the resource. And a physiotherapist and a dietitian and a general practitioner and a nurse and we can name any other type of specialty and any other colleague, they all need to know a bit about what the other does. This is where I come down to this thing about generalism. I wouldn't expect a colleague who's a dietitian to be able to treat someone with sciatica, but they have to know a little bit about it. And I think we're getting siloed off a bit in medicine where if you're not careful, you just focus on what you do and that doesn't help anyone. It just repeats a lot of work.
Dr Rupy: Yeah, certainly not the generalist either. Because if we were just operating silos, then we wouldn't be prescribing antihypertensives or dealing with diabetes in clinic and that kind of stuff. So we need to certainly extend our toolkit and maybe have a bit more of a collaborative approach.
Dr Oyan Panja: Yeah. I think also the thing about diets is you can find loads of information out there. Knowing whether it's accurate is the challenge. In some ways it's harder for healthcare professionals because we have a duty to make sure that whatever we're recommending is not hokum. And I get people who come in who've had advice from their hairdresser. Sometimes it's really good advice. I think, oh my god, they're on it. Where did they read that? That's really good. Obviously that's informal advice, but when you're giving advice as a healthcare professional, you have a duty to make sure that it's accurate. And one of my patients asked me recently about extra virgin olive oil. And as you know, Rupy, as someone who's an expert in culinary medicine, the more you know, the less you know. There are loads of different types of extra virgin olive oil. It's a minefield, isn't it? But keeping it generalist, he said, look, why is it good for brain health? And it was a really good point because I can make a hypothesis, but it brought me actually to look at this study by a chap from the University of Philadelphia who did a study on mice called Dr. Domenico Pratico in 2014. And what he found was that the group of mice that he gave olive oil to, actually they were able to get rid of waste substances from their neurons a lot better. So going back to that toxic group of Alzheimer's patients, can you imagine that that one intervention possibly, I'm not saying it definitely would, but the science gives you a nudge towards, well, hang on, this might there might be some benefit here. Slightly different to omega-3 fatty acids, for example, which we get too many omega-6s these days because of commercial vegetable oils. And omega-3s historically when we were hunter gatherers, we used to get more of and we don't get enough of.
Dr Rupy: Just for the listeners, omega-3 and omega-6 are types of fatty acids that we find. They're unsaturated and we get them in things like nuts, seeds, extra virgin olive oils and usually from vegetable sources.
Dr Oyan Panja: Absolutely right. Yeah.
Dr Rupy: And the balance is, sometimes when it's out of work, it can lead to pro-inflammatory results. So omega-6 is slightly inflammatory and omega-3 is anti-inflammatory. We need both of them, but the balance needs to be addressed in Western cultures.
Dr Oyan Panja: It's interesting when you mention omega-3 because most people will walk through Morrison's or Sainsbury's down that aisle next to the pharmacy where there's all the sun creams and stuff. And they'll see supplements and one of them they'll sort of think, omega-3, I sort of know that's meant to be quite good. What's it good for again? How does it work? Why does it work? And things like omega-3s, they're phospholipids in terms of what they are. And what they effectively do is they supercharge your cell membranes. So every cell in your body will absorb nutrients a little bit better if you have more omega-3s. And as a result, your levels of inflammation will go down. So that's part of the science bit. But I think it's all about keeping it simple and going back to the person opposite you, like you said, you start with where they're at, what they're eating, what their routine's like. Then you move into other things like sleep. Sleep is a huge thing. Not necessarily directly linked to diet, but in terms of hunger and appetite and the signals that your brain is sending you, it's a huge thing. I'm sure you've had this, when you sort of, so if you drink alcohol, for example, the disruption it causes in your sleep and the amount of hunger it causes sort of in the middle of the night is unbelievable, and it's one of those things where, if you felt it and when you mention it to someone, they kind of go, yeah, you're right actually. I find I eat a lot more when I drink alcohol at certain different times. And this thing about timing of meals. So one very simple tip is about making sure that you don't eat dinner too late. And if possible, eating breakfast a little bit later than you do. So getting all of your meals into a window of around about 10 hours and then having an overnight fast of 11 to 12 hours. Why is that beneficial? Okay, well, two reasons. Firstly, if you go to bed with a full stomach, one, you're not going to digest your food very well because it's just going to sit there and it takes about three hours for your stomach to churn things over. So your digestive enzymes won't work very well. Secondly, all food has some sugar in it. And you go to bed with a bit of a spike in sugar and then your pancreas, your body actually churns out something called insulin. And insulin, what it does is it keeps your sugar levels down. But insulin is also a steroid hormone. Now, anyone listening to this will know that steroids, in popular culture, bodybuilders abuse steroids to get big muscles. And actually insulin does exactly that. It's anabolic. It sort of lays down fat, it makes cells overgrow. And if you're getting too much insulin hanging around in your system, that is really bad for you. So it's not the sugar necessarily that is bad for us. It's what your body does afterwards. It's this insulin spike. And if you go to bed with that and wake up and have breakfast early, you're just increasing the sugar and the insulin again. And that will make you put on weight. It will drive inflammation. And all those things that we said lead to these diseases like diabetes or Alzheimer's. So that's something I tend to try and get my patients to do, whatever they've come in with when it's non-communicable. It's a quick win. If you do it five days a week, you're doing well. You don't have to stick to it at weekends because no one's superhuman.
Dr Rupy: There's some really interesting research looking at that actually, having that defined period of window, not changing calorific intake, sometimes not even changing what you eat, just that very simple means of changing when you eat and the effect on inflammation. So you mentioned a couple of things there with the effect on insulin. I suppose eating later on can also affect your hormones that can affect your circadian rhythm, can affect your melatonin. And not to sound like this is scaremongering about eating, but when you eat, your body is put into a slightly more inflammatory state where you need to have that inflammatory state to essentially metabolize and process your food. So if you're doing that over an extended period throughout the day, you're not really giving your body a chance to rest and to essentially operate on its normal homeostatic mechanisms. So that's why I think it can be a very interesting therapeutic strategy.
Dr Oyan Panja: Yeah, absolutely. And again, bringing it back to the person, one of the things I notice is and I often start like that where they go, oh no, I can't eat that, I can't eat this. Okay, well, eat exactly what you're eating, just change the timing of your meals. But often they'll come back after six or eight weeks and they go, you know what, I feel a lot better already. And they're still eating not great food. And at that point, they're much more likely to start eating something that is better for them because they've felt better just by this one intervention. So then they start entertaining the idea of possibly buying some cabbage or something that isn't in their...
Dr Rupy: Or broccoli in the morning.
Dr Oyan Panja: Broccoli in the morning. Yeah, yeah, yeah. My buddy Rongan does that, doesn't he? Yeah, yeah. I've and or sometimes it's just the making something more appealing like one of my patients just he loves broccoli, but as long as he's got it with some garlic and some chili, probably a bit like myself, because it just makes it slightly more palatable.
Dr Rupy: Absolutely. Yeah, you've got to you can't just have broccoli on its own. You've got to have it with spices, have it with mustard seeds. There's even broccoli in my book for breakfast as well with chestnut and stuff.
Dr Oyan Panja: No, it's great stuff. So that's what happens at the coal face. And then you can take it as far as you want really because there's a whole other thing, so in the middle of all this is the science, about inflammation, what leads to inflammation. One of the things I'd like to mention as a food group if we're keeping it sort of food focused, are berries and nuts. So berries are really interesting in that polyphenols is a type of compound and berries are very rich in these and they are split into something called flavonoids. I don't want to get too scientific. The great thing about these is a lot of foods don't make it to the large intestine in any way, shape or form. And berries, 60% of them get absorbed in your small intestine. But a lot of the rest of it make it to the large intestine where it directly interacts with your gut flora, and this is one of so it works in lots of ways. They're antioxidants. And again, I'll come back to what that means in a minute because I think that's a word that everyone hears. It's bandied around a lot, isn't it? Yeah, like omega-3, it's like, I know they're meant to be good for me, but um, but also they have a direct effect on gut flora and increasing good levels of bacteria and that is the food for our immune system, most of which is in the gut. They're also antioxidants. And what are antioxidants? I think this is quite important this because one of the big drivers, if you look at non-communicable disease, and I'm hoping people after listening to me drone on about this might go and look up something like inflammation and what causes it. One of the big drivers...
Dr Rupy: And non-communicable disease is just to clarify are things like diabetes, cardiovascular disease, those that you don't pass from one person to another. Although there is some interesting research about epigenetics and how you can actually pass it to your children, but we won't go into that.
Dr Oyan Panja: No, no, yeah. But I mean, you're right, that things that you don't catch from other people, they're not airborne, they're not infectious or contagious diseases. These are not communicable. But going back to antioxidants, one of the reasons I'm mentioning them is that one of the drivers for inflammation is something called oxidative stress. And oxidative stress is if you speak to anyone in the world of preventive medicine, they'll go on and on about this going, oh, that's just the big evil thing. Everything is bad because of oxidative stress. What oxidative stress is is essentially you get these molecules floating around the blood called free radicals, which contain oxygen. And they cause a lot of damage and a lot of inflammation. And what they do is they, in order to for them to survive and cause havoc, they have to steal electrons from other cells in your body. And you know, like they steal things like lipids, fats and proteins. But antioxidants, what they do is they actually give the free radical this electron, but the antioxidant itself stays nice and stable. So just to clarify this, if you eat berries, which contain antioxidants, and you've got these nasty free radicals floating around that cause inflammation, your berries will sort of give the free radical what it's looking for. It's weird, I've got a very visual memory, so free radical makes me think of like some guy with his sitting outside Trafalgar Square, but no, just think of it how you will, but free radical is basically not good for you and drives inflammation. And one very simple thing that will, you know, put a lid on that is if you up your antioxidant intake. And actually, you know, legumes and berries and nuts, they are very rich in those. So a handful of those, as long as you're not allergic, obviously, is pretty essential, I'd say. Almost in terms of food as medicine. I've got to stress, I'm not a dietitian, I'm not a nutritionist, but this is stuff that the science is obvious. And actually the University of East Anglia do a lot of studies in this particular area, which is why I become interested in it.
Dr Rupy: Definitely. And I think the MIND diet specifically recommend, which is the mixture of the Mediterranean DASH diet, they specifically recommend berries because there is so much evidence about it. But first of all, what you said about the freezer, I think freezer berries are fantastic. They're really cheap. You can mix them into smoothies and porridge and that kind of stuff. So it's actually quite accessible to a lot of people. But also you can get these antioxidant rich foods with all the different polyphenols from really easily accessible foods up and down the country, all across our grocery aisles shelves. So beets and tomatoes and all the different sorts of greens. And in particular from the brassica family. So, getting all these amazing isoflavones that you get from broccoli and cabbage and it's quite amazing the science behind all these different items. And when you lump them together, you're really looking at a medicinal sort of food package there.
Dr Oyan Panja: Yeah, absolutely. And people don't think of it like that. And I don't want them to think of it like that in a way because I think it's you can get too hung up.
Dr Rupy: Very prescriptive, yeah.
Dr Oyan Panja: Exactly, and people eat food because, and you're a, your world is doing great things there, I think in terms of what it means to eat and eat together and enjoying food and we've forgotten that a bit in the modern world because we're always in a rush. But yeah, so people don't eat macros and micros, they eat food. And I think keeping things simple and trying to make more whole foods, just even that one thing is a start, timing of meals, we can go further into other interventions like Dale, going back to Dale's work, there's a lot of stuff on supplementation. But actually again, if you look at a lot of the supplements like turmeric, for example, again, very topical, it has to be in the right form, it has to be activated, but turmeric actually binds amyloid and stops it being able to multiply. So that's one of the reasons it helps people with Alzheimer's. And I think it's really confusing for me actually even, but also members of the public because if you pick up a paper, there'll be some story which has it's all well-intentioned like, did you know that India has a very low rate of Alzheimer's and we think it might be because they eat a lot of curries with turmeric. It might be, but how does that help the guy in front of you? That's what it's about. And I think there are some basic principles. So whole food diet, changing timing of meals definitely, keeping your brain active, going back to that neuron, stimulation is really important.
Dr Rupy: Yeah, let's talk a bit about that actually, stimulating the neurons in different ways in which we can improve that sort of plasticity.
Dr Oyan Panja: Absolutely. Yeah. So plasticity, again, just to recap is is more about the resilience of your neurons in a way, how robust they are and how likely they are to survive under hard times, whether that's from drinking too much alcohol or stress or whatever. And we know from, there's an organization in the states called Brain HQ that make a program for cognitive stimulation and they've now got really quite compelling data that cognitive stimulation improves memory, even in people with cognitive decline. And the key is a variety of tasks. If you don't use it, you lose it. And the brain is a muscle in some, not to sort of this is not science talk, this is sort of analogy, but it really is, you can't expect to go to the gym and have big biceps by going to the gym once. And it's the same with the brain. The more you do something, the better you'll get at it. And a lot of it's to do with physical stuff as well. So one of the things I when I'm doing my physical examination, I get people to toe the line with their eyes closed because that and I often get them to stand on one leg and do some cerebellar tests. So this is the hind brain, the bit of the brain right at the bottom. It's amazing how many people can't do it and they're really shocked and you can see them thinking, hang on a minute, I can definitely do this. And they try it again and they can't do it. It's not to scare them, it's just to give me a rough idea of what's going on in terms of their neurological status, are there any early signs of the fact that they might be very, very, very early signs that their brain could be working a bit better. Not that they've got any disease necessarily at this stage, but they've usually come in because they're worried about their memory or because they're feeling some sort of brain symptom. What I'll get them to do is I'll get them to stimulate their vagus nerve, which connects the gut and the brain. And a lot's been written about vagus nerve stimulation as a therapy for various conditions. And so this is the nerve that calms you down, the one that's activated when you're doing yoga or meditating. And it seems to play quite a key role in the gut brain link and so it works it's a two-way street. So if you work the vagus by meditating, it can improve your gut health and if you work on your gut, it can improve your brain health. And it's almost like a highway between the two. So I give them some vagal exercises. Singing is a really good one.
Dr Rupy: Just to talk about singing actually, there was this paper that came out. They examined the brains of nuns who had classic features of Alzheimer's on their brain, but they didn't have any symptoms. Yes, yeah. And they looked at their lifestyle and obviously they had a very simple lifestyle, but they sang a lot as well. And that was one of the activities that they had to stimulate their brain. And obviously you can't put two and two together, but it is quite interesting that we know about this stuff about singing and neuroplasticity and the fact that these nuns didn't have symptoms of Alzheimer's despite having classic features on their brain.
Dr Oyan Panja: Absolutely. And it can be very very simple. It doesn't have to be singing. So I saw a lady recently who didn't really get on with the online type of cognitive training. So there are lots of programs where you can go online and they give you tests that you speed up at the more you do, but she really didn't connect with that. And I realized that actually I'd probably made a mistake in that I hadn't realized that that wouldn't work for her and then I had to ask her about things that she liked and it turned out that she really liked reading. And so what we decided in the end was that perhaps she should read aloud and her husband should read aloud, so he she reads aloud for a book that he wants to, that type of thing. And and you know, she's doing quite well with that. And starting up doing crosswords was something that she really used to enjoy, but over the last few years because they've become too difficult, she's just not bothered doing them. And I think that's sad, when people start adapting their lifestyle and they're not even sure why. So, you know, the benefits can be huge because just by doing the basic things we've talked about, forget the mega doses of supplements and all that sort of stuff, most people don't need that. But just by doing the basics, you will notice that you feel a lot better. I mean, I know on a personal level, my memory is definitely better now than it was five years ago because I've changed a few things in my diet and I do remember the time it really came up for me was when I was going into the BBC and I just couldn't remember my script and I kept having to read these lines and my I was thinking my co-presenter can get them and I can't. What is going on? And actually it was for me it was just a very simple thing of just eating too much of the wrong stuff and I've corrected it. So I felt the power of it myself.
Dr Rupy: And I find these stimulating exercises can be almost a form of mindfulness as well. And that kind of feeds into the stress and that impact on the brain and what we're talking about cortisol levels and how they can affect inflammation, sugar. It's quite interesting how interconnected even these exercises are in themselves. And I think mindfulness and reducing stress is a really interesting tactic for those having brain health issues or trying to prevent dementia going forward, right?
Dr Oyan Panja: Yeah. Oh, completely. I mean, stress, just to stress the point about stress, beyond blood sugar control and beyond any kind of injury to the brain like a stroke, which prevents oxygen from getting to the brain, stress is I would argue the third most important factor. So it's right up there. And the problem with stress is it's not very measurable. It is one of the big illnesses of our time along with Alzheimer's, I think. It's something that defines the era that we're living through. Who's not stressed? But it's a big thing and I do worry for future generations. They're not going to be able to just rock up and live a fairly normal life without actually thinking about how to minimize that. So you're absolutely right. I think being mindful and one of the things I often get my patients to do is five minutes of nothing a day. And they find it really hard because no one ever tells you to do that because it's always like, right from, even now I'm thinking after this, I've got to go and pick the kids up because it's a half day because it's end of term or whatever. But we're always planning ahead and that's not good. You've got to stop sometimes and it allows your brain to just calm down, a bit like sleep is so important for brain regeneration.
Dr Rupy: And leads very nicely on to probably the last topic we're going to talk about, which is sleep, right? It's essential for our brain health.
Dr Oyan Panja: Yeah, you can last longer without water than you can without sleep. And again, it in my days as a young junior doctor, it was a bit of a badge of honor, I started on a Saturday morning and I went home on Monday night. I had a 56-hour shift with about two hours sleep, and they let us drive home. I mean, it was absolutely unbelievable. We were allowed to work in those conditions. But the impact it has on your health in terms of your blood sugar, your hormones, your mood, it's not something you can do. And we've all done it when we were sort of in our early 20s, you sort of, you kind of stay up all night and you're back at your desk at 8:00 a.m. and you can't do that anymore. I mean, I would just physically not be able to function. And so sleep is underrated and it's probably in some ways more important than the food, I'd say, honestly, because it's such a given thing. And because we're all so busy, we don't prioritize it. I've done it myself, I was looking at my phone in bed, which is really bad. I mean, just the worst thing you can do. And I didn't sleep well. I was tossing and turning, I was fidgety, I remember thinking, I've got to be up in four hours time, and now I've paid for it. And maybe I would have got away with it. We didn't have smartphones 20 years ago, did we? But maybe I would have got away with it when I was younger, but certainly, in my mid-40s, it's one of these things that is sending the wrong signal to the brain at the wrong time and that will screw up my hormones. If I kept doing it, my blood sugar control, my hormones would make me inflamed and it would make me develop a non-communicable disease. That's the thing. It's a sort of a process that you can turn the clock back on it just by doing these things a bit better.
Dr Rupy: And from a holistic perspective, it's not just going to impact your brain health, it's going to affect your endocrine system, it's going to put you at a higher risk of diabetes, cardiovascular disease, high inflammation. So we've talked a lot about inflammation. I think it's it's quite a difficult topic for a lot of people to understand because we live in this constant continuum of pro and anti-inflammation. Anti-inflammation is actually very necessary. It's part of our infection fighting system. But I think in modern life, we have this chronic low level of meta-inflammation that is over long periods of time culminates in non-communicable diseases like high blood pressure, diabetes, etc. So it's um, yeah, it's something that we need to probably readdress the balance amongst Western populations in particular. I think we've talked the legs off brain health today. A pleasure chatting to Oyan. I mean, he's an absolute wealth of knowledge and I've basically come up with a few things that I think you can try at home and they basically summarize essentially what we were chatting about. I'd always work with your practitioner every step to make sure your lifestyle changes are relevant and tailored to you. If you're on medication, it's really important to make sure you go through all these different points if you are thinking about any lifestyle changes, just to make sure that everything's personalized. Polyphenol rich foods. So that's something that we find in a Mediterranean style of eating. So that's the greens, the yellows, the purples, all these different sorts of food have anti-inflammatory properties in way of their polyphenols. So we're talking about broccoli, brassica vegetables, cauliflower, tomatoes, these beets and berries, obviously, that's one thing that we did heighten on. The use of spices is really important. So we talked about turmeric, which you can find in my book quite a bit. There's the spice lime cauliflower and sweet potato bake with prawns, for example. But there's loads of other spices that you can use that all have those polyphenols and those anti-inflammatory effects. We're talking about things like sumac and clove and cinnamon. They're fantastic and they add a wealth of aroma to your food as well. Defining your eating period. So eating in a rough 10 to 12 hour window can be effective at giving your body a rest and improving hormone control of your body as well. We didn't talk too much about exercise, but exercise has a powerful effect on our body in multiple different ways, including our brain health. It encourages production of certain hormones, one of which is BDNF, that's brain-derived neurotrophic factor, and that has been shown to improve the neuron health in your brains. Improving sugar control. So you want to have less processed foods as much as possible and less added sugars in your diet. If I was to suggest one recipe that pretty much sums up our conversation from my cookbook, it would be the elegant flavonol porridge. It has whole oats in it, it includes berries, and it includes cacao, which is a lovely chocolate spice that adds a wealth of aroma to your food. Thanks so much for listening. You can find Dr. Oyan at Dr. Oyan Panja and Lobe Medical.co.uk to find out about his amazing project teaching general practitioners and other practitioners how to improve their lifestyle medicine consultations.
