Dr Rupy: We are back again with the supplementation series with Kamal Patel from examine.com. If you haven't listened to part one, I highly recommend you listen to part one and it will give you a bit more context as to where we're coming from and why Kamal is so uniquely positioned to talk about supplementation in general. I'm going to let you carry on with the podcast if you've been listening since part one. Enjoy. I know you've got a whole bunch on the website, you know, supplements for fertility, skin, hair, etc. But I'm not vegan or vegetarian, I eat like 90% plant-based, but I'm constantly asked about supplementation regimes for those who are predominantly plant-based or fully plant-based. Is there sort of clarity on exactly what supplements people should be considering at least if they are 100% plants?
Kamal Patel: Yeah, so most people who are plant-based, either 100% or 90%, know the usual suspects, you know, B12, etc. But the things that are maybe a little bit less known are, there's a few that start with the letter C, so they're easy to remember. And this applies a little bit more if you have a specific goal in mind, like if you're trying to lose fat or gain muscle, but creatine, carnosine, carnitine. Those all start with C. They're relatively lower in people that are vegetarian or vegan or even plant-based. But the other thing is not a supplement per se, but it might be relatively more important to pay attention to the type of fats you eat if you're vegan or vegetarian. And that's because the general consensus 30 years ago was that the reason why eating meat is bad is because of, or 40 years ago was because of the cholesterol. Then 30 years ago it was because of the fat. And now it's really like what type of animal you eat. You know, depending on the type, it could be healthier or less healthy fat. That correlates pretty well to whether the animal was more or less tortured, you know, in a feedlot versus kind of raised naturally or caught naturally. But when you are vegan or plant-based, then you're getting a variety of fats on a consistent basis that are not the type of fat in our own bodies. And that's neither good nor bad. It could be good, bad or neutral, but when you're eating an animal, if it's a naturally raised animal, it kind of mimics the type of fat we have in our bodies. It's a mix of saturated, unsaturated and polyunsaturated. But if you're eating like a coconut, you're getting a ton of saturated fat. And some people who are plant-based eat a ton of coconut. And on the one hand, maybe it's good because in general, cultures that eat a lot of coconut are not super unhealthy. That's a really contentious statement because there's research more so in India about health differences between southern, middle and northern India depending on the amount of coconut fat that's eaten, but I don't really care about that too much because that's all observational. What I'm looking at is that is randomised trials or even animal studies. The coconut fat is good because it's stable and the stability because of the saturated fat is probably okay for our body, but in certain scenarios, especially if you have any gut issues, saturated fat in those high amounts is not good for gut permeability. And that can be extremely important if you have gut issues or autoimmune issues because you don't want things hitching a ride along with those fatty acids to get through your intestinal membrane. So having a ton of coconut oil or coconut milk or whatever is not a good idea in those instances, but having some is totally fine. It's just that that consistent insult to your intestinal lining is not good. And then at the opposite extreme is getting too many polyunsaturated fatty acids, which you definitely can do if you're plant-based. And that's because having a ton of like canola oil or something, sure you're going to get a lot of omega-3s, but you're going to get a lot of other fatty acids that you don't really need. We don't need a lot of omega-3s or 6s, we need a sufficient amount and it's actually pretty hard to force deficiency symptoms in a given person. Back in the day, you know, 50, 60, 70 years ago, it would take months in a study to find symptoms in an individual person if you completely eliminate omega-6s and 3s from their diet. Which goes to show that it's important, but not super duper important. So it's like, if you think about it in terms of the general level of importance for your diet, water is number one. And then at the very back is trace minerals. So, you need a ton of water and the rule of thumb to drink eight cups of water is not true, but it's not a terrible rule of thumb. It's just like walking 10,000 steps a day, it's not true. You don't really, really need that, but it's a great rule of thumb. There is some research. At the opposite, but and just another thing about water, there are a decent amount of people who don't drink enough water and there aren't enough studies, randomised trials on water for this because there isn't funding. You know, water is free, nobody's really going to pay for it. But there are some studies, like there was one a few years ago that showed that they gave a group that drank a ton of water, like 40% less water or something, and they gave a group that didn't drink much water, 40% more water. And the group that, both of the groups had a big swing in their mood that sustained for at least a week or two. And this was a study where they controlled the amount of water they could drink. It was not like a recommendation, they literally gave them the amount of water that they can drink. So that means we more or less, there was some other issue with the study design, I can't remember what it was, but the methodology was good enough that we know for sure there's people whose mood will be improved by drinking more water. That means that if you find yourself at the end of the day being like, you know, I think I drank water, maybe, you probably should drink more water. And then at the other extreme of needing a lot of water is trace minerals. You don't need a lot of trace minerals, but the reason why you might want to consider them is because our soil doesn't have a lot of minerals and we don't drink hard water. And because we don't drink hard water, we don't get the minerals that would have been released by sedimentation. So there are certain observational studies, like there's a county in Texas that has a lot of lithium in their water, which is a trace mineral. And then in a neighbouring county, they don't have a lot of lithium in their water. And the county that has a lot of lithium, or that doesn't have a lot of lithium, has way more suicides than the county that has a lot of lithium. And that would be just random evidence if it wasn't for the fact that that's repeated in several other areas around the world. So it's observational, but it does show some importance. Sure, it could be a different substance in the water or it could be nothing related to the water at all because the evidence isn't that strong. But it does show me personally, like it might be worth it to consider maybe not like supplementing with trace minerals, but just getting more mineral-rich foods because minerals often come together. And then in the middle is stuff like fatty acids. You do need omega-3s and you do need omega-6s, but it's much less important to concentrate on micromanaging those than it is just to get mostly whole food sources of them. Are you going to get canola oil from its natural source? Probably not, because the natural source is rapeseed. You know, and you're not going to eat rapeseed. In fact, it used to be that you couldn't eat rapeseed because it had too much of whatever acid, but you know, olives, yeah, you can tell that you can press it and get fat out, so that's probably not a terrible source.
Dr Rupy: Absolutely. You mentioned earlier actually, collagen, that I just wanted to go back to. And particularly when we were mentioning gut health there. Collagen as a super ingredient, does that actually have any legs when it comes to arthritis or as a lot of beauty influencers are promoting for skin health and vibrancy and wrinkles?
Kamal Patel: Yeah, it's got some legs, but it has, you know, it doesn't have four legs, it has like one and a half. So it's not bad. That's actually really good when it comes to supplements. So the thing is there's different types of supplements and some apply to certain conditions and some apply to others. So for joints, for example, the one that tends to show more efficacy is undenatured type two collagen, which is not that stuff that you would eat in large amounts. So it's not like taking 10 grams of collagen, it's more like, I don't remember what it is, a gram or 400 milligrams or something. So that's undenatured type two. Then there's collagen that is from, you know, bovine or fish, marine sources or whatever. And that's the stuff you would take for skin or for, you know, general health and whatever. And the reason why that might have some benefit is not the collagen in and of itself, probably. It's more so the amino acids that are in it. You know, so it's high in glycine, proline, stuff like that. And the other reason why it might be somewhat beneficial is that generally people who eat meat tend to eat muscle meat only for their entire life and you get a lot of methionine and the amino acids in muscle meat. So there isn't strictly a balance, like a methionine, you know, glycine or methionine, proline or whatever balance, but people in years past would cook in the kitchen and eat meat, except for in Western India, you know, where we didn't eat meat forever.
Dr Rupy: My parents are from Punjab, so we eat a bit of meat, but traditionally, like my dad grew up on a farm, it was vegetarian.
Kamal Patel: Okay, yeah. So, you know, we were at that or one step beyond growing up. So a lot of stuff was centred around the kitchen and plants, but there's parts of India and the entire rest of the world that didn't have that experiment. So, you know, every part of the world ate meat, unless one is very religious and believes that certain Indian people didn't eat meat going back thousands of years. Even our ancestors ate meat. And in those cases, humans developed ways to eat more than just muscle meat. And you would eat cartilage naturally, and then if you could cook, which happened a long, long time ago for humans, you would boil stuff and get collagen. So in that sense, it's natural. Natural is not always good, but it is a good heuristic to think about. Yes, it is natural to get collagen. So it might be worth it for some people to supplement collagen for a limited basis at a relatively low amount. And the thing is, it's actually pretty easy if you make smoothies. And smoothies are healthy. I don't think juicing is necessarily a great idea, but smoothies, it's easy, it's creative, it tastes good. So if you make smoothies, then try adding some collagen for a bit and see if it does anything.
Dr Rupy: Yeah, yeah. I think the experimentation element is definitely there. And I'm definitely on team smoothie rather than team juice. I smooth every now and then as well myself. I wanted to ask about supplementation and contamination. So are there any concerns that you have about certain, and obviously you're not going to name brands here, but just how big the supplementation industry is and how unregulated it is and the potential for contamination that could lead to some serious effects, particularly as most people see supplementation as a regime that you do lifelong.
Kamal Patel: So I know more about the US, you'll have to fill in the gaps for the UK. In the US, it's mostly completely unregulated because of legislation from the mid-90s where it was purposely done to not put too much undue regulation on supplements and make it like drugs. And there's pros and cons. Our party line for Examine is that supplements are woefully unregulated. Personally, I think that's both true and a little bit more subtle because some supplements probably shouldn't be regulated like drugs, but there is a little bit of generally recognised as safe with supplements. Like if somebody wants to take a traditional herb that doesn't seem to have many detriments, fine, or a certain amino acid, fine. But the thing is, there's way more supplements than I can even, you know, I could take two days to count and I couldn't, there's probably over a thousand. So because there's so many, I think supplement manufacturers can more or less do what they want and focus on the bottom line. And to focus on the bottom line, it's good to do things such as not being as strict about batch testing. If you don't do internal testing that much, you can have very high batch-to-batch variability in the amount of active ingredient in your product. Most of the time, it might even out. Like if somebody is taking BCAAs and sometimes it has more or less of the BCAAs as shown in the label, it's no big deal because BCAAs are fine and it'll mostly even out. But let's say you're taking a fat loss supplement. Those things usually can have side effects at higher levels. If you get some pills that have low amounts and some pills that have high amounts, all of a sudden you're encroaching on the like, might have random heart attack space. And one might think, oh, that doesn't apply to me because I'm young and healthy, but when I was in college, I started lifting weights sophomore year of college and I got sort of like a wake-up call because the guy who told me about lifting weights said right away, focus on the library and the kitchen, not on the gym reps and sets. So I got set on a really good path early on and I was doing all this stuff, doing research, going to read the journals in the stacks of the library. And within maybe two months, there was news that a wide receiver on our football team, football meaning American football, had passed away from taking a fat loss supplement. And I was like, whoa, I didn't know about this at all. And I had taken that ingredient. And I was like, well, I need to do more research into this. And the guy who does the most research into it in the US, probably in the world, is Peter Cohen from Harvard Medical School. And he found a lot of batch-to-batch variability in certain types of supplements, like yohimbine, various fat loss supplements. There's a lot of adulteration in muscle-building supplements because if you put a little bit of something that actually builds muscle into a supplement that might not build too much, then people will be like, wow, this really did a lot. But it's not the ingredients on the label, it's the other adulterated stuff they put in. And the last one is generally like every herb that does mysterious things, you know, that helps your energy and, you know, makes you a whatever, tiger in the bedroom. That stuff, way more supplements are adulterated than anywhere else. Actually, the very last thing is, this isn't adulterated supplements so much, but there's an increasing number of older people that go to the emergency room because of choking from larger pills. So a check that I do for people that I know is trying to either split the pills using a pill splitter, if they're those horse pills, or not using big pills at all, either using small pills, like instead of multivitamin, a small D, a small whatever, or using a liquid when possible, because there's liquid vitamin D. Because the last thing you want is, you know, your great-grandmother or grandmother to go to the hospital because she choked on a supplement.
Dr Rupy: Yeah, yeah, totally. Yeah. Actually, in terms of the formulation of supplements, because I've noticed a lot of them have gone spray form, liquid, or even, you know, droppers and stuff like that. Is there any difference in terms of the bioavailability of the products themselves when they're taken or is it pretty much the same?
Kamal Patel: It does depend on the supplement. So there are some where they shouldn't be taken as a liquid. Creatine, for example, you know, that breaks down and storage over time and liquid is definitely not recommended. Whereas like, you know, liquid vitamin D is fine, liquid magnesium is fine. And then I've been meaning to look into this actually. There was a recent trial about like solubilised or something vitamin D that comes in liquid form because if one were to megadose vitamin D, for example, for COVID prevention, then you would want to have a very bioavailable form. Now, D3 is very highly bioavailable, but this study looked at patients with ulcerative colitis where nutrients would not be highly bioavailable. So it used like a micro whatever form of vitamin D. And I wanted to see, check to see if this has been replicated in other studies so I can recommend to people who might have lower absorption for whatever reason. So it does depend on the supplement or nutrient whether liquid is good or bad.
Dr Rupy: Absolutely. Yeah. And in terms of immune health, I'm sure this is probably the number one asked question to you this year, but have you seen, it's a stupid question, you've definitely seen an increase in people looking for immune supplements and immune supporting nutrition. What are the ones that may have evidence for COVID-19 that we know of and coronaviruses in general? We mentioned vitamin D3 already.
Kamal Patel: So the evidence for D3 is, you know, let's say it's like a, I don't want to put a figure on it, but it's by far the highest out of any supplement. And then way below there is everything else because nothing really, really has double-blind, randomised, placebo-controlled trials. So you can try to cross-apply evidence based on mechanistic understanding of other coronaviruses and then think about things like elderberry or zinc lozenges. Actually, those are probably two of the biggest ones. So zinc lozenges because it acts on the back of the throat. So this isn't oral zinc that you would take like a nutrient, this is zinc lozenges that you take and then they act to kill microorganisms at the back of your throat. It's a similar reason why, like I have a friend who works at the US CDC and he works in hospital infection control and they look at grants for copper use. And copper is expensive, but it's, I guess, selectively used in hospitals because it's, you know, antibacterial. And zinc works in a very similar way. And in fact, probably my, you know, my grandparents' parents might have told them like the, I don't know if you have a term for this, the thing that you clean at the back of your tongue with.
Dr Rupy: Oh yeah, I know what you mean, the tongue scraper.
Kamal Patel: Yeah, in Gujarati there's some word for it, but you know, they think that works at the back of your throat. And actually it might, like maybe a copper one does, I don't know, but it could also hurt you, so I wouldn't necessarily use it for this purpose. But so zinc, you want it to stay at the back of your throat for a long time, which means the bigger lozenges, not the smaller ones. And I think maybe zinc acetate has more evidence than zinc gluconate, but I can't quite remember. And then elderberry, it's standardised elderberry syrup that has some evidence for previous coronaviruses. And then everything else really is like random studies about immune stuff. And that can be garlic, that can be vitamin C, that can be whatever, but the evidence is so low for that, I would say it's not that important to think about other than the supplements I've mentioned. Probably the most important thing that I haven't researched yet is my biggest problem, which is not eating too much sugar. Because there is some acute effect on the immune system of a high level of sugar consumption. And I'm going to do a test today, an observational study, where I'm going to have to eat a lot of sugar because it's Thanksgiving and I can't help it. So I hope I don't, you know, nothing happens. Fingers crossed, but yeah, eating a ton of sugar at one time is not great.
Dr Rupy: I've noticed loads of people doing intravenous vitamin C. And there was a Chinese study, I think, that started at the start of this year. I don't know if I haven't come across it published yet, but real like high doses of intravenous vitamin C for ICU patients. I wonder if you've come across any of that, the results of that or anything.
Kamal Patel: Yeah, I don't know if that's been released yet, or maybe not because I haven't seen it, but that's probably overestimating my ability. But I think that was, like lay people read that as they should take vitamin C. And it was not. It was sick people in the hospital. So like people are getting vitamin C and glutathione IVs here. Probably not the best use of money because it is somewhat expensive and the important thing for vitamin C is not your acute level because if you get vitamin C through an IV, it's water soluble and your levels are going to go way up for a while and then down. So what people do who want sustained levels of vitamin C, it's one of two things. There's a prescription vitamin C here in the US that you inject into your butt and that is intramuscular and that releases over time. And then the second one is liposomal vitamin C where I don't, it's not necessarily like longer lasting, but there probably is a little bit better absorption. So you're not going to saturate your absorption. But it's way more expensive than regular vitamin C and regular vitamin C works totally fine. And in fact, vitamin C is either similar to, better than, or slightly worse than sustained release formulations of vitamin C. So vitamin C doesn't have a lot of detriments. If you have found benefit with vitamin C before, I guess it can't hurt to do like a gram a day, maybe two, but megadosing has not shown any benefit.
Dr Rupy: Yeah, definitely. On that note, have you come across any sort of wacky supplements that have kind of stood the test of time without actually having much robust evidence for? Like, are there still things there that are being promoted that actually have really no evidence whatsoever, but they've just sort of permeated into the culture of, oh, you take that because it's good for you?
Kamal Patel: Yeah, I'd say like almost everything is in there. In fact, there's so many I can't, like, a lot of people are taking silver now.
Dr Rupy: Silver?
Kamal Patel: Silver, yeah. So silver as a supplement. You know, that can very easily turn harmful, but people take it anyway. And then there's a bunch of herbs. I actually on the, we get a lot of questions about libido. And there's a lot of supplements there, like horny goat weed. You know, it's actually not like a, I think there's a horny goat plant, so it's not actually like a goat being horny, it's a horny goat weed is the name of the plant. But, you know, evidence is low for that. There's other stuff called like, there's deer antler velvet, which is the stuff on their antlers. It's like, you know, cut off to be a supplement. I don't know. Yeah, there's a lot of stuff and the thing is, there's things that have permeated every area of supplementation and there's not a lot of evidence for most of it. Which I think is mostly fine except for the fact that when there's not a lot of evidence for benefit, there's also not a lot of evidence for detriment. So people don't seem to realise that to only pharmaceuticals generally have large enough trials that are statistically powered to find side effects. Supplements almost never have that. So, yeah, you can take supplements your entire life and never have anything bad happen, but you know when something bad happens because something bad will happen, you'll be like, well, I don't know if it's one of the dozens of supplements I took because I love supplements so much that I never took the time to take one at a time. So don't be that person is my advice.
Dr Rupy: Have you changed your mind on anything? Like something that you were like dead against and actually over the last, let's say 10 years, you're like, actually, yeah, I would consider taking that or I have started taking that.
Kamal Patel: Yeah, I've changed my mind a lot and I think that's one reason why I'm not popular. You know, like aside from the fact that my social media presence is nil because I get addicted very easily, so I try not to post much and then, you know, if I could have somebody post for me and I just never looked at it and I was blocked, I'd be okay. But the other thing is like, I'm so, if you look at it on the, on the glass half full side, you could say I'm very objective and I, if I need to change my mind because the evidence changed, then so be it. On the glass half full side, you could say I'm wishy-washy. So even on like vitamin C and fish oil, I've gone up and down on a bi-yearly basis. So like really every two years. I was up on vitamin C when I found out that, this was like, I was involved in the ancestral health society, the paleo conference stuff, like 10 years ago in the US. And then I started being less involved when I figured out like, hey, like, why were the original paleo authors against potatoes? Like, tubers are paleo. Like what makes sweet potato okay and white potato not? You could say, oh, nightshades, there's various glycoalkaloids in them and some people react and yeah, people, some people do, but I'd say it's like one out of many hundreds or thousands. So I was like, okay, paleo as is sold by most paleo practitioners is not whatever. Like there's cultures that eat a ton of carbs because you can, you know. If you're going to gather roots and tubers, why not? If you're getting a lot of fruit, why not? So I changed my mind on paleo. Then I changed my mind on vitamin C because at first I was like, mammals except for humans synthesize vitamin C when they get stressed, often in many gram amounts. So for humans, because we're under a lot of stress in modern times, because we stress ourselves out, why not take a lot of vitamin C all the time? But then the evidence didn't really pan out for megadoses of vitamin C. And I was like, is it because we didn't test the right things or we didn't test a high enough vitamin C dose? But then I saw people who kept taking higher and higher amounts of vitamin C to bowel tolerance, you know, meaning being on the toilet a lot, and not experiencing a ton of benefit. I was like, I don't know. And then Linus Pauling, the two-time Nobel Prize winner was really pro-vitamin C and he took it and he lived until like 90-something. So I was like, let me try to find out if maybe there's not a lot of studies, but maybe older geniuses took it. Right now, I have no idea. Like I honestly have no idea. And I think there's promise because the right type of studies haven't been designed, yet I think orthomolecular megadose sort of people still overestimate the potential benefits, but I'm undecided.
Dr Rupy: Yeah. Well, honestly, mate, I think it's refreshing to have that degree of transparency and actually just throw your hands up and like, I don't know, because I think that's super humbling and people should respect that. Because it is a, it's a minefield and for someone who is in this industry 24/7, you know, it's, it's as difficult as it is for you, it is for, you know, other people trying to understand the science.
Kamal Patel: Yeah, I think some people like hearing that things are uncertain. Some people hate it. Like there was a, we made a page about our mistakes that we've made over the years.
Dr Rupy: I saw that. I did. I saw that.
Kamal Patel: And we update it every now and then and we got really good feedback and I was giving myself a pat on the back. I was like, good idea. I mean, I stole the idea from another website, but I was like, yeah, way to steal. But then, one day I got an email that said, hey, I really like examine.com, but can you stop virtue signalling? And I was like, hold on, am I, was I virtue signalling? And I was like trying to gaslight myself and I was like, hold on, no, I think I actually did this because it's good to say what your mistakes are. And we get a lot of guys, they're basically always guys. I don't know if you have, tell me what this term means. I only saw this like 15 years ago on Ali G, so maybe you can give me some insight. Do people still use the term C H A V?
Dr Rupy: C H A V. Yeah, yeah, it's a derogatory term. Chav.
Kamal Patel: Chav? Okay. So we have people like that over here and like they write in to Examine all the time. They're like, hey, you know, like I took your advice to take like creatine and I gained like 10 pounds on my bench and whatever, but can you stop virtue signalling, man? Or like, we wrote this page about inequalities during COVID and how like certain people get a greater effect because of income or geographic or whatever and some people face more pollution and that leads to this. And like some guy wrote in and he's like, never thought you would get into politics. And I was like, this is literally not politics. Like, it's just there's so many people being affected. We thought we would write an article related to public health. So I wrote this long-winded reply to him and he just never wrote back. And I was like, you know, I got to like grow a thicker skin because these guys think they know everything. Not just guys, girls as well, but
Dr Rupy: No, I it's it's super annoying, man. And I I totally resonate with that because no matter what you put out there, no matter how genuine and authentic your intentions, we live in a outrage culture where people want to find things that they're angry about. And even if it is that page that is actually, you should be patting yourself on the back. I mean, I know granted it was stolen from another website, but you know, I think that was really, I saw that and I was like, wow, that's such a good thing to do because it it's in the spirit of good science to to own up to your mistakes. And I I yeah, all power to you, man.
Kamal Patel: Yeah, I'm like, you know, sometimes I go through Instagram and I start thinking like, you know, which of these people with the million followers and stuff is thinking scientifically? Like, will change their mind depending on whatever and, you know, like certain clinicians or just lay people who think about stuff, like you should have, I think you have a fairly large amount of Instagram followers and, you know, what podcast listeners and stuff, but you should probably have like five times that many because the people who have five times more rather have people on who are telling people what they want to hear, generally. And I want to hear what, I want to hear what I don't know. Like I don't want to hear, if I'm low carb, I don't want to hear why low carb's good, I want to hear why low carb's bad. If I'm plant-based, I don't want to hear why plant-based is good, I want to hear what I might be missing. But people want to feel good and I get that, but it's like if you want to be healthier, figure out what you don't know.
Dr Rupy: Totally. Yeah, yeah. I mean, that's precisely why like the podcast really is for me a platform to learn from experts who I might disagree with. So, you know, I just had a colleague of mine who's a dietitian and she's a ketogenic diet therapy dietitian. I've had vegans on who are good colleagues of mine who have got, who've gone through the scientific process and rigour to come up with their own opinions. And I think that in a public forum, such as a podcast, is a great way to bounce around ideas and actually educate the audience. So, um, yeah, no, I I really appreciate that.
Kamal Patel: Yeah, and that's, I wish that somebody summarised all these podcasts because that is, it really is, I think, the best way to get information these days. It's no longer reading stuff on the internet. I know like, I run a website that is 100% reading stuff on the internet, but but really the best way to get information is like while you're washing dishes, listening to podcasts. And yeah, if you want to delve more into stuff, go to Examine, but really podcasts, like that's where you get, you know, people giving really novel insight.
Dr Rupy: Well, this is my suggestion to you actually for the company going forward. I think you should actually do it because I would, because I'm a, I'm a, and again, for the listeners, it's, uh, um, uh, what's the word I'm looking for? Chav, is it chav? My conflict of interest is that I'm a, I'm a big fan of Examine and I subscribe to the digest as well that I pay for monthly. But if that was a podcast, I would listen to someone reading out those abstracts that are relevant to me.
Kamal Patel: It's funny, I'm going to write that down because, um, we used to have somebody reading it out.
Dr Rupy: Honestly, you need to do that because I would listen to that, like, you know, if it was 20, 30 minutes long, I would 100% listen to that whilst I was doing the dishes or on my walks or whatever.
Kamal Patel: So here's, I'll ask you this question because, um, you can just tell me what to do and I'll do it. So originally we had somebody read the digest every month and, um, I actually picked a British person because, uh, I think a lot of American accents just don't sound good when you listen for a long time. So we picked this British woman and then, um, we either didn't ask people enough if they listen or we put it in the wrong format. And I feel like maybe we shouldn't have them read it exactly as it is. Maybe we should have like a condensed version or something. And then the other thing we're trying to do is, um, we don't have a YouTube channel for whatever stupid reason, but we're going to make one and just talk about stuff and answer reader questions. And I don't know what the exact format is, but what would you most want to see on a YouTube channel about supplements and nutrition and evidence?
Dr Rupy: I would want to see some of the top articles converted into a YouTube channel. So you should go through all your website at the moment, examine.com, look at your most read articles and convert those into YouTube videos that I would, I would 100% watch and I'm sure everyone listening to this would definitely watch as well. I'd want a podcast version of that. And I think what's what's endearing about podcasts isn't just someone reading it out, it's actually someone having a conversation about it. So perhaps you saying to one of your other researchers, oh, I came across this paper, these were the issues with it, this was the finding, this is why I think it's good, this is how it's contributing to the wealth of other science rather than just the headline. And then the person just having a normal conversation. And then the other one, you know, another thing that's again in the digest because there's a whole bunch of the last, I think it's the last four or five months, I haven't read. I just haven't had the time to sit down in front and just read, even though I'm fascinated by the subject. You know, I'm doing my masters in nutritional medicine. This is definitely something that I would use, but it's, yeah, it's it's very time consuming to read these days. So you definitely need to create your own Examine podcast.
Kamal Patel: Okay, we're on it.
Dr Rupy: You're on that. Good. Good. Listen, I'm going to let you go, but just a couple of questions before I do. And I would love to do this anytime. Honestly, it's such a pleasure to be able to speak to you about this because you're just such a wealth of information. But in terms of going forward, if you could design investigations that could marry up with supplement regimes, um, utilizing whether that be health tech or, you know, bloods or whatever else. I know perhaps you guys don't look into that as much. But what what are the key sort of like trackers or or health tech devices or investigations would you recommend people start thinking about or investigating now?
Kamal Patel: So, um, I've actually thought about this a lot because I used to work with a physician in San Francisco that had a quantified self-tracking program and he was going to make his own app. Um, I think he decided not to, but we had a group of 10 to 20 patients that he tracked. Um, so the first thing is, like generally when people get into it, they overtrack, generally, you know, not everybody, but, um, it's easy to lose the forest for the trees when you have 10 things you're tracking. So starting with one, two or three is usually good. And then the important things are different for different people. It's usually the trigger that causes something bad or the thing that makes you feel good that is good. And, um, one really obvious thing is sleep related. So either if you're going to go at it through like the more hardcore tracking angle, it's if you're wearing an Apple Watch or a Fitbit or even just have a phone and have a program, seeing if you wake up during the night is great because of sleep apnoea. And that's not applying to everybody, but when I used to work at the evidence-based practice centre at Tufts, then we did a systematic review on therapies and prevention for sleep apnoea. And all of that kind of didn't matter because people usually didn't know if they had sleep apnoea. So it's like, you know, we can talk about therapies all we want, but, you know, these there's people out there that need to diagnose themselves. And before you get a polysomnography or whatever, you have to indicate that you might have a problem. So first use a sleep tracker or whatever. And then figure out the one thing you want to try to do before bed, whether that's when you shut off the lights or turn off whatever or not have any electronics. So that's probably one of the most important sleep related things that's also very difficult for people. Um, the second thing is kind of controversial. Some people do awesome with calorie counting and some people it turns them obsessive and makes them into disordered eaters. So it really depends on yourself. Um, calorie counting plus stepping on a scale in various cadences can be good for some people, whether it's once a week or every day, if it's part of your routine, um, that can be great. And for some people, it's not even calorie counting, it's like carb counting or protein counting. Like there's arguments to be made for each one. Protein is so satiating that no matter what diet you have, if you count protein and make sure to hit your personal threshold, like you'll probably be less likely to overeat other things. Um, fat is usually not something that's super important to track independently of other stuff. Um, and then there's other stuff that's just fun to track. Like I know a lot of people like tracking walks and runs. Um, like people who have more money than I do have Pelotons and, you know, sit in their glass houses and and do that all day. Um, but something activity related is great. Uh, and then, uh, it really depends on on what the person wants.
Dr Rupy: Are you wearing an aura or are you wearing a wedding band? I am, yeah. I'm wearing an aura ring. Yeah.
Kamal Patel: So, um, yeah, there's a lot of, uh, figuring out what the best device is. For some people, aura is best. Like it would probably be best for me. I have an Apple Watch that I don't wear, but I don't like intrusive stuff, so I should probably
Dr Rupy: I'll tell you why, like, and this is not, I'm not sponsored by Aura at all. I just genuinely think it's a very good product. Um, and the reason why is because it's so inobtrusive. I look at it once a day when I wake up and that determines how well I've slept and how many times I've woken up and the number of hours will determine the intensity of my exercise in the morning. So if I've had a really bad night's sleep, I'm not going to be doing, you know, a crazy hit workout in the morning because it's just counterproductive for me and I'll feel groggy the rest of the day. But if I've slept well, I'm hitting the gym really hard or, you know, I'm hitting the floor really hard at home. So that that's one of the best ways of using it because I don't wear a watch, I don't like looking at my screen. I try and, you know, minimise my screen time as much as possible and an Apple Watch or something similar would be detrimental for me.
Kamal Patel: I get a little worried about that for Apple Watch because the Apple Watch is really great for tracking, like it's so amazing for tracking everything. Um, but it's really easy to go overboard as well. Uh, like I've seen it for myself and for other people. It's the now that there's the always on option, you can literally track anything. So that doesn't mean Apple Watch or Aura is better or worse or Fitbit is in between kind of, but it really is tailored towards the person, I think what works best. Oh, but the more important than all those things probably, possibly, is um, some people, including myself, yo-yo track. It's like yo-yo dieting, but you track this, then you stop tracking it, then you track more stuff, then you track nothing, and then you hate yourself, then you track more stuff. The best thing is telling somebody, having an accountability partner. And there's some ways to do this that are more formal. Like I think there's a subreddit on Reddit where you can just say, hey, I'm looking for an accountability partner for this or this. Um, you can also ask somebody in your life and there's some services, paid or unpaid, I don't remember, but it can be awesome. Because you can also, like, you can cheat on any of these things. Whether you have an Apple Watch or an Aura ring, um, you can like kind of ditch what you plan to do, but if you have to tell somebody, you can't ditch it. And there's also, um, even for like remote working, there's websites where you have an accountability partner, either like on camera sitting there or you have to report to them. And I think it's awesome because most people only have their GP, but really you should have somebody who knows your stuff and in the US at least, you don't have enough time with patients. So outsourcing the accountability is great. Outsource as much as you can. It doesn't apply to everybody, but some people can really benefit.
Dr Rupy: Definitely. Yeah. I think there's a big role for health coaches within the NHS and certainly if you can't afford a health coach or someone that you you you contact with regularly every week, then just having a friend, a colleague that's just going to have your back and keep you on that straight and narrow. It's it's it's really game-changing. I I feel like I'm a health coach for a lot of my friends. And it was like that what you were saying at the start, like, you know, a lot of my friends are medics and they wouldn't have these kind of conversations with their patients, but as soon as it comes to themselves, they're like, oh, Rupy, I've heard about this in the news. What do you what do you think about keto? What do you think about low carb? What do you think about this supplement? And it's it's funny like that, but uh, yeah.
Kamal Patel: It's funny because then sometimes when the clinician talks to the patient, they're like, oh yeah, keto. Or like, oh no, don't do keto. And they're like, hey, what's going on with keto?
Dr Rupy: Kamal, honestly, mate, it's been such a pleasure. Um, I really want to chat again. I've got so many more things on my list of things to ask you about. You know, I want to talk to you about meditation and general health and well-being and getting out there in nature and all that kind of stuff. Um, but uh, I know it's Thanksgiving. We've been chatting for almost two hours, so I'm going to let you go. But honestly, it was such a pleasure and I'm such a big fan of the site and uh, I can't wait to see where you guys go next.
Kamal Patel: Yeah, it's my pleasure. I'd love talking about this stuff and, you know, I'll bang my fist on the table at some point. So anytime.
Dr Rupy: Thank you so much for listening to today's podcast. I know it was a long one, both part one and two. I'm glad I separated them to give you a bit of space, but to summarise would be quite difficult. But we talked about circadian zeitgebers, supplementation for stress, sleep and anxiety, nootropics, the placebo effect, as well as collagen for arthritis and skin, contaminants in supplements, and where to get good supplements from and how to look at different websites that actually independently verify them. I recommend labdoor.com and specifically for probiotics, the USprobioticguide.com as well. Those are good websites. But also, do go check out examine.com. It's a very, very good source of information and I think you'll find value there. Until next week, see you then.
