Monthly Archives: May 2018

May 28, 2018

The diabetes code with Megan Ramos

Today we meet Megan Ramos and discuss Dr Jason Fung’s book, the Diabetes Code. She co-founded the intensive dietary management clinic with Dr Fung and she's also a co-host with him on the Obesity Code Podcast. They talk about keto, obesity, diabetes, and fasting. It’s really fascinating things they're doing with their patients. I know you're gonna enjoy this. I heard her speak at Keto Fest last year. She's an active speaker and author.

Allan (3:45): Megan, welcome to 40+ Fitness.

Megan Ramos (3:47): Hi, thanks for having me today.

Allan (3:49): I'm really excited to have you here. It's funny, my Internet went down over the weekend and I haven't quite gotten it up, so I'm just putting this through my phone. So I'm hopeful that we can get everything in. This book we're talking about today is The Diabetes Code by Dr. Fung, and you work with Dr. Fung in his clinic so you see this stuff every day. I was driving down the road the other day and I saw this business, and it was a renal care facility where they basically do the dialysis. And I was thinking, how can that be a standalone business? But in some of the stats that were in the book, it's really amazing how many people are affected by diabetes and then go on to have kidney issues.

Megan Ramos (4:38): Almost all of them. I've worked with Jason for 20 years and we co-founded this clinic, the Dietary Management Clinic. It's within our nephrology practice. And over 80% of our patients that come in for intensive dietary management have a diabetic-related kidney disease. It might not be full blown, but they have the early onset of diabetic-related kidney disease. The number every year of people that come into the clinic with diabetic-kidney disease is incredible. When I first started doing research there 20 years ago, diabetic-kidney disease was not as common. The other causes of kidney disease were much more prevalent, but nowadays over 80% of these kidney patients have kidney disease because of their diabetes. This is the most disheartening thing to both Jason and I, was that as diabetes got worse, the kidneys totally failed. And there is nothing as people in the field of nephrology or as kidney specialists we could do for these people.

As the diabetes became more out of control, the kidneys declined and declined and declined, and we couldn't help these people. We were essentially watching them die, or watching their kidneys fail and just telling them they need to prep emotionally for dialysis, and helping guide them through dialysis education and emotional support and connecting them with other people on dialysis. Because that was all we could do for these people. We couldn't help them out. Probably until about five years ago, we had nothing that we could do to help these people. As long as the diabetes got worse, they were going to end up with complete kidney failure.

Allan (6:33): I guess that's what's shocking, because I looked it up – there are about 6,500 of these dialysis centers around the world, and growing. It's a growing industry. But this is mostly a preventable disease. I guess the doctors had always thought this is just a progressive thing that happens. But the subtitle of the book is Prevent and Reverse. So, if someone does have prediabetes or diabetes, there are some things that they can do to deal with those. And that's what you guys are getting into as part of what this book is about. We'll talk about in a minute, but I want to take a couple of little divergences, because there were things in this book that I found fascinating, and they're not topics that people talk about a lot. One of those was the TOFIs, which I know basically means that they look thin, they look healthy, but they have diabetes effectively, or they're close to having diabetes because of their visceral fat. Can you talk about TOFIs in particular, because I think a lot of people think, “If I lose weight or I'm thin, then I'm healthy.”? And that's not entirely true.

Megan Ramos (7:45): No, we spend a tremendous amount of time trying to explain body composition to our patients. Actually, I had a patient in clinic the other week. She was 98 pounds, but her liver was so fat and her pancreas was so fat. She was diabetic. As a result, even though she was 98 pounds, her body fat percentage was way over 40%. So she's clinically morbidly obese, even though she weighs 98 pounds and she's about five foot three. She looks very slender, she's a size zero, maybe a size two on a bloated day. But we spend a lot of time talking about body composition. A lot of the people who follow the standard North American diet have more fat than lean mass. They don't have a whole lot of muscle mass. We’re a very sedentary society here in North America, so we're not as active, we don't have as much lean mass, and our dietary choices too, especially in women, have led to destruction of our bone mass density. And now we're seeing osteoporosis more and more often in men too. So bad food choices, things like phosphoric acid being extremely abundant in a lot of the processed foods that we're eating, are really taking a toll on our bone mass density. So this woman is very petite, but she's just a little sack of fat. It's fine if you’re a certain weight, but the majority of your body is strong bone and good muscle mass that’s going protect your joints and your body and your organs in general as you age. So we try to talk to our patients about how the scale doesn't really matter. Of course you don't want to weigh 500 pounds, you don't want to weigh 600 pounds. But myself, I've been 90 pounds and I've been morbidly obese, and I've been 120 pounds and extremely healthy. So it's really about body composition.

Diabetes originates in the liver, and certain kinds of foods that we eat can make us more prone to developing a fatty liver, and that kickstarts diabetes. We have a lot of these patients come into the clinic, they're very slender and they have an extreme fatty liver and as a result they have diabetes. And they go on to tell me about how they've never really eaten that badly and they don't understand how they had a fatty liver, because they don't drink alcohol very often or not at all. And I say, “You're diabetic because you drink too much soda. You're diabetic because you drink too much fruit juice.” The fructose and the excessive sugar diet cause this fatty liver disease. As a result, you might not have a beer gut with your belly hanging over the edge of your pants, but your liver is much larger than it needs to be, and your liver has a beer gut in itself. So we have to eliminate the organ fat.

There are a lot of people out there that are digitally obese and that are in much healthier shape than the skinny people who have a lot of this organ fat. When you have so much organ fat, that fat's going to prevent your organ from functioning well. We see fatty liver, fatty pancreas, fatty spleen. When you have a fatty liver and it gets so fatty, you start to develop liver cirrhosis, hardening of the liver. Then the liver can't do its job at detoxifying the body, then you have fatty pancreas. We see this all the time now because we have these type 2 diabetics and we see that their liver is so fatty that they can no longer produce adequate insulin to be able to regulate their blood glucose levels. So they end up with very high blood glucose levels and they end up on insulin as a result.

Allan (11:45): Yeah. There was another thing. Like I said, I love these little tangents. Sometimes I get into a book because I think that's where I really learn some things that help me be better at talking with people. And one of them is the Randle cycle. The Randle cycle makes sense to me in a lot of ways because so many people will say, “I want to lose fat”, and then they're eating a low fat diet. But based on what the Randle cycle says a cell can only use sugar or it can use fat, but it really can't use both simultaneously. I think that's a really important fact to put out there, because if someone wants to burn body fat and they're eating a predominantly sugar-laden or carbohydrate-laden diet, they're making it that much harder for themselves, aren't they?

Megan Ramos (12:38): Absolutely. You can't be a sugar burner and a fat burner simultaneously. The hormones that are produced when you eat excessive carbohydrates block fat loss. So you can't be eating a diet that's producing hormones that are blocking fat loss, and actually expect to lose body fat. That's just not how it works.

Allan (13:03): I think a lot of people think, “If I eat less calories total…” There are more calories in fat than there are in carbs. When they want to do the calories in, calories out, it seems to make more sense from a math perspective. But our bodies don't actually work that way.

Megan Ramos (13:21): That's correct.

Allan (13:23): There’s a drug I know that a lot of people will get on when they're prediabetic or diabetic, because they go in, and the symptom and how we know someone is diabetic is effectively blood glucose. They get up to a certain level of blood glucose and they’re said they're prediabetic. And then if they get up to another level, at that point they're called diabetic. A drug that's very commonly prescribed is called metformin. Could you talk about metformin, when it is appropriate to have metformin and when it's not?

Megan Ramos (13:58): Usually we’re not necessarily opposed to metformin in our clinic. It's a relatively benign medication and it does have some benefits that other medications don't have. The risk factor for taking metformin is much lower than a lot of the other medications on the market. But usually at our clinic, if someone is being proactive with their lifestyle and their diet, we usually don't put them on anything. We wouldn't start them on metformin until the sugars went over 10 or 180, or their hemoglobin A1c was over 9. If someone's being proactive with their diet and their lifestyle, so they've gone low carb, they increase the fats in their diet, they're not snacking, they're following a restricted eating protocol – we usually leave them off of metformin.

And we don't actually find it helps a lot with weight loss. A lot of our patients come into the clinic with lower hemoglobin A1c of 6.4, 7.1, and their doctors have told them that metformin will help them lose weight. I've never in 20 years have seen metformin help a patient actually lose weight, and the research out there on that is not very compelling. It's not really great quality research studies to go by. So when someone's blood sugar levels are excessively high… For us there's a certain range that we like to cap our patients under when they're being proactive with their lifestyle, because we do see their blood sugar levels drop really quickly. Cut out the carbs, stop snacking, stop eating late at night, skip breakfast. We see people's blood sugar levels drop by anywhere from 25% to 50% within two weeks, so we really don't engage in metformin until someone's blood sugar level’s over 180 or until their hemoglobin A1c is over 9 in our clinic.

Allan (16:01): Okay. And that's because at those levels now, this is dangerous to the brain and its function, because it needs the blood sugars in a fairly tight range and you're well outside that range at this point. So, a drastic measure like a medication actually does make some sense. And when they make the lifestyle changes, I'm guessing they start to come off the metformin as well.

Megan Ramos (16:23): Very much so. Usually most people who are just on metformin when they start can be off of it within a couple of months of being very proactive and consistent with their dietary changes. When the blood is so concentrated with sugar… Sugar is very pointy, it's spiky, it's like a little ball of spikes. And as it goes through your circulatory system, it has the potential to really scrape and scratch the sides of your blood vessels. When you lose integrity in your blood vessels, you prevent them from being able to expand and contract when they needed to, to allow more blood flow at certain times. So they can no longer expand, and this is where you run into a lot of difficulties. It's okay to have some spiky little balls of sugar go around in your circulatory system, but when you have so much and the blood is so concentrated with it, you can guarantee that your blood vessels are being scratched to heck. At that point when they can no longer expand the way they need to, then you're going to run into a lot of problems and have blockages and put yourself at high risk for stroke.

Allan (17:40): Yeah. Everybody loves simple rules. You can say something like calories in, calories out, step on the scale. It's a very easy number for us to use, and I think people love those simple things. But what I found is a lot of the times simple doesn't actually answer the whole thing. One of the cool things is you've taken the time to write basically three rules, and then there’s a fourth add-on to it, that are fairly simple. They're simple on the outside, but when you actually start drilling into them, it’s very important. In fact, for many of us it’s a huge life change to do some of these things. But I liked the idea that they're simple enough for you to know what the rule is, and then you can start applying it. The first rule that you have in here, and this is for reversing type 2 diabetes, is to avoid fructose.

Megan Ramos (18:39): Absolutely. So fructose doesn't go into your bloodstream. When you check your blood glucose levels, you're checking your blood glucose levels. You're not checking your blood fructose levels. So when you break out your glucometer, you're not measuring fructose. Fructose gets directly imported to your liver. If you give your liver a little bit of fructose, your liver can handle it, and it will process it and utilize it for energy. But when you dump a massive amount of fructose in your liver, it gets overwhelmed by it. And how it copes with that onslaught of fructose is to pump it out as fat and convert it to fat instantaneously. And when it gets so overwhelmed, that fat gets stuck in the liver, because the liver can't process it as effectively as it needs to. So that is the number one cause for fatty liver disease, is excessive fructose.

I was diagnosed at the age of 12 with fatty liver disease and I can tell you that was from excessive apple juice consumption during the first 12 years of my life on this planet. And I was a skinny kid. I was underweight until I was 26, and then I went from skinny fat to just plain out fat at 26. But it's just fructose; it really doesn't reflect in your bloodstream. This is why when you look at the glucose index, you'll see something like a popular mainstream chocolate bar is considered to be moderate, and that's because the sugar that we use is half fructose and have glucose. So if you look at the glucose index, you'll see something like a popular chocolate bar being considered moderately okay. Where something like a slice of bread is one of the top things, being the food most likely to raise your blood glucose levels. The sugar in bread is all glucose, but that in fruits and things like chocolate bars – those are all half fructose and half glucose, so you're only actually seeing half of the sugar that you're consuming with those items when you're checking your blood glucose levels. So fructose goes straight to your liver, it overwhelms your liver, it becomes fat instantaneously, and if it becomes so overwhelmed with fructose, you start to develop fat in the liver as well.

Allan (21:06): We're getting most of this fructose now from soft drinks, and it's a food additive now because it’s very cheap to get from corn, so they have the high fructose corn syrup that they use to sweeten just about everything that's processed. That's where we're getting a lot of this, and from the fruit juices, as you mentioned. This isn't to cry against fruit; there's a lot of nutritional benefits to having some fruit in your diet, but you shouldn't drink those calories as a form of juice, because then you're not getting the fiber and the other things you would be getting from that fruit. Rule number two is to reduce refined carbohydrates and enjoy natural fats. And I like that term, “natural fats” a lot, because I think that's been the struggle. We say “good fats” and “bad fats”, people want to try to define those in different ways. But I like the term “natural fats” because at that point it's very clear what it is. This is from a plant or an animal product and it's something that's naturally occurring. It's not something that you have to squeeze or process to make this thing happen. It’s just there. Can you talk a little bit about how eliminating refined carbohydrates and focusing on natural fats is going to help us?

Megan Ramos (22:25): Absolutely. When you consume carbohydrates, your body has to produce insulin to help you utilize the energy from those carbohydrates. Carbohydrates are large bunches of sugar molecules, primarily glucose. When we can consume a carbohydrate from our mouth, and then continuing down into our small intestine the carbohydrate is broken down into its individual sugar molecules, or glucose molecules, and they're released into the blood. In order for those glucose molecules to get into our cells, they need to be guided there by insulin. You need to have insulin latch onto the glucose and take it to the cell because the insulin molecule knows which cells need the glucose, and the insulin molecules have the key to enable the glucose to get into the cell, so the cell can gobble it up and utilize it for energy.

Our bodies only need so much energy, Allan. We don't need to be eating and constantly refilling our fuel tank, and this is what we do in society. We eat multiple times throughout the day, we're eating refined carbs, we're trying to bombard and completely overwhelm ourselves with energy, and our cells don't utilize this energy. So we have all this insulin and all this glucose hanging around, and then the insulin essentially packages the excess glucose that your cell doesn't need and stores it as body fat to be utilized later. So insulin is a fat-trapping hormone in a sense. Its purpose is to trap this excess sugar and store it for us to utilize later when our cells need it. We’re constantly feeding our bodies nowadays, so we're constantly storing excess sugar energy with insulin’s help, rather than going back and burning what's already been stored and saved to be utilized later on.

When you consume dietary fat though, you get very little insulin secretion. So a fat molecule is a bunch of fatty acids attached to a glycerol backbone. When you consume fat and you're digesting fat, your body doesn't actually need to produce any insulin or any fat-trapping hormones to help your body break down the fatty acids to be able to utilize those for fuel in the body. You do require a little bit of insulin to metabolize that backbone of the fatty acid molecule, but you don't need a whole lot of insulin to be able to get rid of that glycerol backbone. So it's negligible. When you consume fat, you produce zero fat-trapping hormones. There are other fat-trapping hormones – estrogen and cortisol. You don't produce those when you consume fat.

Another thing about fat is that it's absolutely the most satiating macronutrient that we have. When you consume fat, it sends a powerful and rapid response to your brain that you're being fed all this energy. You can actually get satiated off of eating fat before your belly starts to expand. Whereas when you eat carbohydrates, the message that's being sent from the stomach to the brain is very slow. When you eat carbohydrates, you have to wait until your belly is fully expanded, and once that expansion has occurred, that's when your brain starts to receive faster messages saying that you're full. So you get quite bloated and you end up overeating when you eat carbohydrates, because you have to wait for that belly expansion to occur before your brain gets the message that you need to stop eating. You don't need that for fat, so people actually end up eating only what they need when they're eating primarily natural fats. So you don't end up bloated, you finish eating and you're quite satiated before you have to undo that belt notch and undo the button on your pants. That's one of the other great things about eating fat. We tend to just eat the fat that our bodies actually need at the time for energy. We tend not to overeat it because of that rapid messaging that occurs when we consume fat, to our brain, telling us to turn off our hunger.

Allan (27:02): I think another thing when you are eating high fat, low carb, is that you're not as hungry as often, whereas with carbohydrates and sugar, if you have a high carbohydrate breakfast, they now have a term called “second breakfast” that's become very popular. The fast food restaurants are latching onto that by serving breakfast foods later in the day, because they're high carb and it gets people eating another breakfast fairly soon after they ate the one they just ate. It’s insane, but it is what it is. I can't blame McDonald's for wanting to make that money if people are going to take them up on it. The third rule of these three rules and the plus, is actually my favorite, and it's because it's a very simple thing that I think if people wrap their heads around, they're like, “Yeah, that actually does make a lot of sense.” And it is, just eat real food.

Megan Ramos (28:00): Absolutely. A lot of our patients live on government assistance. They're in bad shape. They're given $700 a month to live off of. I can't imagine that, because of the cost of living in Toronto. That’s what I pay to rent two parking spaces a month downtown Toronto. So the fact that they have to pay for all of their expenses with that, it’s astounding to me that they can live off of that. So sometimes buying all these fancier food items that are labeled “ketogenic friendly” or have different stamps of approval on them from for low carb, aren't possible. But eating real food is the most important thing. If you can only afford to eat legumes and lentils because they're more economical, at least they're real food. So really trying to utilize this real food to keep away from the refined carbohydrates, preventing your blood from having this rush of glucose and this insulin surge and really damaging the connection between insulin and your cells in the body.

Allan (29:14): It's one of the strangest things, when I really started getting into food and understanding the foods that I should be eating versus not eating – I go to the farmer's market and I buy a stake. And it's a one-pound steak, which is normally what I would have eaten. That would be my dinner, a one-pound steak. But I get this grass-fed beef and I find that I only need about a quarter of it and then I’m full, because my body's getting the nutrition it needs, it's getting high quality fat, natural fat. So I feel satiated with actually less food, because it's a higher quality product. I know it can seem expensive when you start pricing out what these are, but there are two things that are going to happen here if you can do this, and do this more often than not.

One is, you're going to find that you get satiated by whole food, real food, much faster because you're getting the nutrition your body needs, and then two, if we're out there buying this stuff, the supermarkets are going to start trying to carry it more and more. And you're seeing that now – you can go into the Walmart supermarkets here and you can find higher quality meats, grass-fed meats and local meats in some cases, because they're trying to cater to what the demand is. So just adding one or two of these high quality meals and trying to stay away from the processed stuff I think is going to mean a world of difference.

Megan Ramos (30:46): I agree. The more of us that do it are going to put a lot of pressure on these big corporate organizations to be able to charge this at an affordable price. In Canada, we're a little bit slow on this. Costco every now and then is a bit better, but I've noticed a huge improvement in the States. My husband's American and every year we go down to Florida for a few weeks at some point to visit with his family. It's amazing how in some of the supermarkets down there like Publix, they actually have pretty affordable grass-fed beef and hormone-free, antibiotic-free free range chicken. It's cool to me now that you can see that even at regular chain supermarkets within the United States. It's really neat.

Allan (31:34): Yeah, and that's what I'm saying, I think they're getting on board and realizing there's a demand for this. As we create that demand, we're going to drive these stores to start carrying that type of food. Invariably they compete with the other stores. There's, like you said, Publix here, there's Winn-Dixie and there's the Walmart market. They're all within two miles of each other, so they've got to push for your business and that's going to drive the price down. So again, just eat real food. These three rules will work for the vast majority of us that have walked into your doctor and the doctor's like, “Your A1c, you're prediabetic”, and you're like, “Okay, what do I do?” These three rules are going to work for quite a few of us. But you get patients because of it being a kidney issue – they're typically a good bit further down the line of this, so some of the strategies, some of the things that you have to do go above and beyond these three rules. That's where we get to talking about fasting, both intermittent and in some cases extended fasting. Can you talk a little bit about fasting as a protocol? How someone should go about this and what they should look for, as far as how to do it and the benefits they're going to get from fasting?

Megan Ramos (32:51): In terms of how to do it, it's always very important to have physician supervision or have a nurse practitioner watching over you while you do this, because like I said earlier, we see really rapid reductions in blood glucose levels. We also see very rapid improvement with blood pressure too, even in our kidney patients. Kidneys control blood pressure, so usually when there's so much kidney damage, we can't do anything about blood pressure. But we even see huge improvements with our patients as they start to lose weight, as their blood sugar levels start to come down, with their blood pressure, and so patients will feel very dizzy and unwell. So always have physician supervision, have someone monitoring your meds, go to your doctor if you don't feel well, stop fasting if you don't feel well. You can always start again once your medications have been adjusted. But the best thing to do is just to start off slowly.

So if I have a patient who comes into the clinic who's quite nervous about fasting but has done some research and does understand that there are benefits to fasting, such as weight loss and blood sugar reduction, blood pressure reduction, less medications across the board, improved lipid panels. They want to do it, but they're frightened to do it or they're just someone who's always eaten. When I was diagnosed with diabetes, I probably ate every two hours that I was awake for about 27 years. So the idea of not eating for an entire day… It was just habitual, constantly eating. I ate 30 cups of popcorn every night for probably a good 25 years to satiate myself after dinner time. And it's just habit. You go to make it whether or not you actually feel like you need it. So there are habits that need to be adjusted too, and those definitely take a lot of time.

The first step that we have a patient do is we encourage them to eat real meals. Eat a proper sized breakfast, eat until you feel satiated. Eat a proper sized lunch; again, eat until you feel satiated. We really encourage our patients to start fasting between meals. Sometimes going from breakfast to lunch and lunch to dinner, and then from dinner to breakfast the next morning – that's a huge change for them. Women in particular are terrified of feeling full, because we have chronically followed these low calorie diets that are very low fat and very high carb and if we ever ate to satiation, that meant that we overate and that we didn't lose weight, and that we rather gained weight. A lot of women in particular have been conditioned to think that when they feel satiated, that's counterproductive.

I was one of those women. It took me years and actually seeing that in other patients to realize that was a big part of my own struggle too, was that if you ate a proper meal and you ate until you're satiated, that you had failed because you were going to gain weight. And in the past on a high carb, low fat diet, that's absolutely true. That’s not the case on a low carb, high fat diet. It's quite different in how your body produces these hormones when you consume these macronutrients. When you eat back to satiation, you don't overeat, you don't produce fat-stimulating or fat-trapping hormones – you're in the clear, you're perfectly safe. You’re just going to give your body the adequate amount of fuel that it needs. That's really difficult for women.

So first thing we do is try to teach our patients how to eat proper meals and eat until they're full, and just cut out all snacking. Sometimes that's still really hard for them, so we'll first work on cutting out evening snacking. And that's the biggest vice for everyone we work with, is that evening snacking, sitting around the television with your family or going on the computer and surfing the Internet and having your bag of snacks or your bowl of snacks with you. So the first thing to do is to cut out snacking. Then the next thing that we recommend is that people try cutting out one meal and going down to two meals a day. We usually encourage people to cut out breakfast first, because diabetics will know that no matter what they do, their morning blood sugar levels are always the highest, unless they take a lot of long-acting insulin at night time or a medication such as Diamicron or Glyburide in the evening time, which stimulates a lot of insulin to be produced and secreted by the pancreas throughout the night.

But otherwise, if we're not taking these medications in the evening, our blood sugar levels are high regardless of what we eat in the evening before. So we encourage our patients initially to try cutting out breakfast. At breakfast time our blood sugar levels are high, as a result our insulin levels are high and this is because your liver tries to dump out extra sugar and tries to get you to burn it in the morning time. It's a survival mechanism. You've got excess sugar in you, your body needs to burn it. It will dump it out in the morning time, because historically we never ate in the morning time. In cavemen days they didn't have cavemen cupboards or cavemen refrigerators.

Allan (38:16): Or microwaves.

Megan Ramos (38:18): Exactly. We've evolved to have this process where our body self-fuels in the morning time anyways. When your liver dumps out the sugar in the morning, your pancreas automatically secretes insulin first thing to help your body metabolize and utilizes glucose to fuel you. So your glucose is already higher, insulin is already high, so burn it out, use that fuel. If my car has a completely full tank of gas in the morning, I’m not going to go to the gas station and try to squeeze in more fuel. My gas tank doesn't need any more fuel; it's completely full. It's better that I drive to work in the morning time and do my errands, and then later on in the day when my fuel tank is no longer full to add some fuel to it.

So that's what we encourage patients to do next, once they've sort of mastered the eliminating snacking and eating proper meals, is just to cut out one meal and then see how they're feeling, see how their bodies respond. Usually by this point we can gauge whether or not they're going to be a quick case or a more challenging case. It's hard to predict because there are some people with very stubborn insulin resistance who were only diagnosed with diabetes a few months ago, and there are some people who are actually quite quick to respond to therapeutic fasting, even though they were diagnosed with diabetes before I was even born. So we gauge this. We use the 16/8 diet, which is where you just eat lunch and dinner, we gauge how well a patient will respond. From there we would either recommend an intermittent fasting regimen or a prolonged period of fasting. Of course that depends on the patients, how they're feeling about fasting – if they've decided to develop a good relationship with it, if they're willing to try to do a little bit more.

If someone looks like they're going to respond quite well to fasting and they're going to be able to come off their medications quite quickly and see a good reduction in weight loss in a short period of time, we would have them do an intermittent fasting regimen anywhere from three 24-hour fasts a week to three 42-hour fasts a week. So, the therapeutic intermittent fasting regimens we recommend are 24 hours, 36 hours or 42 hours. And the frequency at which we like our patients to do them is three times a week. We've experimented; three times a week gives us the best overall results. Sometimes twice a week is just not enough to give us consistent results or give the patients enough results that really motivates them to continue fasting. But three times a week seems to compensate for any blemishes they might have in their diets on the weekends or when they eat out on Friday nights. So we have stuck to this three-time-a-week rule for the last five years and we've had a lot of success with it. So we start someone out with 24 hours with the goal of working them up to doing a 42-hour fast three times a week if they're suitable to do so. We'll keep them there until they start to hit normal blood sugar ranges, normal fasting insulin levels and normal A1c. Then we start to bring them down into more of a maintenance range.

If someone looks like they're going to be more of a stubborn case in terms of losing body fat or reducing their blood glucose levels, we’ll try to work on more prolonged periods of fasting with them. This could be anywhere from doing two 48-hour fasts a week or a 72-hour fast a week to sometimes doing five to seven days. We usually cap patients at 14 days within our clinic. The odd time we have a patient that will surpass 14 days. Usually at that point we're checking their bloodwork once or twice a week, we're seeing them in clinic twice a week. So we get to know them pretty well in a short period of time. We just had one gentleman, I saw him last Thursday and he was on day 26 of a fast. And his A1c had come down from 13 to about 11, and his blood sugar levels in millimoles per liter were 14 when he started and he had finally broken the double digit barrier. So after 26 days of fasting his sugars dropped to 9. That's just a little bit below 180, I believe. So sugars were still that high and he was actually taking a little bit of insulin still. I joke with him and I say he's the sweetest man I've ever worked with, because his body is just full of sugar. And he's quite slender; it's all in his organs. It's all visceral fat.

Allan (43:15): I think there's a couple of key things here. One, this is not a protocol that you just up and do yourself. You work with your physician, because if you're on certain medications, those medications will very likely have to be adjusted at some point in there and you don't want to be in a situation where you've done something and your physician's not available to know that you're doing that, to guide you through that process. So, it is important to involve your physician. Then the other question I had was, as you're putting them into these fasting protocols, is this just them drinking water, are they taking any kind of electrolytes? I know some folks have used bone broth while they're on a fast. What is the protocol you're using most with your clients?

Megan Ramos (44:01): For people who are just looking to lose weight and for those who are trying to combat metabolic syndrome, diabetes and obesity – we do permit them to utilize bone broth – not unlimited quantities of it. If they're doing a 24-hour fast or even less, like 16 or 18 hours of fasting, we usually ask them to try to do the fast with just water, if they can. Usually bone broth we would recommend to someone who's doing 36 hours of fasting or longer, and no more than about one or two cups a day at most. We definitely recommend bone broth once a day for our patients who are doing longer than three days of fasting. That's sort of a guideline. Sometimes our patients choose to ignore us, but we make them sign a form saying they're ignoring us. The purpose for that is to prevent refeeding syndrome and to make sure that they are getting in phosphorus and magnesium and calcium when they're fasting.

But for shorter fasts, it's not much of a concern. Most of us nowadays, especially us who are obese and who are combating diabetes – we're not malnourished. We have too much excess body fat, we’re too nourished – that's why we’re struggling. For most of our patients with metabolic syndrome, we do recommend a bit of bone broth. We do let our patients have about three to six cups of coffee a day if they don't experience a glucose spike from drinking coffee. Some of our patients do, even with decaffeinated coffee, it's very bizarre. But I'd say most of our patients can consume coffee. About 10%-20% of them have quite a large glucose spike, so we'll take them off of coffee. They're allowed to drink herbal tea and water – flat water, mineral water or carbonated water. So that's what we use for metabolic syndrome.

We do treat patients with various neurological conditions and some cancer patients, and for them we focus on shorter bursts of water-only fasts. We don't do longer fasts with these patients, because we're trying to induce autophagy in these patients to help kill cancer cells and repair their mitochondrial function. We need to have some nutrient deprivation in order to induce that. We don't know if too much autophagy, too much of the cellular regeneration is a bad thing, so we do these shorter bursts of water-only fasts. And another reason why we keep them short is to, again, prevent refeeding syndrome in cancer patients. A lot of these cancer patients have already lost a substantial amount of weight and they're not as hungry, and there's lots of nausea associated with chemotherapy treatments as well. We try to keep them short, so there's lots of refeeding in between each round of fasting, just to prevent any issues when they are fasting.

Allan (47:06): Okay. Again, the book is called The Diabetes Code. I learned so much, and I do every time I read one of Dr. Fung’s and your books. It's fascinating, the tidbits here. But I think if people do follow those three basic rules… And whether you have diabetes or not, they're still really important rules for you to function by, so that you keep from getting diabetes with our current food supply. Eating real food, avoiding the processed stuff and cutting out fructose, particularly in your drinks, like apple juice, like you said, and sodas. If someone wanted to learn more about you, learn more about the book, where would you like for me to send them?

Megan Ramos (47:50): People can check us out and learn more about Dr. Fung and myself and all the work that we're doing up here in Toronto on our website. Our website is IDMProgram.com. There's information about our podcast, our books (The Diabetes CodeThe Obesity Code, and The Complete Guide to Fasting, where you can get more information, what we're doing, clinic-recommended resources, as well as our program and how our program works, up on our website. And there's links to following both Dr. Fung and myself and the rest of our team on various social media platforms, like Facebook and Instagram and Twitter, up on IDMProgram.com as well.

Allan (48:29): Okay, cool. This is episode 321, so you can go to 40PlusFitnessPodcast.com/321, and I'll be sure to have a link there. Megan, thank you so much for being a part of 40+ Fitness.

Megan Ramos (48:42): Thanks for having me on, Allan. It's great to talk diabetes code with you.

Allan (48:46): Absolutely, thank you.


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How to make disease disappear with Dr. Rangan Chatterjee

Our guest today has the mission to help 100 million people feel fantastic by returning them to optimal health. That's a big one. He's The star of the BBC one show Doctor in the House. He has practiced medicine for over 20 years and he wants to help simplify health. I think he's done that with this book, How to make Disease Disappear. Here is Dr. Rangan Chatterjee.

Allan (1:57): Dr. Chatterjee, welcome to 40+ Fitness.

Dr. Chatterjee (2:00): Thank you so much for having me.

Allan (2:01): I am so happy to have Dr. Chatterjee here. His book is How to Make Disease Disappear. And the reason I really liked – and I know I say I really like a lot of books, and I really do. But this book is special because it puts a lot of medical stuff out on its ear a little bit, because it actually gives you the understanding that you can reverse a lot of the diseases that we’ve come to accept, like diabetes, and heart disease, and Alzheimer’s. There are some opportunities for us to basically reverse and in some cases potentially cure ourselves of these diseases, and hopefully through what’s in this book give people tools to make sure they don’t get these diseases going forward. Dr. Chatterjee, thank you so much for being a part of the podcast. And again, I want to thank you for this book because it’s very actionable. It’s something that I think anyone can absorb and get a lot of benefit out of.

Dr. Chatterjee (2:57): Thanks for having me. I’m delighted to have the opportunity to share some of my ideas and my philosophy with your listeners because this really matters. You look around you, I can see it in the UK. But I was actually in the US last week and it’s even more noticeable when I’m in the US that people are struggling with their health. Whether it’s obesity, Type 2 Diabetes, mental health problems, the list is endless. And the reality is that the majority of them – not all of them, but the majority of them are related to the way that we are in some way living our collective modern lifestyles. I’m not putting blame on people. I’m not saying people are doing it to themselves. What I’m saying is that actually the modern world, the modern living environment for many of us, makes it very challenging for us to make healthy choices. My book really is to try and give people an actionable plan, a blueprint if you will, for how they can live well in the 21st century.

Allan (03:58): There’s a concept you bring up at the beginning of the book, and I really like this concept. When we go to the doctor and we think of going to the doctor, it puts a lot of that into question in my mind, because it makes sense to me what they’re doing is they’re looking at a symptom – like you have Eczema, so I’m going to give you a cortical steroid lotion or cream. Or you have depression, so I’m going to give you an antidepressant. So they’re basically saying symptom equals solution, but we’re a little bit more complex than an if/then statement. We’re a system. Can you talk about how we’re a connected system and how that works within your paradigm?

Dr. Chatterjee (04:41): I think that’s a great point. The underlying premise of the whole book is that we are interconnected. Every single system in the body influences another system. For far too long we’ve looked at these things in isolation. I’ve been a practicing MD now for nearly 20 years. I’ve seen tens of thousands of patients. Over my career I’ve really had to progress my understanding, because earlier on in my career I was using a lot of drugs. I was suppressing a lot of symptoms with medication. I’m not necessarily saying that that’s a problem. The problem is if we don’t also explain that there may be something that we can do to help get rid of the problem in the first place. And I think that comes down to the fact that the medical establishment has been set up in an era very different from the era that we’re living in today.

Fifty, sixty years ago, the bulk of what we saw as medical doctors was acute disease. Acute disease responded very well to this sort of approach. A little bit like you have a chest infection. A chest infection is the overgrowth of a bug in our lung. The doctor will usually give you an antibiotic, something basically to kill that bacteria. The bacteria goes away, the chest infection goes away, and you no longer have your problem. We’ve tried to apply that kind of thinking to these chronic, degenerative diseases such as Type 2 Diabetes, heart disease, and obesity. And the reality is that these things don’t respond very well to that single-bullet approach because many of these modern, chronic diseases have at their core lifestyle choices that people have made.

I have put those lifestyle choices into this four-pillar framework because health has become incredibly complicated. I think a lot of people out there sort of know what they should be doing but they’re not doing it. So why is that? My view is that we’ve got to simplify health. The core rules of good health haven’t really changed. They’re the same today as they were fifty years ago, a hundred years ago, a thousand years ago. What has changed is the modern living environment. What I’ve really tried to do is to say, if you make small changes in these four key areas – food, movement, sleep, and relaxation – you get really big outcomes and really big benefits for your overall health. And this is the approach that I take with my patients.

I’ve done quite a few prime time documentaries on BBC, where I’ve used the same approach to help people get rid of diseases such as Type 2 Diabetes and Fibromyalgia, and even reducing weight by 70 lbs. So I’m very passionate that all the listeners who are listening to this podcast think about those four pillars and try to think about their own lives. Identify the pillar that needs the most work and start there. I think that’s how you get really quick, but also sustainable benefits.

A lot of patients that I see, their actual diet is pretty good. They’ve read a lot of blogs, they’ve made a lot of changes, and they come in to see me. They get frustrated. “Maybe I need to cut out this little bit of sugar here” or, “I go out with my friends on a Saturday and maybe I should just eat in every single day of the week.” And I think, “Hold on a minute. If we look at this four-pillar framework, your food choices are actually very, very good. What you need to do now is look at one of the other pillars.” Rather than trying to max out and get the very best and the most perfect diet that you can think of, I’m more about saying, “Your diet is good enough. You’ll get much more benefit by focusing on getting to sleep one hour earlier each night than you will trying to make a 5% improvement in your diet.” That’s how my approach plays out in reality for people.

Allan (08:41): You had a concept in the book, and you talked earlier about how people might not be recognizing the problem. I think one of the core concepts in your book – you call it “threshold effect”, is that there’s going to be a point when all of these different things that we’re not focusing on across the four different pillars – they’re added, they’re basically going to accumulate over time. So we see our friend and our friend is fine. They’re eating the same foods we are. We don’t know how well they’re sleeping, we don’t know how much they’re moving, and we don’t know how their stress level is relative to ours, but what we outwardly see from them is they’re living the same lifestyle we are. We don’t understand why we’ve gained 30 pounds and they have not. Can you talk a little bit about this threshold effect and how that actually is the point where we start to recognize a problem?

Dr. Chatterjee (9:34): Absolutely. I think this is a really key concept for people. This is the idea that as human beings, we’re incredibly resilient and our bodies can deal with quite a lot of stress before we start to show symptoms or signs of any disease. What I mean by that is, let’s say you were born in optimal health. And I guess we can’t make that assumption for everyone, but I think for most of us, we start off life in a pretty good place. We can deal with multiple insults. It could be a poor diet for five or ten years, it could be bullying at school, it could be the fact that we’ve sat on the couch a lot and not been very active since we’ve left college, and we’ve just started working and we just come back and sit on the sofa every day.

It could be the fact that we think that we can kill it really hard at work and actually stay up late watching Netflix every night and get by on four hours of sleep. But what we don’t realize is all of these things start to add up and accumulate. Just because you’re not showing symptoms, it doesn’t mean everything’s okay. And what tends to happen is that we’re getting closer and closer to our threshold with every new insult that we have to take. And then what happens is that something new happens. Let’s say we lose our job, or our girlfriend leaves us or something like that. That’s a stress onto the body and it tips you over your threshold. We often don’t think at that point, “That was the thing that got me ill; before then I was fine.” The point is, before then you weren’t fine. You were very, very close to your threshold, but that was the final piece that pushed you over.

It’s a little bit like if I’m in the room where I’m sitting now, if I try to juggle a ball, two balls, three balls, four balls, and if somebody lobs in a fifth ball, suddenly everything falls down. Back to the human body, especially with these chronic complaints that I’m seeing day in, day out in my practice, these things aren’t just down to one thing that someone’s perhaps not done to the best of their ability. This is a combination of lifestyle choices and factors over the years that have mounted up, and now it’s causing a problem. And when you get to that point, you almost have to start from scratch and rebuild everything.

A few years back I used to think nutrition was everything. I really did. And I maxed out with my nutrition, I used to do that with my patients. And it’s not that I think nutrition is unimportant, I just realized that it’s not everything for everyone. There are four core components of health that we have some large degree of control over – food and movement, sleep and relaxation. I passionately believe that when you actually take that rounded approach and do a few simple achievable things in each area, that’s when you get the long-term benefits. I don’t know if any of your previous guests have spoken about low carb diets at all. Has that come up on your show before?

Allan (12:25): Yeah. I spent a good portion of the year in ketosis, kind of seasonal ketosis. I don’t have any metabolic problems or any other issue that I think I should use it as a treatment. I just feel better when I am in a low carb, but I know that there are periods of time when I’m going to want to be with family, go ahead and have some beers with the guys while we’re watching football – that’s American football in this case, and there’s a season for that. So I go through that season as my feasting season, and after my feasting season ends with the New Year, I start working my way back into more of what I’ve called “famine” scenario.

And you talk about micro fast – it’s one of the things in there, but I look at what my ancestors would have gone through living in your part of the world – northern Europe. I’m not going to have access to tropical fruits for most of the year. In fact, in UK, unless it’s shipped in, you probably don’t have any tropical fruits. So just recognizing that my ancestry is from that part of the world. Tropical fruits and high sugar things are probably not something my body tolerates very well. And I find that if I can cut my sugars down relatively low, I do feel much better.

Dr. Chatterjee (13:44): Yeah, that’s incredible. Obviously you’re in tune with your own body and you’ve experimented and figured out what works for you. And that really isn’t a million miles away from what I’m trying to do with people with my book. It’s really to help show them how small changes can very quickly become new habits, and these new habits can become your health. Once you understand them, you can be empowered to make those choices. There’s nothing in the book where I’m telling somebody what to do, because that’s not really my approach as a doctor. I think if I told someone what to do, they might do it for a week or two weeks or three weeks, but then they’d get bored. What I’m trying to do is give them the science, give them some case studies and show them how that’s helped patients of mine, and then give them a choice.

So the way the book is structured is there are four pillars, so 25% of the book is on each different pillar of health – food, movement, sleep, and relaxation and relaxation. In each pillar there are five chapters, and each chapter is a suggestion. It’s not a prescription; it’s a suggestion. And four times five is 20. That means there are 20 suggestions in the book. I don’t expect anybody to do all 20. In fact, I think it’s going to be incredibly hard in the modern world to do 20. What I say is the majority of my patients need to do about two to three in each pillar. I think that takes the pressure off, because if one of the chapters, if one of the suggestions I’ve got doesn’t resonate with you and you think, “I can’t fit that into my life. That’s not really for me” – fine, don’t do it. I’m not trying to tell someone what to do. If that’s not going to work for you, fine. Move on to another one and find the recommendations and suggestions that you naturally resonate with and think, “Yeah, I can fit that into my life almost immediately.”

I think that’s what makes my approach slightly different. There’s not hard and fast rule. It’s very much about treating the reader like an adult and a partner and saying, “This is what’s going on. This is how some of my patients have been helped. What do you think? Is it worth a try?” The example I was going to bring up just before we went off on that low carb and you shared your experience with ketosis was, I’ve never been a huge fan of the term “low carb”, and the reason I’ve never been a fan of the term, even though I do use what would be considered that approach with some of my patients, particularly those with Type 2 Diabetes or insulin resistance, I think the quality of food very much determines a lot of its health benefits to the body.

Allan (16:13): Say that one more time please. I really want the listener to hear that statement because that is gold.

Dr. Chatterjee (16:21): I’m basically saying the quality of food is so, so important. If it was only about carbs, we have to be able to explain why in Okinawa in Japan they eat an 80% high carbohydrate diet, yet they don’t have Type 2 Diabetes and they don’t have all this degenerative disease that we get in the West. And one of the reasons is that the carbs they are having are very nourishing. It’s a lot of locally grown sweet potatoes that actually nourish our gut microbiome, which are the trillions of bugs that live inside us. So healthy microbiome often leads to positive health outcomes. The other thing we forget about sometimes is that those guys in Okinawa are also very well-slept, they’re physically active and they have low levels of stress, and they’ve got a very strong sense of community.

So it’s very hard to just look at their diet in isolation. I absolutely agree in the West, where we are under-slept, overstressed, physically inactive, and where we’re eating a lot of highly processed junk – a lot of it is highly processed carbs – there’s no question that what would be considered a low carb diet seems to have a really powerful benefit with so many people. But I speculate in my book, I try and take people through the science on both sides and say, could it be that there’s a particular role for this sort of low carb diet here in the West? In Okinawa, they actually find a way not to cross that threshold; another way. Does that make sense?

Allan (18:03): Yes.

Dr. Chatterjee (18:04): Health is a result of multiple things. I think looking at these four pillars, it’s a really great way to actually look at your own health. It’s not too big. You could easily make these six or seven or eight pillars, but the reason I chose four is I wanted this idea to take off and I want people to get their head around that. I’ve got an example of a patient who I saw recently, who had Type 2 Diabetes. And they had been reading blogs. In fact, they read one of my blogs on how a diet low in refined and processed carbohydrates can be helpful. And they have gone and changed their diet. Their blood sugar was getting better, but it had plateaued. He was a business executive. He was stressing out over his carbohydrate intake; he was pushing it further and further lower. He said, “I can’t understand why my blood sugar is not coming down any further.”

We used this four-pillar framework on him, and identified that he was highly stressed, he never had any time off, he’s a busy executive, and that stress was also leading to him not having good quality sleep. And I said to him, “I actually think it’s your stress levels and your lack of sleep that is keeping your blood sugar high, rather than your diet.” So I actually eased him off his diet. We increased the amount of carbohydrate he had. The refined and processed carbs were still low, but I increased the amount of carbohydrates he was having. We put into practice five minutes of meditation every day to help with the stress management. I said five minutes a day. I wasn’t talking about half an hour, crossed legs, saying “Ohm”, sitting in the corner. He had a one-hour wind down routine before bed, and we did a couple of other things around sleep and relaxation. And within four to six weeks his blood sugar started to drop back down to normal.

This is the point I’m trying to get across. We’ve become far too reductionist about health. Even in the lifestyle medicine movements, we are overly focused on one area. I genuinely feel that when you focus on all four areas, but you take the pressure off yourselves so you don’t need to be perfect – you don’t need the perfect diet or the perfect gym routine; you just need to do enough in each area – I think that’s where the magic happens.

Allan (20:24): In the book you had said something to the effect of, if they had two in one pillar in four in another pillar, they would do better to spend some time in the two pillars that they haven’t done any work in than to try to get to that fifth item in any of two pillars. I think a better math would have been to say the first one in a pillar gives you five points, the second one gives you four points, so there’s a diminishing return. Go to a different pillar – you’re going to get five points, versus the diminishing return you’d get staying in the same pillar. A good distribution process across all of these pillars is going to probably do you more good than trying to stay in one pillar.

Dr. Chatterjee (21:09): I think that’s a fantastic idea.

Allan (21:12): I’m an accountant by trade. It’s what I started out as, so when you give me a math problem and want me to gamify something, my head’s going to go there pretty quick.

Dr. Chatterjee (21:20): I think that’s a great idea. That really gets that concept across really well, that it’s about that balance. I’ll give you an example. The “Eat” pillar is the second pillar in the book, and I did that on purpose. I think a lot of people in the UK would have expected me to start with food. and I think relaxation and stress is very much undervalued in society, which is one of the reasons I started the book with that pillar. One of the recommendations I make in the “Eat” pillar is, if you have tried in the past to change what you eat unsuccessfully, perhaps you should start with changing when you eat. It’s this idea of, can you eat all of your food that you’re going to eat within a 12-hour window? That could be 7:00 in the morning until 7:00 in the evening or 8:00 in the morning till 8:00 in the evening. You can choose as to what fits your lifestyle.

A lot of this research comes from studies that Dr. Satchidananda Panda in San Diego has been doing at the Salk Institute. Lots of these so far have been done in animals, I do accept that; although human trials are underway in the early results are very, very promising. It’s this idea that actually if all you do is compress your eating window, and let’s be honest, 12 hours is doable for pretty much everyone; there are very few people that won’t eat all their food within a 12-hour eating window.

Allan (22:43): All it really means is if you get a good eight hours of sleep, which is one of the other pillars, then you’re only going to be awake for four hours that you’re not eating. So that can be two hours before you start eating, after you wake up, and two hours before you go to bed; or it can be you stop eating four hours before you go to bed. It’s just what fits your lifestyle, but that’s a very doable intermittent fasting window.

Dr. Chatterjee (23:12): It’s very doable, and we know that you can have lower levels of inflammation, better blood sugar control, improved immune system function, you can lose weight, improve your mitochondrial function. All kinds of things have been reported, benefits of this kind of intervention. Here’s the key for me. A lot of people say, “I can do the 12 hours, so can I get more benefit if I move that down to 10 hours?” Or move it down to eight hours or six hours. And here’s where my approach probably is slightly difference. I say some people can, there’s no question. But for me, if you can eat all your food within a 12-hour eating window, give yourself a tick and move on to another pillar or move on to another suggestion, because my approach isn’t about maxing out in one area.

I see this all the time. I see this on social media, I see this with many of my patients. If they’re into food for example, they want to go all in: “How much better can I make this? Can I fast for 16 hours a day? Can I make my diet 2%, 3%…?” Meanwhile, neglecting the fact that they only get four hours sleep a night, neglecting the fact they’re glued to their smartphone from 5:00 AM till 1:00 AM. My point is trying to say that is good enough for me. For most of my patients 12 hours seems to be good enough. I get it – some people will say, “When I make that smaller, when I make it an 8-hour eating window, I feel fantastic.” Of course, there’s always going to be that trial and error that we can do, but the primary focus of my approach is to say 12 hours is enough. Let’s focus on something else now and give you that really rounded 360 degree approach to health.

Allan (24:50): I’m working on a book myself, and one of the concepts I put in the book is a story of this professor who brings out these big rocks, these little rocks and the sand. And he tells the class that they can get all of that into this particular jar, and he tasks them with doing so. And they try several different ways. They can’t seem to get all the big rocks, little rocks and the sand in that jar. And he comes out and demonstrates by putting the big rocks in first, starting to put in the little rocks and shaking them to a point where they settle, and then putting the sand in and shaking it to a point it settles. You chain effect to get all of that in there, but it takes a methodology. The core of that methodology is to focus on the big rocks first.

As think about your four pillars, it’s like I might have a bigger rock in my relaxation / stress pillar than I have in my food pillar, because I’ve already done all the big rocks in my food. So moving onto the stress one and actually focusing on a big rock is going to give me a lot more benefit than trying to deal with the sand that I have left in the food area.

Dr. Chatterjee (25:58): Absolutely.

Allan (26:00): We’ve talked a little bit about food, as far as looking at an eating window, we’ve talked a little bit about stress from the perspective of your client that incorporated some things about his meditation. And you talked a little bit about him having a ritual beforehand of about an hour getting ready for sleep. Could you talk a little bit more about that one?

Dr. Chatterjee (26:24): Sure. Why do you start with sleep? There’s no question, we’re in the middle of a sleep deprivation epidemic. About a year ago, some scientists from Oxford University came out and said that they think we’re sleeping one to two hours less per night than we were 60 years ago. That’s incredible because in the context of an eight-hour sleep cycle, we may have lost up to 25% of our sleep. I think that’s absolutely incredible. When we think about what happens when we sleep and the potential benefits of having a good night’s sleep, we know in the short term we have better energy, better concentration, our relationships with those close to us and our work colleagues and much better. We crave better foods when we have slept well.

But long-term as well, we know that a lack of sleep is associated with pretty much every single chronic disease that we’ve got, whether it’s Type 2 Diabetes, obesity, even Alzheimer’s disease. Matthew Walker is one of the world’s premier sleep researchers recently, and he said there’s pretty compelling evidence that a lack of sleep may be causative for Alzheimer’s. If that’s true, it’s just incredible how much we undervalue sleep. The crux of the matter with sleep is that for the majority of people who are struggling with their sleep, they are doing something in their everyday lifestyle that they don’t realize is affecting their ability to sleep at night. I think it’s a really important point to hammer home. Yes, primary sleep disorders like obstructive sleep apnea do exist, there’s no question. But I’m saying that the majority of people who I see in my practice or when I go around the country in the UK speaking – the majority of people who want to improve their sleep can do so by changing various aspects of their lifestyle.

I mention something that I call in my book, the “No tech 90” – this idea that for 90 minutes before bed, can you switch off your modern tech? If 90 minutes is too much, start with 10 minutes. Build it to 20 minutes, 30 minutes. I’m not too prescriptive, but I think 90 minutes is a really good thing to aim for. And there are two reasons why that works so well. The first reason is because a lot of these electronic devices like smartphones and tablets emit a form of light called “blue light”. If you go out in nature, blue wavelength light is only really seen in the morning. So your body’s used to seeing it in the morning and we’re not really seeing it in the evening. What happens is if we’re looking at our devices in the evening, that blue light is sending a signal to your body that it’s daytime, and it can reduce quite dramatically levels of a hormone called Melatonin.

Melatonin is a sleep hormone. If we had a drug that was going to reduce the levels of your sleep hormone, Melatonin, there would be a huge alarm sign on it. In the side effect package it would say, “Please note, this changes your hormone levels.” Yet, the majority of the Western world at least are actually doing that every night by looking at these devices. So, blue light is one reason why these devices can have such a detrimental impact on our sleep, but the other reason is that if you’re scrolling Facebook or [inaudible], the emotional noise coming into your brain is just continuous.

Just as with your children, you don’t wind them up with scary stories and lots of sugar and bright lights in the hour before bed. You start to wind them down to create the right environment so that the body wants to switch off and relax. We as adults are no different. I’ve found that both for adults as well as children, actually switching off your tech an hour, an hour and a half before bed, can be incredibly helpful and helping you fall asleep. So that’s something you can do in the evening. But the other one, which is rather counterintuitive, and there’s a chapter in the book called Embrace Morning Light. That basically explains to people why if you’re struggling to sleep in the evening, often it’s because you’re not getting enough natural daylight in the morning.

And the reason is that we as humans have evolved to have a very big differential between our maximum light exposure and our least light exposure. So if you were to go outside on a sunny day for about 20 minutes or so, you’d probably be exposed to 30,000 lux of light. Lux is a unit of light. A dark green will be zero lux. Go outside on a bright sunny day and it’s about 30,000 lux. Even if you go outside on a cloudy overcast day, you’re still probably getting 10,000 to 15,000 lux. If you go into a brightly lit office, at most you’ll be getting 500, or even you might be getting up to 900 or 1,000 lux. But nothing compared to going outside. Here’s the points. If you, particularly in the depths of winter when it’s dark, depending on where in the world you live, a lot of people are spending the majority of their day indoor or in the dark. Your body is not getting that big differential between maximum light exposure and minimum light exposure.

So this book came out in the UK a few months ago, and the feedback I’m getting from people is just incredible. Some people are saying that they’ve not slept this well for 20, 30 years just by applying some of the tips that I talk about, and one of those is getting outside in the morning. One of the things you alluded to at the start is that this book and my approach is full of practical tips, because I didn’t want to just write a book where people read it and go, “That sounds great in theory.” I wanted to write something that people feel as they’re reading it, “I could do that straight away.” The tips that I put in the book have literally come from 17 years of seeing patients; not only what the science says, also what the patients report back, what actually works in real life, with busy people with busy lives. And that’s the core thing for me – I try to make all these things achievable. So the Embrace Morning Light chapter, I say, “Can you make a habit – every morning you’re going to get out for 10, 15 minutes, ideally half an hour? Can you build in a morning, breaks at your work, even at lunchtime, the first thing you do is go outside for 20, 30-minute walk, just to get you that light exposure?” These things work, and are not as hard as people think.

Allan (32:57): Yeah, and I think that’s why I really liked this book. Across all four pillars, these are reasonable, actionable steps, and they're fairly simple. Obviously someone can do more after they feel like they’ve gotten good coverage across the four, but if they do the four, then they’re really getting themselves away from that threshold we talked about and they’re pulling themselves back into understanding that this is a system – a system of movement, a system of sleep, a system of stress reduction, and a system of eating the right things to fuel your body. And as a result, all that pulls you together to be more healthy, and as you put it, make disease disappear. Dr. Chatterjee, if someone wanted to get in touch with you to learn more about the book, learn more about what you’re doing, where would you like for me to send them?

Dr. Chatterjee (33:47): There are lots of resources on my website DrChatterjee.com. If you guys go to DrChatterjee.com/book, there are all kinds of resources and blogs relating to the book, including something called The Five-Minute Kitchen Workout, which is one of the big hits from the book, which I encourage you to check out. You can actually find a very quick and easy way that you can start to incorporate strength training into your everyday life that doesn’t cost any money or require you to join a gym. So I’d probably point you there. If you’re on social media, I’m very active on Facebook and Instagram and the handle is @DrChatterjee. And on Twitter it’s @DrChatterjeeUK. Those are probably the best places to find me.

Allan (34:28): Outstanding. So you can go to 40plusfitnesspodcast.com/320. This is episode 320, so go to 40plusfitnesspodcast.com/320 and I’ll have all the links there. So again, Dr. Chatterjee, thank you so much for being a part of 40+ Fitness.

Dr. Chatterjee (34:47): Thank you. Really appreciate you having the time to get me on. Thank you.




Another episode you may enjoy

Wellness Roadmap Part 1

Outstanding health with Michael Galitzer

Dr Michael Galitzer is a nationally recognized expert on energy medicine and integrative medicine. He also works in hormone replacement therapy. He understands how our bodies work from a biochemical perspective and from an energy perspective.  On this episode, we discuss his book, Outstanding Health.

Allan (08:41): Dr. Galitzer, welcome to 40+ Fitness.

Dr Galitzer (08:44): Good morning. Glad to be here.

Allan (08:45): Your book is Outstanding Health Longevity Guide for staying young, healthy, and sexy for the rest of your life. I love the subtitle of that book. Actually, I love the whole title of the book because it is something that we often sort of sell ourselves short. I want to stay healthy or I want to be healthy. But your premise in the book is that we should really try to have an optimum energetic life where we're feeling and looking younger.

Dr Galitzer (09:14): Allan, I ask a lot of my patients said, do you want to live to a hundred and they say not if I'm going to be in a wheelchair or a walker. So it's obvious that really what people want is outstanding health. People really want to be outstanding and what they do, whether it be his appearance or at their job. We reward outstanding. We get Super Bowl rings, Academy Awards, Gold Metals, and so what people really want is outstanding health and if you do have outstanding health, you will get longevity. And so that's why the title was picked. Outstanding Health.

Allan (09:49): I recently interviewed Dr Lee Know about Mitochondria. And so this whole concept of “it's the energy stupid” concept is in my head lately. If you can maximize the energy in your body and fix that, that tends to have the downstream effect of fixing a lot of our other health issues. In the book, you have a pretty comprehensive quiz that someone can go through that will direct them to bits of the book that are going to be more relevant to them.

I like the way you put it up front end of saying, let's not just aim for okay, let's aim for awesome. You have some energy self-boosting tips in the book. Would you mind going through some of those tips?

Dr Galitzer (10:38): Certainly. Exercise is one of them. In my practice, I ask my patients what kind of exercise do you do? And some people say, I walk the dog? That's not really sufficient. Exercise has been one of the proven techniques to help improve energy. There are various different ways of exercising. I found that the high interval intensity exercise seems to work really, really well. You go fast and then you go slow. So maybe 30 seconds on a treadmill or an elliptical fast and then a minute slow. You can do the same thing with walking or running. I find that for health, high interval intensity exercise seems to be the optimal way. There's less time involved and you're more efficient.

Breathing is really, really key. The word I don't like and I hear it every time, is stress. I'd rather look at a better word like challenge. I think if you use a different word you get to a different place to describe how you're feeling. Stress is really about people being fearful. Ultimately when they say they're stressed or a stressed out, they’re not accepting the moment for what it is. And when we do get into that state, we tend to shallow breathe, or hardly breathe at all. You can't really think when you breathe and when you think you really don't breathe well. Most people in that challenge state tend to have very shallow breathing. And I think breathing is really, really key. The Yoga breathing, where you're breathing into your stomach is really, really important. So slow, deep breaths. Maybe inhale for a count of four, hold it for a count of four and then slowly exhale for a count of four. So the slower and a deeper the breath, the better. So again, breathe. Really, really important.

I find meditation really important as another exercise, as an energy booster. All successful people seem to meditate. Meditation really is about quieting your mind and concentrating on your breath.

Sleep maybe the most important or one of the most important energy boosting techniques because the lack of sleep seems to really interfere with everything in our life. Create the ideal situation in your bedroom, take certain supplements for sleep, magnesium, Melatonin, calming your mind before you go to sleep. Instead of reviewing all the frustrations of the previous day, program your subconscious in the five minutes before you go to sleep as to how you like to sleep, how you can sleep through the night and feel when you wake up. I find sleep to be a really, really critical. You want to stop the alcohol if you're drinking four hours before you go to sleep. We want to stop all food three hours before we go to sleep. You want your digestive system to be as quiet as possible.

Another thing that would help with energy would be the whole concept of EMF, electromagnetic pollution. We're exposed to so many different things everyday. One example would be somebody talking to their friend on a smartphone with it to the ear for about an hour. These things are really, really interfering with our health, and are draining our energy. We need to look at this whole concept with EMF, Wifi, a cell towers. You can go to a website called and tennis search.com. And you can type in your address and just notice so many antennas and cell towers are in your area. We're really getting hit left and right with ems and they're a huge, huge energy drain.

And finally, people with mercury fillings. Not only as mercury toxic, mercury in the presence of saliva causes electrical currents. So then if you're in front of a computer or on your cell phone, those those EMF currents are amplified and can override currents in our brain creating all sorts of difficulties, especially with sleep. So getting those mercury fillings out has two different purposes: 1) to eliminate the toxic effect of mercury; and 2) to eliminate the electrical current caused by cell phones and computers.

Allan (15:16): Other things in the book, Outstand Health that I thought were really, really important were you were talking about having more time for loved ones. Just something as simple as that and having more fun, taking your time with your life, and being more in the moment. I think those are the types of things that when look at all of this, if all we did was work, workout, eat and sleep, it wouldn't be that great, but taking the time to enjoy the life that you have. Pulls it all together for me.

You also got into all of the toxins, which would include, the EMF. I want to get into a little bit more detail later.

On the mercury fillings, everybody in my generation probably has them. We need to ask ourselves are they causing us a problem? We probably need to have them removed and removed safely because there's a right way and wrong way to deal with mercury fillings.
Now on the EMF, because it is a topic I really haven't spent a lot of time with on the show. And I hear a lot about it. It isn’t only about the fact there is an electronic signal around me. We have an energy going through our systems. We have our own frequencies. Can you kind of explain what EMF is doing to us? Almost all of us use a cell phone and a lot of people leave their cell phone right by their head on the nightstand at night or on their hip in their pocket. What are these things doing to us and what can we do to protect ourselves?

Dr Galitzer (17:06): Well, first of all, I think that the stronger we are energetically, the more we're able to be less affected by these EMF. I see a lot of people in my office that have some serious illnesses and the more serious the illness, the more you're affected by the EMF, whether it be computers or cell phones. Certainly for computers, you don't want to be on your computer late at night. The blue light that comes out of computers can interfere with your sleep. There are programs like Flux where you can eliminate the blue and get it into a warmer orange. Smart phones and tablets also have the capability to get rid of the blue. Basically you set the time on his computers and phones to a switch from the blue to the orange. And so you have an orange screen say at 10 at night until seven in the morning. I think those are really, really helpful. I think your real energy drain is from the EMF source, smartphones and computers. People with heart cardiovascular illnesses should not be putting their cell phone in their shirt pocket right over the heart area. It’s not a great idea. They distort our natural energy field.

There are smart meters that are outside the home that to interfere with the energy flow.

Where we're most sensitive to the EMF is the bedroom. We can really deal with a lot during our waking day/working day. But the bedroom should be electrically quiet. You shouldn't have your smart phone as an alarm clock in your bedroom. You shouldn't have electric alarm clock near the head of the bed. If you can maximize sleep, you should have your head to the north when you're sleeping.

So no electric blankets, no waterbeds, which were more common in the seventies and eighties. All these things really contribute to a electrical energy that interferes with sleep. A lot of people unplug Wifi. We have Wifi here but Ethernet (a cable) would be a better way to connect to the Internet. If you do have Wifi, unplug it every night. So I think it's really about how do you maximize your EMF situation within your home.

In Alternative Medicine, there's always a hot topic every year. This year it's microbiomes and everybody talks about the microbiome of your gut. Put the good bacteria into your gut. Well, how about the microbiome of your house or your home? And that's where the EMF thing is really, really key. So the less exposure to get in your home, the indoor pollution, the healthier you're going to be.

Allan (20:05): Yeah. So we're getting these from our phones, from our computers, from our IPADS, from our Wifi, the Bluetooth, and even from some electrical currents. And then obviously if there's a tower or electrical wires near our home, those are going to be emitting some EMF as well. So the more we can reduce our exposure to those, the better off we're going to be. Also, the better health we have, the more resilient we are going to be towards those things.

Dr Galitzer (20:32): Absolutely. You know, it's really about staying as healthy as you can. A lot of this you just can't avoid. So certainly you don't want to put the cell phone to your ear., use Bluetooth, use the speaker. The studies that have been done are basically saying, we've done these studies for one year and we see no adverse effect. Well it's cumulative and nobody has done the studies, certainly not the manufacturers, that show what happens over 10 years or so.

Allan (21:03): We’re really the first generation to come along and have long-term exposure to as much EMF. More than anyone's ever had in the history of the world because it's just getting bigger and bigger. Every year, more and more connected devices are using wireless and all these things are happening around us. My Google home sits over there and it's wireless, connected to my Wifi and so it's obviously getting a signal. My phone is getting a signal. I like keeping all that stuff down in the living room.

It's just funny you mentioned sleeping with your head toward the north, because the top of my bed is actually facing north. That's really just a coincidence. It wasn't a planned thing, but hey, I'm glad I did one thing right without actually trying.

You put it in the book six key essentials to outstanding health. Do you mind going through each of those? Because I thought these were really, really good.

Dr Galitzer (21.56): Well, first and foremost it is getting your head together, the mental, emotional aspect. As physicians, we really have the time to address that. The office visit in this business is short. As a rule medicine, traditional medicine doesn't seem to have the technology to cause people to want to change, to effect, or show them how they can change. So I think emotional mastery is key. When we talk about emotional mastery, I think purpose, passion, and gratitude are the three keys. What's your purpose? Why are you here? What's your vision? What’s your dream? I ask a lot of people I asked that question, what are you curious about? And so I think knowing your purpose and aligning with your purpose I think is one of the really, really keys to mastering your emotions.

Passion, passion is really, really key. To get excited, do what you love and love what you do. The more you can do that, the more life flows for you. There's that old thing we said as a kid, row row your boat gently down the stream. Merrily, merrily, merrily, merrily, life is but a dream. So go downstream, don't go upstream. And your boat is your body and rowing your boat. Maybe your assault, rowing your boat down the stream. Merrily, merrily, merrily, merrily, life is but a dream. I think that's a great thing that we said as kids and we don't say it too often as adults.

The last thing that's a really, really key is a gratitude. Being grateful. The focus of your life has got to be a being grateful for what you have as opposed to what you don't have. Do you focus on what you have or what you don't have? Do you focus on what you can control not what you can’t control? Do you focus on the past, the present or the future? Obviously it'd be ideal to spend most of your time in the present. And that brings us to the concept of mindfulness. Patients come into the office and they're always complaining. They figured, well, I’m going to see a doctor. I might as well tell them what's wrong. But it's really about what's right. The more that you get into being what's right, being grateful for what's right.

The real key emotion is love. Anger and fear ultimately a come out of the fact that there isn't enough love in your life. Do what you love and love what you do. Do you know that old Crosby Stills, Nash and Young, song, if you can't be with the one you love, love the one your with? Those are the real keys for emotional mastery.

The second part is cleansing your body. We’re exposed to toxins in the air, the water, the food. We can't quite trust the food. A lot of the food isn't organic, is full of pesticides. Glyophosate: I think the statistics are we consume 880 million pounds of glyphosate as a country, which is just really creating havoc in our bodies and our gastrointestinal system. So you’ve got to eat organic. But more importantly, you know, they're toxins in the air, the water, the food, prescription drugs or chemicals. So we've got to cleanse our bodies. But the big, one of the big things that people talk about is we've got to detox. And what I try to tell people is know we have to do drainage first.

There are three key organ systems that can allow the toxins to move out of the body. They're the liver, the kidneys, and the lymph. Liver sits higher than most people think right behind the right breast. The kidneys are in the back. And then there’s the lymph system. Most people associate lymph glands with a sore throat, but there's slim throughout the whole body. There's lymph in the breast, armpit, abdominal, and pelvic area. Toxins, first pushed out of the the cell is going to the lymph system. From there, it's a very elaborate system and the limbic system empties into the big veins under your collarbone from which they go to the liver, which can either take it into the intestines and out the stool or back into blood, kidneys and out the urine. So stimulating the drainage systems (lymph, liver, and kidneys) is key before you try to get the toxins out of the cells.

You can do lemon in your water for the liver, lots of veggies, juicing green vegetables. You should have a green juice everyday, cucumbers, celery, green apple, parsley, kale, or something like that.

For the kidneys, you’ll want lots of great water. Water is probably going to be the theme. Cape Town, South Africa is running out of water. Healthy water, you don't want distilled water because it's dead. Distilled water doesn't have any minerals in it. Filtered water. Alkaline water is pretty popular these days. There's hydrogen water out there, there's oxygen water out there, and a clean water is really, really key. Parsley helps the kidneys. Pomegranate helps kidneys. Asparagus helps the kidneys. And there's a tea called horsetail tea that helps with kidney drainage.

For the lymph I recommend no dairy. Dairy tends to clog the lymph. Deep breathing, which we've talked about previously. And exercise, bouncing, there's rebounders, trampolines, jumping jacks, jumping rope, really any kind of exercise will help lymph system.

So drainage is so important. If you try to do detox, colonics, chelation, or infrared sauna without drainage, people get sicker. It's kind of like having a bowel movement on a toilet that won’t flush, there's nowhere for the stuff to go. So drainage has to be first before you attempt to do detox. We can then proceed to getting a little more in depth with detox.

I find intravenous vitamin C to be extremely effective in helping the body, especially the liver, with the drainage. Out here in La, there are clinics all over now. Vitamin C clinic so where people can just walk in and get intravenous vitamin C. I find that to be really, really helpful. So cleansing your body of toxins is key, but the real key is to do drainage. And the more that one does drainage, the better off the body's going to be.

The third area is the gut, the health of the gastrointestinal system. Let's talk about nutrition first. I think one of the keys in our modern day lifestyle is that it is too acidic. People drink too much coffee, sugar and people are smoking cigarettes, drinking a little too much alcohol, having soft drinks which are fairly acidic. A Coca Cola has 10 teaspoons of sugar. Diet Coke has the sweeteners that really don't help anybody. So coffee, sugar, cigarettes, alcohol, soft drinks, and, that word stress again. Those are the real contributors to tissue acidity.

The more acidic our body, the less well we function. We have to get people off the acidic foods and eating more alkaline foods. Basically it's really about more fruits and vegetables. In terms of beverages, coffee, alcohol, and soft drinks are acidic. Green tea and lemon water are alkaline. So the more that we can have a alkaline foods in our diet, the less acidity we're going to have from a nutritional point of view.

And obviously, you know, stress is a major contributor. We’ve talked a little bit about things that you can do in terms of a deep breathing and meditation. Stress is really about not accepting the moment for what it is. So the less don't accept that the better we'll be.

Think of your body as a Ferrari and you really want to feed it high-octane fuel. The, the higher the octane of the nutrition that we put into our body, the healthier we're going to really going to be.

I practice a certain type of energy medicine, a German biological medicine that I started doing about 30 years ago. It was impressed upon me that the health of the body really starts with the health of the gastrointestinal system. It's a really like a triangle, Allan. It's the liver, the pancreas, and the intestines. Any part of that triangle can affect any other part of the triangle. And so, it becomes really, really important to optimize each of these key areas.

For the liver, there’s homeopathy, there's herbs, there's acupuncture that'll help all of these areas of the triangle. The pancreas makes digestive enzymes, that are really important. As a society we tend to eat a very small breakfast and very large dinners. But in terms of the energy of these organs, the pancreas is strongest in the morning and weakest at night. When you're having your large evening meal, your body has the least amount of pancreatic enzymes to help digest that food. Certainly, if you’re socializing or having a business meeting, you’ll want to take digestive enzymes help your body digest the food. Otherwise you’ll go to sleep with a lot of undigested food and have a problem falling asleep.

So we've got the, got the pancreas, and then you've got the intestines. Everybody is taking a probiotic to put the good bacteria in the colon, but to get this microbiome right. Do you eat right? How do we get the liver and the pancreas healthy.

The large intestine is where the good bacteria needs to live in balance with the Candida and the yeast. I believe the issues are in the small intestine. We call this in our kind of medicine leaky gut, which is the area around the belly button, the small intestine. People complain about gas, bloating, pain, and cramps. Food is normally absorbed through these finger-like projections called villi in the small intestine. And from there the food goes to the liver for processing. There should be tight junctions between the intestinal cells, so only perfectly digested food gets in. The intestines absorb the food, but are also barrier systems. You don't want to toxins from the outside getting into the body through the small intestine.

When the gut gets leaky, there are spaces that form between these intestinal cells allowing partially digested food and toxins to get into the body and overload the liver, and many issues happen from there. The prime contributor to leaky gut is gluten sensitivity. Blood tests won't always pick that up. When people have those kinds of symptoms, you really want to get them off of gluten hundred percent. You can’t just say well I tried to get off it, you have to do it 100 percent.

There's a lot of healing nutrients for the small intestine. Glutamine and a certain powders will really help.

Pesticides are another problem with leaky gut. I see this all the time.

So gluten, pesticides are the two primary contributors to leaky gut or leaky small intestine. You should put the good bacteria into the large intestine. Treat the leaky gut, avoid gluten, eat organic to avoid pesticides, a supplement with pancreatic enzymes, especially at night, and do the things for the liver to help it work a lot better.

The next area is we’ll talk about for creating more energized lifestyle beyond exercise, breathing, meditation, minimizing EMF, and maximizing sleep is energy medicine. I've been doing this for about 31 years. I was an emergency room doctor for 15 before that. Energy Medicine is what I've defined my practice to be. It's more than just an anti-aging, holistic practice. A health is energy number one. There is an energetic level to the body. Just like a cardiologist would do an EKG to look at a electrical heart and a neurologist to do the EEG to look at the electrical brain, there's an electrical liver, kidneys, pancreas, adrenals, and thyroid.

Look at your body as an orchestra, where the organs and glands are instruments. Some are sluggish, which you can't see on a blood test. We do blood tests on everybody or people come in with their recent blood tests. Sluggishness you can't see on a blood test, but we can see it in some of the tests that we do. We do bioimpedance, looking at body fat, phase angles, body water. And we also do something called heart rate variability, which gives us a lot of clues as to the health of what we call the autonomic or automatic or subconscious nervous system. Say your heart rate is 60 beats per minute. Would you think each beat is one second and therefore a 60 times 1 is 60? But there is variability between beats where one is a second, the next is 0.96 seconds, and the next is 1.02. That's variability. The greater our heart rate variability, the healthier the nervous system and the healthier the person's going to be.

So using these kinds of techniques, we can actually spot energetic dysfunction in the body. Once we assess the body from this point of view, certainly we would do a physical and a history on every patient, we can then use energy medicine to help people feel better. We can do homeopathy or acupuncture. Some people prefer to do muscle testing. In my office, there's a lot of use of the light therapy, sound therapy, and music therapy. Pulsed Electromagnetic Fields (PMF), which is FDA approved. Or we can use Ionized oxygen. So we use a lot of different techniques that are in the area of energy medicine.

Obviously traditional medicine uses energy medicine. Not as much in the therapy part, but the diagnostic part in it. We do MRI, x-rays, and ultrasounds. All of these are basically employing different energetic techniques to diagnose. We go a little further than that. We utilize it in the diagnostic part, but also using energy medicine to help people feel better. And basically balance the sluggishness and move from sluggishness to a healthier, more vital body. One of the important things I was trying to point out in this book is that a energy medicine can go a long way to getting people into the mode of outstanding health.

Now, the last part of the six essentials is hormonal balance. Hormones are chemical messengers. They're secreted by a certain glands and affect not only certain glands, but all the organs in the body. As you know, there's been a whole push towards a bio-identical hormones, estrogen, progesterone, and testosterone. Suzanne Somers popularize that in 2004. They're not the major hormones. They're the minor hormones. You can cut out my testicles I’ll still live. Cut out a lady’s ovaries, they'll still live. The majors are insulin by the pancreas, thyroid hormones, and the adrenal hormones.

You really want to keep your sugar low. You want to keep your insulin low. If you don’t, you’ll wind up in trouble with things like the high triglycerides, high cholesterol, metabolic syndrome, etc.

Thyroid is essential. Think of the thyroid is the fuel injection system in your car and think of the adrenals as the gas pedal and you really need both to drive the car. Thyroid is very easily assessed with blood tests. You can get a history of constipation, sluggishness, low body temperature, but the blood tests are pretty accurate.

There's a condition called Hashimoto's thyroiditis that a lot of people have these days. I don't see it as an autoimmune disease. I think that's a mistake. The body isn’t attacking itself. I see this more as a toxin, gets into the thyroid. Most likely gluten or mercury from the mercury fillings and the body attacks the toxins in the thyroid. So we pick up art antibodies in a blood test, but to tell people that they're attacking themselves, I think that’s a disservice to people. We can easily pick up thyroid dysfunction and Hashimoto's thyroiditis with blood tests and treat with thyroid supplementation. Some people like the synthroid, some people like the pig thyroid, armour thyroid, nature thyroid. Those are pretty easily treated.

The one that most people overlook is adrenal function. The adrenals sit on top of the kidneys. The adrenals are the first organ affected by stress, mental stress, emotional stress, nutritional stress, environmental stress, electromagnetic stress, physical stress, or infectious stress like virus, bacteria and yeast. Whenever there's a stressor, the adrenals are stimulated to secrete stress hormones, cortisol, and to a lesser extent, DHEA. If the stressors occur for too long a period of time or there are too many stresses occurring at the same time, the adrenals ultimately get tired. And your ability to handle stress is reduced. You can't differentiate between big stress and little stress. You overreact to little things. Stress is no longer a challenge, it becomes a threat and it’s a vicious cycle. And so I'd say that one of the key issues in the body is trying to maximize adrenal function.

The adrenals have the highest need for vitamin C in the body. So that's a must. Magnesium is really important for the adrenals. Vitamin D in some people is really important for the adrenals. And again, intravenous vitamin C may be even quicker way to strengthen the adrenals. You can't really see too much of adrenal fatigue on a blood test. People order at 8:00 AM, but Allan if somebody coming at you with a needle at 8:00 AM, your cortisol's going to go up. So the best thing to do is saliva testing before trying to diagnose adrenal dysfunction. And you get clues. Hypoglycemia as a clue for a weak adrenals. When your blood sugar drops, 11:00 AM and 3:00 PM are typical times. And sometimes it happens in the middle of the night at 3:00 AM. If you wake up, a buzzed, it's frequently adrenal dysfunction. The adrenals are overlooked. The adrenals attention.

You've really got to balance the major hormones. Low insulin, you can pick that up on a hemoglobin A1C on a blood test, which looks at your blood sugar over 90 days. Maximize your thyroid. Maximize your adrenals. So when people complain of fatigue to their doctor and the doctor will immediately put them on thyroid. And if you put a person on thyroid without treating the adrenals first their fatigue will get worse. So I find that the adrenals are probably the most important area. If I had to pick two areas of the body to really look at the liver and the adrenals. Balance out the major hormones, insulin, thyroid, and adrenal hormones first.

Bioidentical hormones can be very helpful. You want to do a blood test first. A women's started losing progesterone in their late forties, causing menstrual disorders, abnormalities of PMS, and shortened periods. And then a little later on, early fifties, there are hot flashes, night sweats, dry mucous membranes, foggy thinking. These are all signs of low estrogen. So those people after the blood test proved that these are really low can really benefit from bioidentical estrogen and progesterone. It's a little slower with men. There's a gradual decline in testosterone. In your late 50 days, certainly sixties and above, if you get a blood test, you'll see testosterone levels to be pretty low. Men will be grumpy, not have the edge they used to have, and lack the libido they used to. So combining those symptoms with a low testosterone level on a blood test would be indicative of low testosterone and testosterone should be replaced. There is either an injection once a week or as a cream everyday.

That’s the overview of a hormonal balance and how it relates to, uh, an outstanding health

Allan (43:49): That’s what is so cool about this book. It literally walks you through a quiz, then gets into what's possible, and then gets into these different things we can do. You gave us so much great information today. I really appreciate it, Dr Galitzer. If someone wanted to get in touch with you or learn more about the book, Outstanding Health, where would you like for me to send them?

Dr Galitzer (44:12): Well, you can certainly go to the website drgalitzer.com. The book is available on Amazon and again it's called Outstanding Health. My office is always available. The number Is 310-820-6042.

Allan (44:32): Cool. You can go to the 40plusfitnesspodcast.com/319 and you can get access to those links and that phone number there. So again, thank you so much for being a part of 40+ Fitness.

Dr Galitzer (44:??): My pleasure, Allan.



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Easy keto with Carolyn Ketchum

One of the biggest struggles people have with sticking with an eating plan is the effort it takes to cook meals.  In her book, Easy Keto Dinners, Carolyn Ketchum gives us some great tips and recipes to make eating ketogenic much easier.

Allan (03:42): Caroline, welcome to 40+ Fitness.

Carolyn (03:45): Thank you. Allan. How are you?

Allan (03:46): I'm doing very, very well. Your book is Easy Keto Dinners. This is going to be really cool because it's hard to be prepared. It's hard to always be cooking and even though we can do certain things like batch cooking, or just keep things very simple, like a steak and Broccoli. Some nights it is a struggle.  You've put together a cookbook that makes some of our favorite meals available to us in a fairly easy way.  Can you explain the concept of easy for us a little bit?

Carolyn (04:29): Yeah. It's interesting. A lot of people ask, does this mean everything's under 30 minutes and I can make it quickly? Well, yes and no. There are plenty of easy fast recipes in the book and then there are plenty of easy, slow recipes in the book because sometimes if you have a 30 minute meal, that means that you're staying ending. They're chopping and cooking and sorting and doing everything, you know, standing there for 30 minutes actually working. And then there's recipes where it takes you 10 minutes of prep time and you throw everything in a pot or a slow cooker and you walk away and you know, a couple, three or four hours or up to eight hours and then it's done, but you're not actually cooking the whole time. So my concept of easy is just, it's really the minimal prep time and the minimal work and the minimal sort of having to create everything yourself.

Allan (05:17): Yeah. Some of the recipes are so simple and they are very quick. Some of these you'll have done in almost no time. Others, you are going to spend a little time on the prep and then you're setting it free and you can go about your life. You're not right there. It's a good mix of both. Do you mind if we take a step back a little bit and talk about why you're writing keto cookbooks?

Carolyn (05:51): Well, yes. I have not ever had weight to lose. That's lucky me. A lot of people come to keto for weight loss. But I had gestational diabetes at ease with my third child and after she was born it seemed to go away. All my blood tests seem to be saying I was good to go. I kept testing every so often. I started to see the numbers creep back up and I got concerned. I went to my doctor and we agreed that I had prediabetes and needed to do something about it. I did my research. Very few people in the medical world are actually suggesting low carb, although it's becoming more and more common. Thank goodness.  I decided after doing some research and having known when I had gestational diabetes how much work it took to keep my blood sugar under control when I was on a standard American diet. I just knew something had to change. So I just started cooking and baking low carb.

Allan (06:58): Even though I eat keto most of the year. That's not something that I really try to push on anybody else because I don't want to be that guy. It's funny. Not Funny. It's actually kind of sad. My sister and I were having a conversation this morning about her having the same issue. She had gestational diabetes and then after her third child, she now has to be very careful. She'll notice her blood sugar going way, way up. I don't think she's as diligent at checking it and managing it and doing those things.  At least this week when I'm feeding her, she's gonna be eating low carb

Carolyn (07:40): Good. And maybe she'll see. I think the thing for me and the reason I write cookbooks and write a blog is I've fallen in love with this lifestyle, but it took awhile. When I decided I had to go low carb and gluten-free. I basically sat on my kitchen floor and cried because I'd always been a passionate baker and I thought that was over for me. I've discovered it's not, which is fabulous. I've discovered there are so many wonderful ways to cook and eat and be keto. I think people are very much afraid of it and I understand why. Because I'm going to have to give up all my favorites, but you're not going to have to. You're just going to have to make them in a very different way. And sometimes you do have to change your taste, but it does happen. And then you start to love it. Why would I ever do anything else?

Allan (08:27): My wife was getting into it. She was doing the shopping on Saturday. I took a picture of your cookbook, the ingredients list, and I told her to get these things. One of the recipes I sent her was for the cheesy biscuits that I planned to make for breakfast this morning. When I went up in the pantry, started looking around like, there's no coconut flour.  She didn't get it. She thought we had some.  No.  I said, and you don't get any cheesy biscuits. No cheesy biscuits for you. But I will probably go shopping this afternoon and buy some coconut flour so she can have cheesy biscuits tomorrow.

As you get into these things and you start learning more and more about the kind of recipes and stuff that's out there, you do realize there are adaptations. It's not as convenient as going to the grocery store. And the freezer section and there being a whole keto section. Paleo kind of took off and now there's that. They advertise that they're Paleo dishes and that's wonderful. There aren't that many low carb stuff convenience foods. There are diabetic sections and stuff where they'll have the candies and the other stuff. But now we're using real whole food and prepping it ourselves. This is really cool because you've, you've made it really easy.

Can you give us some tips? For me, it's always been batch cooking. That way you're getting a lot of value out of the amount of time you're investing. I could see taking some of these recipes, adapting them times four, times five and putting those away. Can you kind of give us some of your tips on how to have an efficient and effective kitchen?

Carolyn (10:31): Yeah, I have a lot of tips. One of the things is you say batch cooking and I'm just not good at that. I never have been. I know it's a great way to do things and if I'm making something like Carnitas or pulled pork or that kind of thing, it always ends up being a whole bunch and then we put some in the freezer. That's great. It's just never been my style. Part of the reason is that I like a lot of variety. I don't want to have to eat the same thing within two days of each other. There are not a lot of keto convenience foods out there, but it's growing. But I would say be careful there because a lot of people are calling things keto and they have a lot of junk in them.

Be careful if you purchase some of those things. But one of the things for me is these days grocery stores are making things really easy on us so you don't have to make all your own bone broth. Maybe it's not quite the same. Maybe it's not quite as nutritious. But buying, Pacific Foods bone broth or a Whole Foods brand bone broth is going to save you a lot of time and energy. Things like we were talking about cauliflower rice earlier. The grocery stores are now putting out rice cauliflower, whether it's in the fresh section or the freezer section. I make a lot of my own tomato sauce. But then there are times when I've blown through my stash from the summer.  I go to the store and I check the labels to find the lowest carb one that I can.

So one of the things that I did in this book was a resource guide for store-bought options. You don't have to reinvent the wheel and make everything yourself. I think that that saves you a lot of time. Try prepping ahead sometimes if you know you're going to be having a busy week prepping things ahead, like cutting things up or you were saying cauliflower, you do sometimes just sort of sit there in front of the TV and rice your cauliflower. Sure. Why not? That's a great idea. And one of my favorite tips though is rotisserie chicken. Almost every grocery store has a rotisserie chicken section. You grab one and you can make easily two to three meals out of that. Or you can just cook your own chicken ahead and have it shredded and in the freezer and then you pop it into a recipe.

Allan (13:01): When I say batch cooking, it's not always dishes. I'm going to grill, you know, a lot of chicken quarters because I'm out on the grill cooking steak and then I'll grill a bunch of chicken. I'm doubling up on my time. And then another, another thing is if I, if I know I'm going to be making a crockpot meal that day when I get back from the grocery store or the farmer's market, I've got all fresh vegetables and fresh meat and as I'm unpacking, I'm washing, cutting and putting it in a crockpot rather than putting it in the refrigerator. So, by the time I finish unpacking my groceries, I've already got the meal started.

Carolyn (13:56): I think that's fabulous. If you have an instant pot you can do some of that stuff too. That's always fun. I'm getting used to mine and trying to do more recipes with it. When you talk about going to the farmer's market or the grocery store, you have to have a stocked pantry. I mean if your cupboard's bare and you come home from work and there's nothing to make, then even my recipes won't help you. You have to pick a day of the week where you go and you have your list of what I might probably make this week. It can change a little as you go and you have to stock things. Keeping some proteins in your freezer like ground beef and chicken thighs. I'm, I'm a fan of chicken thighs rather than chicken breasts personally. I think they have more flavor.  Just having them on hand, and even if you forget to take them out of the freezer, there are ways to quick thaw them.  There is a section on that in the book with tips like that to save you some time.

Allan (14:57): Yeah. It's really about having it all stocked.  In the future,  I will have coconut flour on hand to make those cheesy biscuits. I didn't have it and like you said, if you're missing that one ingredient, then you're now looking for option number two, which is probably the same thing you ate yesterday, that the eggs and bacon or the eggs and sausage. But that's unsatisfying when you want to change things up a little bit. Um, and you said yourself, you, you don't like to eat the same thing, so you like to change things up.

One of the things I like about the Easy Keto Dinners cookbook it has a lot of variety in flavors. Some of them are very interesting flavors and others I know have particular health benefits. Can you talk a little bit about what spices you're using in here, some of the reasons why you're using them, either from a pairing of flavors or a health benefits?

Carolyn (16:03): Well, I have a lovely large spice drawer that I keep pretty much totally stocked at all times. Another question that I get from people is, do these recipes have five ingredients or less? And I'm like, well, maybe if you don't count the spices, because I think, again, people confuse easy with fewer things and if you have a good spice cabinet, you've got tons of things in there to help flavor your foods. I like spicy stuff.

One of my favorite recipes in the book is the one pot jerk chicken and rice because I really love those jerk flavors. I faked it in this one because a real jerk seasoning a has brown sugar. We're not going to do that. It also has scotch bonnet peppers, which are hard to find and at any time of year. So I made it spicy without the Scotch bonnets. It's a dry rub too, whereas a real jerk seasoning mix would be sort of a wet paste. You can fake flavors and get really close to the real thing.

There's tons of health benefits to so many spices. I know turmeric fights inflammation, but you have to eat a lot of it to do that. It's flavor that gives us a sense of safety. So along with the fat from the keto diet, we need flavor for us to be like, wow, now I'm full. I don't need anymore. And I think knowing when we're full is part is one of the benefits of the keto diet.  Knowing when we're satiated and stopping.

Allan (17:55): Yeah. And I think that's another thing cooking, is you can be proud. I don't mean this in a bad way, but if you can take pride in the fact that you prepared a really good dish, even if it was easy, the fact that it tastes good and you really are enjoying it, you're probably going to slow down. You're going to make eating a lot more mindful, right? Which is going to make everybody's life better.

Carolyn (18:22): I learned that early in college. I remember being in my dorm and the food was so bad that everybody would eat a meal but they wouldn't feel full or they wouldn't feel satiated and they'd head to the convenience store afterwards and get chips and chocolate bars. I remember doing that too. And feeling like, wow, you know, food needs to have an impact on your taste buds for you to feel satiated.

Allan (18:45): Yeah.  You've got things in here like the chicken Parmesan casserole, spicy pork and cabbage stir-fry. So there's, there's variety and you've organized it based on the protein source a throughout the book.  Then you have a little guide at the back that's really cool because if you're wanting to manager your prep time, which ones are fast, which ones are slow.  It has a food allergy and sensitivity guide as well. It is great to have this little guide where you broke down to make it even easier to know what you're doing.

Carolyn (19:19): I made sure that 50 percent, it's a little more than 50 percent of the book is dairy free or can be made dairy free. And there aren't a lot of recipes with nuts in them. So if you're a nut allergy person then you're good to go with most of these recipes. I think that that's important too because somebody needs to know at a glance whether something's going to have something that they're intolerant to

Allan: (19:44): And you flag those. So it's very easy for us to go through and know which ones would impact us.

Then the other thing is, because a lot of a lot of recipe books don't do this, you actually have the breakdown of the macros. I think is very important for someone when they're first coming on to keto. They're trying to get their fat intake up to a certain level and keep their carbs low. You've put that together in a way where I know this is going to put me in the right macro profile for the day. I'm maintaining my ketosis.

Carolyn (20:24): I think everybody needs that. I calculate them all myself on a program that I have downloaded on my computer. It's a paid program. So it's not like My Fitness Pal.  My Fitness Pal has tons of errors because it's user inputted data.  But even my paid software will have errors since it pulls from the USDA web database.  The problem is they are using averages. My chicken thighs weren't as big as the average chicken thigh. I get a lot of pasture raised chicken. My chicken thighs are not that big because they were not plumped up by all the grains. I had to do some hand calculating, which was exhausting.

Allan (21:11): I built a spreadsheet when I first started going keto.  When I would cook a Chili it would be without the beans. I would use about a third, maybe a half of the tomatoes I would have used otherwise to cut back a little bit. And I got a lot more meat in there and when I browned it I put all the fat back in there and even put some more fat in there. And so now based on everything I added, I'm like, I've got the calorie counts and they've got the macros of all of the ingredients.  I added them up and divided to make a serving around 500 calories.  How many servings does this make? And man, that spreadsheet was like the banking records for GE,

Carolyn (21:55): I kind of find the math a little fun. And sometimes I would go, whoa, that's way too much protein for this recipe. And I would have to dig and do some research and figure out. Because in my database it will also have, you know, five different chicken thighs in there, based on like whether the bone isn't it or whether the skin is still on or whether it was enhanced (the step where they shoot it up making them look plumper and juicier). I had to find the right one that was more like my chicken breasts. I feel obligated to say that all of those are provided as a courtesy. But if somebody is very, very specific, then they should probably be doing their own calculations because as, like I said, things are pulling from averages and it's very hard to do. And if you're very specific and you weigh everything. I know a lot of people when they first start keto, they're weighing everything they eat. Then they should probably try to calculate it a little bit themselves.

Allan (23:06): Yeah. Once you get comfortable with the way that you're preparing your dishes it actually gets easier and easier. The higher the quality of the food, That's again, that's another reason why I'm such a big proponent of cooking for yourself.  You know what you're putting in your body and your family's bodies.  The food we eat is health. If we're not doing food right, then we're not taking care of ourselves.

Carolyn (23:43): That's why I say to a lot of people, beware the keto products, because there have been several instances recently where companies have been accused of erroneous nutrition labels.  They overstate the amount of carbs.  And they'll call themselves keto.  I would have rather make that cookie myself than have bought your cookie and possibly put myself out of ketosis having done so. Even when the supermarket has the keto section, which they eventually will, because the tide is turning, I feel like you're going to have to read the label and be smart about it.

Allan (24:23): Yeah, absolutely. So the book is Easy Keto Dinners. If someone wanted to learn more about you, get to your blog or learn more about this book or your other books, where would you like for me to send them?

Carolyn (24:35): All Day I Dream About Food is my blog because I really do dream about food all day and I enjoy doing that. I also have a second cookbook, which is my first cookbook and the Everyday Ketogenic Kitchen, which is a more lengthy cookbook that covers everything from breakfast to dessert.  It also has sort of my story a little more and how keto works and things like that. That's a great resource and Easy Keto Dinners is almost like a companion guide. You're adding more dinner recipes to your repertoire.

Allan (25:07): Absolutely. This is going to be episode 318. You could go to 40plusfitnesspodcast.com/318, and I'll have the links there. Carolyn, thank you so much for being a part of 40 plus fitness.

Carolyn (25:20): Thank you. It was wonderful to talk to you.

Allan (25:29): If you're enjoying the 40+ Fitness Podcast, would you please go out to itunes and leave us a rating and review. Go to 40plusfitnesspodcast.com/review. That will take you the itunes page and you can leave us a rating and review right there. Thank you.


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