June 18, 2018

Fit at midlife with Samantha Brennan and Tracy Isaacs

Fit at Mid-Life: A Feminist Fitness Journey by Samantha Brennan and Tracy Isaacs discusses an approach to fitness that does not require you to focus on your looks but more on the quality that being fit adds to your life.

Allan (3:16): Our guests today are both PhDs, academia and researchers on feminist issues. Together they created Fit Is a Feminist Issue – a popular blog offering feminist reflections on fitness, sport, and health. We will discuss their book Fit at Mid-Life: A Feminist Fitness Journey. They are Samantha Brennan and Tracy Isaacs. Samantha, Tracy, welcome to 40+ Fitness.

Tracy (3:41): Thank you.

Samantha (3:42): Thanks.

Allan (3:43): The title of your book, Fit at Midlife – of course, that’s going to attract me because I’m pretty much there. I hope I still have the other half coming up, because I’m 52 right now. Right now I’m targeting that probably being somewhere around the middle. And then I got into the subtitle, and it’s A Feminist Fitness Journey. I wasn’t sure where you were going to go with this, to be honest. And when I see “ist” or “ism” at the end of a word, it can get muddy. I typically try to stay away from those. But the way you approach this in the book I thought was actually very, very good. I didn’t understand where you were coming from just with the subtitle, but once I got into the book, it made a lot more sense to me.

Tracy (4:29): Good. That’s what most people seem to find.

Samantha (4:33): We’re really about inclusive fitness. We’re writing about our perspective as women in midlife approaching fitness, but lots of the lessons there, especially around starting out, when you’re not sure what level you’re at, or your concerns about body image – those might apply more to women, but I think they apply to everybody.

Allan (4:52): Yeah. Contextually, sometimes it’s very hard for me to connect with a client. I’m a man, obviously, and I’ll be talking to them and some of the words that they’re using, I have to sit back and wrap my head around, why are they particularly using that word? Does that mean anything in particular? And I think one of the words that gets used, but I don’t think most people have built a good context around it, is the word “fitness”. And you cover that in the book. You get into, fitness is not always just being able to run a mile in four minutes or just being able to deadlift 500 pounds. Fitness can mean something different for all of us.

Tracy (5:42): Right, because there are multiple measures.

Samantha (5:46): Actually, I think a lot of people do mean one thing by “fitness”, which is you look fit. So they say, “She looks really fit.” What do you mean by that? What it means really is that she looks lean, she looks thin, and I think for me getting beyond that message is pretty important.

Tracy (6:06): I would agree with that. We want to divorce the idea of fitness from the idea of thinness, because almost every single fitness plan or program is about weight loss.

Samantha (6:18): That’s one thing I think that’s different for men. There’s a lot of pressure on men to look muscular, and these days to look muscular and lean, but at least in the sports we recognize that there are a lot of awfully fit big guys. No one thinks football players aren’t fit, or no one thinks that some of the larger male athletes aren’t fit. They’re just big men. But we don’t really have that. Even though those women exist in, say, the Olympics, when we think about women in fitness, we tend to think about maybe the CrossFit ideal these days – the lean and muscular women, and that’s what fitness is about, is achieving that look. It’s not about doing things, it’s not about exercise and health. It’s about attaining a certain kind of appearance.

Tracy (7:05): In popular culture, but that’s not what we think fitness should be about it.

Allan (7:10): When I sit down with a new client and we go through what I call basically “making a commitment” – it’s a vow that I want them to make – and the thing I talk to them about is, first I need to know why. Why you want to do what you want to do. And I have to say that invariably 95% of the clients that come to me want to lose weight. This is what they believe their goal should be. So they’re like, “I need to lose weight. I need to lose 10, I need to lose 15, I need to lose 50 pounds.” And I let them want that. I say, “Okay, I understand where you’re coming from, but we’re going to talk about health and we’re going to talk about fitness. It might not always be about weight, it might be about something else.” So the second part of the commitment piece is where I start getting into what I’d call “vision”. And I might need to change that word, because I don’t want it to be thought of as, this is how you look, because it encompasses a look and feel. It’s being comfortable, being confident, enjoying what you’re doing and knowing that you have the capacity. So mine is, I run, I’ve done some obstacle course races with my daughter – the Tough Mudder and Spartan and things like that. I’ll do those races. They’re extremely intense and difficult and not many people over the age of 50 are doing them, but I’ll go out and do them with my daughter. My commitment, my thought is, if my granddaughters or grandchildren are into that type of thing, I want to be able to compete with them. I want to be out there with my grandchildren. Not just my children, but my grandchildren when they come along.

Tracy (8:50): You want to age well. You want to experience vitality and energy and capacity, not just in your 50s, but in your 60s, 70s, 80s. I look at my dad, who is 80 and he’s told me on the weekend he’s playing the best tennis of his life. He’s played tennis ever since I can remember, and he’s always been a good tennis player. So I want to be like my dad.

Allan (9:18): That’s how I want to put it out there for folks, but it is so hard to get them away from the scale. And I think one of you said you put it in a box and put it in your closet.

Tracy (9:30): I put it back in its original packaging with the Styrofoam ends and everything. We put it way up high so it’d be a big conscious pain in the ass. If I took it down I have to really think about it, and I did not.

Allan (9:47): Yeah. So when I think of fitness – and it’s kind of where you’re going in the book – is you’ll do different things. It might be weightlifting or rowing or triathlon or anything like that, but what you’re doing is you’re fit for a task, fit to live the life you want to live, not fitness as a fitness model or a physique model would look. I’m not after six pack abs. If they happen as a function of what I’m doing to train – that’s great, but I’m not training specifically just for the look that my body would have.

Tracy (10:22): And then if you don’t achieve that look, you won’t abandon your activities, which have all kinds of other benefits. But if it’s only that you’re going for that look, or only going for the weight loss, not everybody’s going to achieve that. In fact, a lot of the data shows that not many people will achieve it in any lasting way, sadly.

Samantha (10:46): We have two groups of people who really lose out. Once the people who start physical activity and don’t lose weight and then say, “Well, it’s not working”, so they quit. So those people lose out. The other group are people – our physiotherapist was talking about his wife who the doctor never mentions to her that she works out, and no one ever suggests that she should exercise. People don’t suggest that because she’s really thin and they think she’s already in pretty good shape, but she’s not. She gets winded walking up a flight of stairs. I think lots of people in their own lives actually mistake being thin for, “There’s no real need for me to work out.”

Allan (11:25): I was talking to a therapist at a clinic, and they deal with people with kidney issues. There’s a term out there called TOFI, which is thin on the outside and fat in the inside. So there’s this whole population of people that are very fortunate that they don’t look heavy. They don’t gain a lot of weight, but they can have a huge amount of body fat and be unhealthy, because they’re not eating the right way. They’re not taking care of themselves. And so, as you’re defining fitness in the book, which you’re basically saying is you find those things to do. We’ll talk about your “Fittest by 50” mindset. This was a longer range thing that you were working towards as you got into your late 40s, and then you were trying to work towards a goal by the age of 50. But you weren’t thinking in terms of, “I’m going to do this till I’m 50 and then I’m going to quit.”

Samantha (12:22): No, not at all. We both continued right on ahead.

Tracy (12:26): Right. We were thinking of it as setting us up for the second half of life.

Allan (12:31): Perfect. And that’s why terms like “diet” and signing up and doing a program – and I know you guys were really negative on boot camps, but I think sometimes boot camps are good about getting people to show up because of the fact that you’re accountable and you’ve got some people there that you can actually connect with. So some of these things, even though they’re not always your favorite exercise – like, who likes burpees – but they are exercises that get you moving. And if it’s a boot camp that gets you started, but you’re not trying to define yourself as the next CrossFit queen and you’re not looking to get on a magazine cover – at that point you now have a more balanced aspect of what your life can be like and what this exercise can do for you. We did a burpee challenge. It’s not a boot camp thing, but there’s a lot of burpees.

Tracy (13:25): We did a burpee challenge too.

Samantha (13:27): I loved it. I had fun with the burpee challenge.

Tracy (13:29): I couldn’t handle it after about 50.

Allan (13:35): I had them over the course of 28 days. The beginners did 1,000 burpees in 28 days, and the advanced ones did 5,000. So you can see it’s a lot of burpees. But I had a woman tell me after she did the burpees, she wasn’t even thinking about it, but her boyfriend came over and they were going to go somewhere and she says, “What vehicle did you bring?” And he has a Navigator and a Corvette. He said, “I brought the Corvette.” And she said, “I hate getting in and out of that Corvette because it’s so low and I struggle to get in and out.” But she said she walked up, she sat down and she got in. It was perfectly fine. And then she got back out. He was even commenting, “You’re not having problems with the Corvette.” She’s like, “No, I guess the squats that I was doing basically have now strengthened me to a point where I can get in and out of your Corvette with no problem.” To me that’s a huge fitness win, in that she can now live the lifestyle and do the things she wants to do without having to be worried about what car he’s going to bring over, or how her inability to do something is going to affect her life. So, I really do like how you guys have gone on to fitness to say, this is about your ability to live the life you want to live.

Samantha (14:47): I think we both have realizations in the book where there’s something like that that we’re able to do, that it was nothing we were aiming at, but at the end of the challenge we were able to do. I’m trying to think of examples, but I think for both of us there are moments like getting in and out of the car, that, “Wow, this is something I used to find difficult, but now seems pretty easy.”

Tracy (15:07): For me, one of the things that really motivated me to get back into it – because I had done resistance training in my younger years, but I had let it go – was my groceries were starting to feel heavy. I thought, “I’m 48 years old and my groceries are starting to feel heavier than they used to.” Now I find I can practically lift them up over my head.

Allan (15:33): I’d say buy more vegetables.

Tracy (15:35): I’m vegan, I buy plenty of vegetables.


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Allan (15:55): The next topic I wanted to get into – and I know that women struggle with this because you hear it on a daily basis – is body image. But I’d offer to share to you, men have the same kind of concern; we’re just not as vocal about it.

Samantha (16:16): I’ve got two sons, so I know watching my sons go through this, so it’s an issue for them too. I just think it’s less of an issue and not the entire thing on which they think they’re judged in the world. Whereas I think for women it just occupies a bigger part of our mental space and a bigger part of how we’re treated in the world and the assumptions people make about us. If you’re a larger person, people assuming that you’re lazy. There’s all sorts of research that shows we have a lot of bad attitudes towards people who carry extra weight.

Allan (16:50): Yeah. And like I said, I think there’s a little of that with men; not as much. I have a neighbor, he’s 55 and he has one of those one-wheeled skateboards, with a big wheel in the middle. He rides all over the place on that thing, and I’m thinking that’s pretty decent balance. He also wind surfs and does these other things that you’re like, “That’s not normal behavior for a 55-year-old”, but he’s doing it. I think one of the big challenges that men have, as well as women, is we just seem to want to compare ourselves to something we see as a peer group. And the magazines don’t help because they’ll sit there and show Robert Downey Jr. I know he didn’t live a really good lifestyle when he was in his 20s, because I read about it a lot. But he’s in his 50s and he’s fitter than he’s ever been, and posing for muscle and fitness magazines and things like that. I guess knowing it’s possible makes you want something for yourself. But to me, I just don’t know that the body part is what’s going to really keep you involved, particularly, like you said earlier, if we’re not seeing the results.

Samantha (18:15): No. I think for most people you don’t get the kind of results you want unless you’re going to make it your full-time job, and most of us can’t do that.

Tracy (18:24): We’re not celebrities like Robert Downey Jr. He has a team, a personal trainer that’s dedicated to him and maybe he works out every day with that trainer. He might have a chef. What I like about our book is that we’re ordinary women with big careers and families and we’ve done this. And we don’t have six packs, but we’re in pretty good shape.

Allan (18:52): I want to talk a little bit about your experiences, because you both got into this together, and throughout the book you take us on a journey, which was basically two years for both of you. Could you each take a little bit of time to talk about your reasons for wanting to do this? It was a two-year journey, so it was not something you just said, “I’m going to do this in six months and do this thing.” This was a targeted approach, long-term approach. And then some things that you learned along the way.

Samantha (19:25): Sure. So I was already pretty active, but I found the things I like to do and just did those things. So, I was a cyclist, I was still riding my bike lots, but I was no longer riding as far or as fast as I like to ride. I was doing aikido, but at that point I wasn’t testing for any belts. I was just doing the things that were easy and made me happy, but I wasn’t really challenging myself. So what I wanted to do going into the Fittest by 50 challenge was up the ante on both of those things. So I wanted to up the ante on cycling, to ride further and faster. I wanted to try some new things, to kind of break out of a rut. So I tried CrossFit, rowing, I tried lots of different things during the course of the challenge. I added a lot more weight training. Then I wanted to do some belt testing in aikido and move up a few levels. And by the end of the challenge, I’d ridden my bike from Toronto to Montreal, which is about 400 miles, 660 kilometers. And I’ve gotten a lot stronger. I’d been faster maybe as a cyclist before, but never as strong at the same time. I used to just weight train during the winter offseason, and I started weight training year round. I tried a bunch of new things, so I think I’ve met my goals. I was pretty happy, and it was a fun challenge for me.

Tracy (20:54): When Samantha proposed being the fittest we’d ever been in our lives by the time we turned 50, I said that’s a project I can get behind because I had also sort of stagnated. I was walking a lot and doing yoga, and I had just started back into some weight training, but I was feeling pretty green at it actually. I very much had associated fitness with thinness, even though I knew that that was not right. We’d been having this conversation about feminism and fitness for many, many years, like 25 years. So I knew that it wasn’t right, but I couldn’t let go of the body image as the main driver of all the things that I did. And so one of my goals in the challenge was this mental shift. I wanted to lose that sense of having to look a certain way and that that’s the reason why I would do these activities. I really wanted to lose that.

Allan (22:00): Can you tell us a little bit about that? It sounds like you were trying to reprogram.

Tracy (22:08): Yeah, I was. So one of the first big things that I did – you mentioned it already – I put my scale away. So about three months into the challenge, I had tried sport, nutrition counselling, and finally, I just said, “Forget it, I’m going to do intuitive eating.” Everything in the sports literature would argue against it, but basically, you eat when you’re hungry, stop when you’re full or when you’re satisfied, you eat what you want and you don’t weigh yourself. That is what I had to do to let go of that obsession.

And then the other thing that I did was I signed up for a triathlon, which was extremely out of my comfort zone. I didn’t run very well, I certainly didn’t know how to ride a bike with clipless pedals or any kind of racing road bike, and I hadn’t been swimming in years. So, all of a sudden I had this daunting thing to train for that how my body looked was the last thing on my mind. It was more like, how the heck am I going to finish this event? So I re-oriented my focus in a way on the performance side. And you know what? It was transformative. I shifted my Fittest by 50 goals after that first summer. My goal was to do an Olympic-distance triathlon in the second half of the challenge. The one year I did four triathlons of different distances, and my entire focus was on the performance. Through the training I stopped weighing myself, putting the scale away. I did reprogram myself and I really am still there today. It was incredible actually.

Allan (24:11): Good. And so, Tracy, what I’m hearing is that you’ve basically put something out in front of you that was going to effectively force you to address your training.

Tracy (24:24): Yes, to focus on something else.

Allan (24:26): Yeah, with passion and knowing that it’s really going to be about the performance: “How can I be comfortable swimming a distance, spiking a distance, running a distance? And then I’m going to put them all together. I’ve got to have the fitness level to be able to perform and do those things.”

Tracy (24:42): Yeah. And it’s a learning curve. In triathlon, the transitions even are things you need to train for, like how do you transition? How do you get your wetsuit off but your bike shoes on?

Allan (24:55): Yeah, I’ve never actually done anything like that. Like I said, I’ve done the mud runs, but you wear what you wear and if it comes off while you’re running, you just leave it. I could see that being one of my huge challenges – if I didn’t just drown in my race really early, then it would be, “Now I come out of the water. How do I get on this bike and not kill myself?” And you’re up there in Canada, so it’s cooler. You are wearing a wetsuit, so definitely.

Tracy (25:30): My first event – the swim got cancelled because it was too cold. They turned it into a duathlon – a run, bike, run. And I hadn’t really prepared for that, because I still wasn’t a very strong runner. It’s like, “Oh my God, we have to do two runs?”

Allan (25:49): That’s good, it mixed it up. And I think that’s where I want to go with Samantha, is that you tried a lot of different things that were going to tax you in ways that you had not been taxed before, and you probably learned a lot about yourself as a result.

Samantha (26:02): Yeah, I did. There were things I loved that I realized just did not fit into my life or my lifestyle. So, I’d always wanted to try rowing. I know lots of cyclists who are good rowers and they’re often thought of as complementary sports. They place demands on the body; you’ve got to be super strong and aerobically fit. And so I joined a master's women’s rowing team and loved it. But I discovered that they have a kind of dedication to schedule that I just can’t have, given my job, how much I travel for work and given family demands. So they have certain times where if you are going to be on the water at 7:00 PM, you have to be there and on the water at 7:00 PM. And if you have a certain spot on a boat, you train for that position. And if you can’t make it because you’re away at a conference giving a paper, you have to find someone who can come in and take that spot in the boat who’s also trained for that spot. It’s tricky.

And so I thought in the end probably rowing for me is going to be a retirement sport. It’s going to be a thing I can do one time somewhere near a lake and I can just say I’m going to be there two or three days a week, mornings or evenings, and make that commitment. It’s also a lot of traveling for racing. So rowing involves derigging all the boats, loading the trailer with all the boats, driving hours. And then some of the races are five minutes long. So it’s a lot of derigging and carrying. It’s a sprint effort, so it’s a lot of derigging, carrying boats, loading trailers, driving, re-rigging, carrying boats to the water, and then it’s over. The comradery is great. I love going to rowing events, but I would rather be on my bike for three or four hours, which simply I throw on cycling clothes, I put some air in my tires and off I go. A lot less coordination, organization. So I found it was interesting to try different things and see what worked and what didn’t. I loved rowing and I loved being on the water, but I’m going to have to wait till I have a less big job and a different kind of schedule, I think.

Allan (28:16): I can see that. Team sports are great for that comradery, for getting you out there and keeping you out there, particularly if they’re counting on you to be a particular function on the team week in and week out – then yes, you’re there. But that is a commitment of time and effort that you have to be able to fulfill. But I think it’s awesome that you guys put this together for yourselves and you went through and followed through with it. You have a blog, and now the book. If someone wanted to learn more about you or the book or the blog, where would you like for me to send them?

Tracy (28:52): For the blog they would go to FitIsAFeministIssue.com. That’s our WordPress blog. We blog seven days a week there, at least once a day. Samantha blogs every Monday and Wednesday and I blog every Tuesday and Thursday, and then we have regular contributors and occasional guests. So that’s the blog. And the book, Fit at Mid-Life: A Feminist Fitness Journey, is published by Greystone Books out of Vancouver and it’s available on Amazon. And we would love it if you read the book and want to write a review on Amazon.com. That would be great too.

Allan (29:29): Cool. This is going to be episode 324, so you can go to 40PlusFitnessPodcast.com/324 and I’ll have the links to the book, to their blog and all of that right there. So, Samantha and Tracy, thank you so much for being a part of 40+ Fitness.

Tracy (29:46): Thanks, Allan. It was nice chatting with you.

June 11, 2018

Living in the chemical age with Janet Newman

In her book, Living in the Chemical Age, Janet Newman lays out a solid plan to protect your family and yourself using some basic protective measures.  In our discussion, Janet and I cover why chemicals are an issue, what is wrong with our drinking water, and how mold can become a huge issue.

Allan (3:09): Janet, welcome to 40+ Fitness.

Janet Newman (3:13): Thank you so much, Allan. It’s great to be here.

Allan (3:16): So your book is Living in the Chemical Age, and it’s something that I’m always just vaguely aware of in the back of my head. It’s like, is this the best thing for me, and how am I doing this, or am I doing the right thing here? Your book really is a good primer, I think, for someone that is beginning to think about these things and how they can go about cleaning up their lives and trying to get some of these chemicals out of our life, rather than constantly be dealing with the toxic issues that we have. Both you and your husband had suffered from some of these problems, and that’s, I guess, what got you really interested in writing the book.

Janet Newman (4:01): Yes, that’s true. I always was aware of what I ate and really tried to be health-conscious pretty much from my young adulthood on, but I wasn’t really aware of all the toxins that we’re bombarded with on a daily basis. It wasn’t until I started having my own health challenges in my early 40s that really started getting me on that track of, what is it that’s in our food and water and personal care products that might be causing some of these issues?

Allan (4:45): I like how in the book you put the whole concept that our body is kind of like a silo. And as we just continue to pile on these different chemical exposures, there’s a cumulative impact. Can you talk a little bit about that?

Janet Newman (5:01): Yes, I can. So I used the description of a silo, because I think it’s from my upbringing. I grew up in Michigan, and although I wasn’t in a rural setting, I did see grain silos periodically. And for me, when I think of the body’s immune system, if you will, and all the toxins that are accumulating, it’s easy for me to imagine a cylinder or a grain silo, if you will, that has different layers of these chemicals filling it up. I believe that if we take in more than we’re able to excrete, then those just keep piling up and up and up until it gets to the top. And that’s when we usually see some kinds of disease, or even just troublesome symptoms that start to appear, when our body can’t tolerate anymore and it just starts rebelling, if you will. It says that there’s a problem, and it could manifest itself in many different ways, from skin eruptions to headaches to inflammation. I think most of these chemicals that we’re being exposed to are man-made; they didn’t exist before the Industrial Age or maybe 100 years ago. So, I don’t think that our bodies have had an evolutionary chance to really adapt to all of these chemicals. And since our bodies can’t utilize or digest these synthetic chemicals, we’re challenged by them and they have a chance to potentially wreak havoc on our body.

Allan (6:50): Yeah. And I don’t know that we want to adapt to these things, because there are some animals that do reproduce a lot faster than we do, and they’ve somewhat adapted to some of these things and it’s not all that pretty. So I’m not sure that adaptation is the right answer here. Probably 20,000 years from now, we might be able to handle something we’re doing today. But there are things we can do today and I wanted to get into a few of the things, because they’re all around us. I try to forget that it’s there sometimes, just for sanity’s sake, but it is always there. So, a few things that I did want to talk about. The first one is water, because I think more and more people are saying, “I’m not going to drink the tap water because of X, Y, Z problems”, and they’re going to the bottled water. But really, one might not be any better than the other. Could you talk a little bit about water, what we’re exposed to in a lot of our tap water, what we can do about it, and then when and how maybe bottled water could be an alternative? What are some things that we could consider as we’re going through this whole process of having cleaner water?

Janet Newman (8:07): Sure, absolutely. Our bodies crave water, they need water to function. It’s just a matter of how clean the water is, and that’s what we really need to focus on. It’s not a matter of, “Should we switch to other beverages?” We need pure water to drink. One of the problems that I have discovered with our tap water – and we’ve all heard about the Flint water crisis and the lead. And that’s not just Flint, Michigan that has the problem; it’s anywhere that has corrosive pipes. There are several things that I discuss in my book that can lead to corrosion in pipes, but there are so many contaminants in our water. Part of it is that our municipalities that filter the tap water weren’t designed to filter out things like prescription drugs or birth control pills or industrial runoff. Some of the chemicals that we’re seeing are beyond what the filter’s capabilities are. So that’s definitely part of the problem with our tap water, is that we just don’t know what we’re getting. And I advise in my book to get your water tested professionally and see what is in there, so you know how to filter for it. There are different filters and filtration systems that you can put on your tap, and depending on what you’re encountering, what kind of chemicals there are, we’ll tell you what kind of filtration system you need.

And I do want to talk about bottled water. I’m actually thinking about doing a challenge for my people that are on my website, people that have read my book, but I think it’s really important. The challenge is to stop drinking bottled water out of plastic for 30 days. It really is not that hard, but I think we’ve just become so accustomed to the convenience of reaching for a plastic water bottle that sometimes we don’t even think about what the ramifications of that might be. One of the issues with plastic water bottles is the plastic itself. The plastic that is being used, if you look on the bottom, there’s a triangle and there’s a number 1 inside. That means that it’s made with PET plastic, and PET is an endocrine-disrupting chemical. What happens is when that ever heats up, say in a hot truck, or if you buy water that comes from overseas, for instance – there are many brands here, but there are many brands that we import. We don’t know the status of the temperature of those ships or those trucks that bring that water to our grocery store. So, when the PET gets hot, it leaches those chemicals into the water. So that’s the first problem.

The second problem is that – and I just saw another study about this last week – little micro particles of plastic that are in the water from the plastic itself. The study last week that I saw said that most of the plastic is coming from the actual top of the water bottle. So that’s the second thing. We don’t want to be ingesting plastic, nor do we want to be ingesting the chemicals that come from the plastic. And the third thing is that the bottled water industry isn’t required to disclose the results of their water testing. So we may be just getting tap water anyway in there; it might not have any filtration. A lot of the bottled water that I’ve looked at the label and it does say that it has reverse osmosis or other types of steam distillation, other types of filtering processes, but some of them don’t. So, when we reach for that bottle of water, I think it’s really important to start thinking about all the different things that could be in that water.

Allan (12:46): Yeah. It wasn’t this way 20 years ago, but now there’s an entire water section in the grocery store. There’s an entire bottled water section in the convenience store, if you’re traveling and you stop to get some gasoline, you walk in. Some of them are spring water, some of them if you actually read the label, it’s just municipal water, it’s tap water in a bottle. So now you’ve gotten the tap water and you’re drinking that; you’re just drinking it out of the bottle, which now, like you said, may be subjecting you to even more chemicals than it had when it was in the water system.

Janet Newman (13:25): It’s true. There are two other factors with bottled water that a lot of people don’t think about, and that is the expense. It’s very costly to produce these bottle, and they’re produced through the oil and gas industry. PET is based from that. I think we’re thinking about cost and we’re also thinking about, what happens when we dump that water bottle? Where is it going? If we throw it in the garbage, then we have pollution to think about that eventually goes into the ground water and eventually it could make its way into our oceans. We have such a problem with plastic in our oceans. I’m sure everyone’s seen recently on Earth Day, some photographs of our plastic garbage patches in our oceans. It’s really kind of disgraceful that we’ve allowed it to get that way. So just thinking about, when you reach for that bottled water there are so many different avenues of why there is a better choice. I always say, filter your water at home, bring it in a stainless steel or a glass bottle, and carry that around with you every day. It’s not going to leach chemicals, we know that it’s filtered and it doesn’t contain any of the harmful chemicals in it from the beginning, and you’re not contributing to our environmental problem.


 I need to take just a minute away to talk about our sponsor, Teami Blends. Go to 40PlusFitnessPodcast.com/Tea to learn more about them. And use the coupon code 40plus to get 15% off your order of $30 or more. 40PlusFitnessPodcast.com/Tea. Thank you.

Allan (15:15): Now, one of the other things about tap water that I think is interesting, and you highlighted this in the book as well, was not just what they’re not filtering out, but what they’re actually putting in. So they’re putting fluoride because we’re eating so much more sugar now, so our teeth are rotting. So they’re putting fluoride in the water to help keep our teeth from rotting. But that fluoride is not in the best interest of our health. Data is coming out now to basically show us that it’s really messing us up.

Janet Newman (15:53): Yes. I think that in the 1940s there was a study that showed that people who lived near certain types of rocks called “calcium fluoride” had really great teeth. Unfortunately the type of fluoride that we’re putting in our water now is not calcium fluoride, it’s sodium fluoride, and it’s actually a byproduct of the fertilizer and aluminum industry. Basically this type of fluoride has shown to have many adverse effects to our health. One of the things that are most troubling is that it accumulates in the brain. It’s been shown to lower IQ and interfere with memory. So, definitely problematic. And from an aesthetic perspective, if you have too much fluoride in your body, it causes something called “dental fluorosis”. You may have seen people with this, but it’s like mottling of the enamel that has bright white spots on their teeth. Who wants that, really? But there are some good things that are starting to occur. They are doing more studies, and there are definitely some activists out there. One is called the Fluoride Action Network and they’re working with the EPA to try to eliminate fluoride in our municipal water supply.

Allan (17:37): Well, good luck with that, because the EPA doesn’t really seem to want to help us out when it’s human health. It’s just crazy. Now, it’s starting to warm up and more and more people are going to be outside, and I encourage people to get outside. They’re going to want to probably apply some sunscreen. And you had a very interesting story. You were basically looking for a particular type of sunscreen that had zinc in it, rather than some of the other chemicals that they might use. And you were at what we would call it a “health store”. They build themselves out as a health store, but they weren’t carrying any brands that had zinc in them, because they said the customer demands sunscreen that absorbs in and doesn’t show white on their skin, and therefore they don’t carry it. At least carry one brand, even if no one’s hardly buying it. Carry it – you’re a health food place, after all. But could you talk a little bit about sunscreen, what we should look for when we’re trying to buy a good quality, healthy sunscreen?

Janet Newman (18:45): Yes, absolutely. Sunscreens are basically divided into two categories – there are chemical sunscreens and there are mineral sunscreens. You can probably tell I’m going to tell you to use the mineral sunscreens. The chemical ones – a lot of them have been banned in other countries, which makes you sit up and take notice, why hasn’t the United States banned those? But they’ve been shown to cause free radical damage. They tend to enter the bloodstream. Instead of just coating your skin, they actually get absorbed into your body and they can do some not so nice things to your body. And it also is linked to the bleaching of coral reef. So if you’re going on a vacation where there is scuba diving or anything like that, just know that you could be potentially harming the environment as well.

I like to stick to products that have zinc oxide in them. Titanium dioxide is another mineral sunscreen; it’s the only other mineral sunscreen. There have been a few studies lately, actually since this book has been written, where it shows that titanium dioxide may cause some issues to be concerned about as well, but that’s primarily when it’s in nanoparticle form. What I mean by that is when the particles are so small that they can be sprayed as opposed to applied like a cream or gel formulation. So because they’re so small, they tend to get absorbed into your skin as well, and there’s some speculation that that can cause damage. So what I like to say is that anything with zinc oxide is definitely safe, it stays on top of the skin. They’re starting to create formulas that aren’t nanoparticle size, but they’re not going to be as white and pasty looking as they used to be. When I think of zinc oxide, I think of those pictures in the ‘50s with surfers with the big white stripe on their nose. It’s not as bright as that anymore. But I think that sticking with mineral sunscreens is definitely going to be your safest bet.

Allan (21:22): Okay, cool. I was sitting on my balcony this morning, and typically the wind blows well enough here that I don’t have to deal with mosquitoes too much, but I guess it wasn’t blowing enough this morning. So I’m sitting outside and the mosquitoes are having a nice feast breakfast on Allan. I don’t typically wear insect repellent at all. I have on occasion when I know I’m going someplace – particularly I’ve had some travels to Africa, and that’s not a place you necessarily want to play around with mosquitoes. If we’re looking for an insect repellent, what are some things that we should consider and be looking for with that?

Janet Newman (22:04): Good question. A lot of people reach for the heaviest possible insecticide that they can find, carrying DEET. And DEET, I have to tell you, is a little stronger than you want to put on your body. It was formulated for World War II soldiers that were in jungle-like conditions to prevent malaria. But honestly, it is so strong and toxic that it can melt synthetic fibers, it can damage paint. I just think that if it’s something that strong, you really don’t want to put it on your body. DEET has been shown to absorb through the skin and it gets excreted through your kidneys. And who knows what it’s doing from point of entry to point of exit? I personally wouldn’t want something that can melt synthetic fabric being put into my body. The EPA says it’s safe, of course, and there are lots of products on the market that contain DEET, but I just don’t think we need something that strong.

If you’re going to Africa or somewhere where there are a lot of mosquitoes and you’re bushwhacking through the rainforest or something, then there is something called “picaridin”. And picaridin is derived from black pepper, and it is super, super effective. In studies they show that it’s as effective as DEET, and it’s not going to have any of the safety risks that DEET does. So, my husband just went to Africa last summer and he used picaridin and he had amazing success with that. He didn’t get bit once. So, if you really need something strong and effective, I would suggest looking for picaridin. Now, if you’re just in the backyard or your kids are out playing, I would use something that has oil of lemon eucalyptus, because that is one of the only plant-based insect repellents that has been approved by the CDC to be super effective.

A lot of times it’s used with other oils, such as lavender or tea tree oil or citronella or things like that, that may be used in addition to it. But what they found is that the oil of lemon eucalyptus is an oxygen mask for your bodily scent. When we sweat or when we exhale, those are the scents that mosquitoes are attracted to, and when you use oil of lemon eucalyptus, it masks those scents in such a way that it confuses the mosquito. So they may see you but they’re not going to smell you, and the likelihood of you getting bit is much, much lower.

Allan (25:21): Cool. There was one part of the book that you got into when you started talking about mold that really, really hit home, because we bought this house and we got inside and there was a mold problem. My wife just knew it. She was like, “I’m sensitive, there’s a mold problem. We need to get this taken care of.” And so we brought in some guys and they went to clean our ducts. They’re like, “We can just clean the ducts and that’ll probably solve your problem.” Well, they actually stirred up all the mold spores, so within three days it was everywhere. It was horrible. So we had to bring in another expert, and this guy stripped out all of our duct work, got all of the insulation out of the attic, because there was mold everywhere. He helped us clean that up. It was not cheap by any stretch, but we got it done and now we’re in a mold-free house. Can you talk a little bit about mold, why it’s such a big problem for us and what people should be doing to one, determine that they don’t have a mold problem, and two, if they do have a mold problem, what steps should they take to remediate the problem?

Janet Newman (26:29): First off I have to say, I’m so sorry that you went through that and I can completely empathize. Secondly, I’m so glad that your wife is sensitive because she was able to sense that something was off, and a lot of people can’t tell. Sometimes mold just doesn’t have an odor and it can lurk behind walls and ceilings and in air ducts and things, and they have no idea. And people just become ill and they don’t know why. So, mold is such a big problem, especially for flood-prone zones, but anytime that you have a leak or a spill in your home, mold only requires 24 hours to start growing. I should point out too that mold requires four things to grow. It needs moisture – obviously that’s a big one. It needs oxygen. It also needs the right temperature, usually between 40 and 100 degrees is kind of the sweet spot for mold. And it also needs a nutrient source. And when I talk about that, I mean things like paper or cardboard, dry wall, even carpeting.

Those four things are in our homes all the time. And so it’s really important – the first thing I say to people is to make sure that you have a really good dehumidifier that is controllable, and that you can adjust the settings to about the sweet spot. Again, it’s about 45% humidity. It can be between 40% and 50% to be safe, but that’s the goal that you’re trying to reach, because mold is tricky. I think there are thousands of types of mold; I think it’s 100,000 types of mold that I read in one source. So we don’t always see it, we don’t always know it’s there, we can’t always smell it. If you suspect that you have mold in your home, there are so many different tests on the market today that you can use. Usually it’s just you take a dust sample and you send it off to a lab, and there are instruction on how to do all of that in the kit. Knowing what kind of mold you have is key. You can also hire someone – it sounds like you did, and we also had to do as well. They have all kinds of different little gadgets, but one of them is a moisture meter, and they can go around your home and test all of your baseboards and your walls to see if there’s potentially any moisture behind that you can’t detect with your eye.

So yes, mold can cause a lot of health problems. My husband and I both had completely different symptoms to the mold that we were exposed to, and that’s why we didn’t think there was a common denominator there. He had arthritis symptoms and was actually diagnosed with an auto-immune form of arthritis. I was having migraine headaches that were just awful brain fog, migraines. And because those are so different, we didn’t think that it was being caused by the same issue. It wasn’t until my husband went to a functional medicine doctor, where she said she kind of noted the timing of our new home and when his symptoms started. And she said, “I think I want to test you and your wife for mold.” And it came back that we both had pretty severe mold exposure. It took a long time, and like you said, it’s not cheap. We had to remediate our home; it took almost a year. We had the cost of remediating the home and the cost of detoxing from the mold in our bodies. It took us quite a long time, it was about a year for both.

Allan (30:56): My wife had to go in for surgery, because her sinuses had gotten so bad. They went in and thought the mold was in there, so they did some work there to basically scrape out her sinuses, for lack of a better description of what it was. She went through that. But the guy came in and was really good. Of course I was getting a lot of bad news. Every time he did something, he’d say, “Well, we pulled this away and we found that, and we did this and found that.” And it’s like the cash register’s ringing, but you have to do it. So we have all new duct work in the house. We have a dehumidifier that actually sits up in our attic and runs full time now. He did the black light irradiating and spraying stuff with, I guess it was peroxide, and probably some other chemicals I might not want in my house. But at that point the mold was the enemy, and it’s all hands on deck.

This book, Living in the Chemical Age – I think it’s really a good opportunity for us to take that step back and really start to assess what our health is, and maybe some of these things that just might be around us that we haven’t paid enough attention to – the fluoride in our water, the chemicals that might be in our water, what’s in our air, what’s in our skin products and our sunscreens and our insect repellents, and obviously mold and other things that could be going on around us.

And I like that I can get your book and say, “If I’m dealing with this kind of problem here, I want to know about this, I can go to that part of the book.” And it’s a really good brief understanding of saying, “These are the things I need to look for. I know what kind of filter I want now, once I get the test”, and all that kind of stuff. It’s really an actionable book to basically help get yourself away from some of these chemicals. I don’t think anyone can ever be completely chemical-free. As long as you’re breathing or bathing or eating or anything, there’s probably going to be some chemicals. But this book does go a long way towards helping us get healthier and being able to use that to somewhat diagnose if we might have a problem with the product, and then we can just exchange that product for something else. That form of substitution might be enough for you to realize, “I did have a problem with that chemical, or maybe I didn’t, but I go and do something else.” But the chemicals are all around us, so that’s the scary part of the book. But I think the good part of this book is that there are things that we can do about it. We just have to be aware.

Janet Newman (33:35): Exactly. You can’t eliminate all the toxins in your environment; it’s impossible. One expert said that we’re exposed to 250 pounds of chemicals on a daily basis. So it’s impossible, they’re everywhere at this point in our lives. But you can definitely do a lot of things to reduce your exposure and to reduce that toxic burden in your silo. I try to give a lot of helpful tips and resources for people, so that it’s not so scary and people feel empowered that they can actually make healthier choices and really take control of their own health.

Allan (34:18): Yeah.

Janet Newman (34:20): I’m glad you liked it.

Allan (34:21): I did, I did. If someone wanted to learn more about you, learn more about the book, where would you like for me to send them?

Janet Newman (34:27): Sure. You can go to my website – LivingInTheChemicalAge.com. I’m also on Instagram and Twitter, and my book is available on Amazon. So, there are lots of different ways to find me.

Allan (34:41): Alright. Well, this is episode 323, so you can go to 40PlusFitnessPodcast.com/323, and I’ll be sure to have links there to the resources that Janet just mentioned. So again, Janet, thank you so much for being a part of 40+ Fitness.

Janet Newman (34:56): Thank you, Allan. It’s been wonderful. Thank you so much.

Another episode you may enjoy:

Manage your microbiome with Danielle Capalino

June 4, 2018

How to deal with lyme disease with Darin Ingles

Dr. Darin Ingles is the author of The Lyme Solution.  He is a respected leader in natural medicine with numerous publications, international lectures, and more than 26 years of experience in the healthcare field. His practice focuses on chronic immune disorders including Lyme disease, autism, allergies, asthma, recurrent or persistent infections, and other immune problems. He uses diet, nutrients, herbs, homoeopathy and immunology to help his patients achieve better health.

Allan (4:00): Dr. Ingels, welcome to 40+ Fitness.

Dr. Darin Ingels (4:05): Thanks for having me, Allan.

Allan (4:07): The book, The Lyme Solution – I admitted this offline to you and I guess I’ll go ahead and make this admission now – I have zero experience with Lyme disease. I’ve never known anybody that’s had it personally, I’ve never seen anyone experience it. So I am coming from a position of complete ignorance, if you will. But I think that’s really important, because as it gets warm and I want my clients out and about, I say, “I want you out there getting into nature, I want you moving around, I want you experiencing nature, getting the sunshine, enjoying the outdoors.” That’s a big function of health. At the same time, there is an exposure out there, and without fully understanding the nature of that exposure, it’s this scary thing. “What if I get bit by a tick, what happens then?” I do think it’s a valuable conversation to have, or at least good knowledge base to have, even if you’ve never experienced it, and hopefully never will. Coming from my point, it was really good to understand there is a risk when I get outside. And I can put those in numerical context – I think you said there were 300,000 cases per year of Lyme disease, which seems like a lot. But when you figure there’s 360+ million people in the United States, it’s not a huge, huge number, but those that are affected, many of them are in really, really bad shape. So again, it’s really a good overall primer and education to understand there is a risk and what to look for, which I think is probably the more important thing.

Dr. Darin Ingels (5:48): Right. Lyme disease has really become epidemic, not just in the United States but really around the world. As you mentioned, we have about 300,000 new cases that are reported, and most of us who are in this world would argue that that’s grossly underreported. We don’t know what that true number is, but consider it’s probably half a million people or more. And remember, that’s every year. So as you start stratifying that over the course of a decade, we’re now talking millions and millions of people dealing with chronic Lyme disease. It’s become one of these things that, particularly for people who really enjoy being outdoors. We know that New England and the central part of the US are areas that tend to be endemic for Lyme disease, but really Lyme disease has been reported in every state in the country. So whether you live in Washington state or Arizona or Texas, in places that we don’t typically think of Lyme disease as being problematic, in reality it is possible. And I think people who spend a lot of time outdoors have to be very vigilant about protecting themselves against ticks because they are out there, and for some people can become very damaging in the long term.

Allan (7:01): Yeah. My wife is the worrier of the two. One of us has to do it, I guess. She’s constantly worried about tick bites and things like that when we’re outdoors. I have a property about seven acres out here and I’ll get out there in the bush of it and be cleaning it up, and she’s like, “Check your body for ticks, check your body for ticks.” And I do. I guess that’s one of the things that I came to learn from your book, is that the deer tick that we’re talking about is actually not the tick I’m used to dealing with in the Southeast as often. The ticks we’re dealing with are a little bit bigger than this deer tick. The deer tick would actually be much smaller, which is something I didn’t know. So let’s take a step back. Things I knew was Lyme disease was an auto-immune disease, I knew that it was passed by certain ticks, I knew about the potential of a bull’s eye type mark where you got bit, those types of things. But could you take a step back and tell us what is Lyme disease, how does it get spread and how do we contract it, as a start to get us going in this conversation?

Dr. Darin Ingels (8:11): Lyme disease is actually a bacterial infection and it’s transmitted primarily through a tick bite, and as you mentioned, it’s mostly through the bite of a deer tick. However, these ticks can transmit other types of bacteria and viruses, independent of Lyme disease. We know up in New England where I spend part of my time, 30 plus percent of the ticks up there carry Lyme disease plus something else. So there’s an additional risk of getting some other illness that’s not Lyme disease, that you can get through those tick bites. Down in the Southeast where the deer ticks aren’t as endemic, there are other types of ticks. There’s the dog tick or the wood tick, and as you migrate over towards Texas, there’s the lone star tick. All these ticks can transmit various types of infections, some of which are Lyme disease, others which are something else.

When people get exposed to these ticks and if they have transmitted that bacteria, you can basically feel flu-like, and a lot of people when they are experiencing symptoms – they get a headache and joint pain and body aches, they might spike a fever and chills. It’s kind of a nondescript illness, and often it gets passed off as you’ve got a virus or some other kind of bug running through you and hopefully it will pass. But that bull’s eye rash that you mentioned is the telltale sign that if you see it, there really is nothing else that we know of that causes that kind of rash. That’s very stereotypical for Lyme disease. Unfortunately, when you look at the research, we know that maybe 40% or less of people who get bit by a tick that carries Lyme disease actually gets that rash. So the lack of the rash certainly doesn’t tell us about whether you do or do not have Lyme disease.

One of the characteristic things we also see in Lyme disease that’s very unusual is what we call “migratory joint pain”. What this means is one day your right shoulder hurts, and the next day it’s your left knee, and the next day it’s your right ankle. When you start getting this pain syndrome that seems to vary from joint to joint and body part to body part – there’s nothing really else that looks like that, other than Lyme disease. So the deer tick is still the biggest transmitter of Lyme disease. There’s some information out of Europe that suggests that perhaps even mosquitoes and fleas may transmit Lyme disease, and that might make sense in that I see a lot of patients who live in areas that aren’t known for having Lyme disease that actually have Lyme disease. So perhaps there is another insect factor that’s spreading it. But again, as of now, when you look at the statistics, New England and the Central Midwest are really the big endemic parts of Lyme.

Allan (10:51): Yeah. And I guess that’s one of the hard parts of this – you may think that you’re just getting a spring or a fall flu, or you might be thinking, “My joints hurt because of the weather. It’s getting a little moist out, it’s probably going to rain tomorrow.” As we get a little older, there are the aches and pains, and we’ve gone through enough flus to say, “This is a flu. It goes away in a few days, and then I’ll be fine. If I’m not okay on Monday I’ll go to the doctor and he can give me a shot or an antibiotic or whatever he wants to do.” So, Lyme disease often gets missed. And I know that in the book you put a quiz that takes us through a series of questions that if we get to the end of that and we score better than, I think it was 45 on this particular quiz, it’s very likely that we do have Lyme disease. It can be confirmed with some tests.

I’ve gone over things in here with podcasts before; we’ve talk about acute and chronic. So I’ll just quickly go through. Acute is something that’s right there – something happened and you know what happened. Here’s the event, you can actually point to it. Chronic is when something sticks around for a while and you might not even know when the actual event, so to speak, occurred. It’s just continuing illness or a continuing problem. You’ve identified acute and chronic with regards to Lyme disease. Can you talk a little bit about what those differentials are of how it’s acute versus chronic and what the basis is? And then what are some of the symptoms that we would look for on the basis of whether we’re dealing with something that’s immediate, like acute, or something that’s a little bit more long-term, like chronic?

Dr. Darin Ingels (12:35): In acute Lyme disease, as I mentioned, you feel really ill and it’s like if you had any other type of infection. You can get a high fever, swollen glands, chills, body aches, joint pain. You can get a headache, you can get back pain. You just feel like you’ve got a bug that often will knock people down for a handful of days. I think the big difference, when you get a virus, a cold, things like that – you might be sick for a few days to a week, maybe 10 days, and then it seems to resolve on its own. Or maybe you’ve gone to your doctor and got a prescription for antibiotics, and that cleared it up and you feel fine.

What happens in Lyme disease often is that you might feel a little better or you don’t feel any better at all. And you start getting into two weeks, three weeks, a month or longer, and really not feeling well. And as it migrates out of that acute phase into a chronic phase, what we really start to see are more neurological symptoms. So people will complain of this condition called neuropathy, where you get numbness and tingling in your hands, your feet and other places on your skin. People will describe these sensory distortions where you feel a burning in the skin and yet you look at the skin and it looks completely normal and pink. People complain of feeling clumsy, they trip a lot, they drop things a lot. They start having memory problems, cognitive impairment, short-term memory loss.

All of these various neurological symptoms can be a sign that you’ve gone out of that acute infection stage and now it’s becoming more of this auto-immune problem. We’ve got some pretty good evidence in the literature that Lyme disease has the capacity to trigger your immune system in a way that it starts making antibodies against your own neurological tissues in your brain, and that inflammation in the brain can really start to cause a lot of these various neurological symptoms. It’s interesting when you look at all of the symptoms that have been associated with Lyme disease – there’s almost 100 symptoms. It’s really pretty varied. We call Lyme “the great imitator” or “the great mimic”, because it looks like so many different things. That’s why when I have people who come into my office who’ve basically been sick for weeks and months on end and they’ve been tested 20 ways to Sunday, and can’t seem to find an explanation of why they feel the way they feel – Lyme disease is always something that’s on my mind, because it is one of the few things out there that can cause this sort of long-term illness, particularly when we hear about a lot of joint and muscle problems, and the neurological symptoms.



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Allan (15:31): I think the thing that struck me with all of this as I was going through the reading – there’s a theory about mitochondria, that it was basically at one point a separate bacteria that moved into our system and became a part of humans and animals over time. It really seems like Lyme disease has a little bit of that nature to itself, that it’s somewhat trying to take over us as an organism. It’s actually very, very smart. I guess maybe not intelligent, so to speak, but the way it works and the things that it does make it very hard to, one, diagnose, and two, to actually get rid of.

Dr. Darin Ingels (16:16): Yeah. Lyme diseas is really the ultimate shapeshifter of its characteristics. For people who don’t know, Lyme disease is what’s called a “spirochaete”. If you look at it under a microscope, most bacteria are like little balls or rod-shaped organisms. Spirochaete is a very long corkscrew-shaped organism. And even though it’s technically a bacteria, it actually behaves more like a virus and therefore it can penetrate tissues, it can penetrate cells and it can literally ball itself up so that the immune system essentially can’t identify it. I think part of the reason that people end up with the chronic Lyme disease is that this organism will change its shape, hide from the immune system so the immune system doesn’t get rid of it the way it should. It kind of hides in the corners of the body where the immune system is either not looking or if it gets inside your cell, the immune system can’t see at all. Then given the right set of circumstances, it starts to rear its ugly head again and uncoils itself, and then it becomes more problematic and can continue to stimulate more inflammation. So like you said, it’s a very clever organism. Out of all the bacteria and viruses that I know of, I think it’s the one that has the greatest capacity to evade the immune system.

Allan (17:31): I think that’s really important to emphasize – we need our immune system to basically deal with this. Initially, I think you said within the first 72 hours, maybe some antibiotics would be able to knock it out, but once it’s gotten embedded, once it’s done its thing and it’s in your body and it’s replicated to a point where it’s got its fountainhead, it’s got its foothold in you – at that point you really need your immune system to fight this, because dealing with antibiotics for month after month, year after year really isn’t a practical solution. But your book does actually provide some practical solutions. And one of the things I really liked about the way you put this out there was, a lot of the things that you’re talking about in what you call the five stages of immune-boosting plan – those stages are probably things we should do getting ready for cold and flu season, getting ready for any other thing that we’re going to do it. We need our immune system to protect us. That’s what it is. It starts with the gut and everything else, but the reality is, these are practical tips you can use. Even if you don’t have Lyme disease, it’s just going to make you healthier overall. Do you mind going through the five stages of your immune-boosting plan?

Dr. Darin Ingels (18:58): Sure. The first step is really about gut health. What we know from science is that 80% of your immune system is, so if there’s anything in your gut that’s not functioning well, it’s harder for your immune system to function well. So many people I work with that have chronic Lyme disease have a history of chronic gastrointestinal problems. Whether it’s constipation, diarrhea, gas, bloating, there’s usually some element that something in that system hasn’t been working well. I can imagine for a lot of people, they already had an underlying gut problem, and then they got bit by the tick that carried Lyme, and that just went from bad to worse. So the stage was already set to start having immune problems. We really talk a lot about how to repair the gut, how to restore it. Certainly for anyone who’s been on antibiotics, perhaps for sinus infections, bronchitis, pneumonia – every time you take an antibiotic, you start eradicating a lot of your normal bacteria. There’s so much research coming out about how important your normal microbiome is, your normal bacteria, for maintaining so much of your good health, and it’s tied into weight, metabolism, mood, of course all the gastrointestinal issues – so really a critical part of having a healthy immune system. So I walk you through certain nutrients that can help repair the gut. I talk about specifically probiotics and their health benefits, having the right strains at the right amount is very important, particularly for people who’ve already been on antibiotics. We can talk about things like glutamine and digestive enzymes that can help your body break down the food and make sure you’re absorbing it the way you should. So, it really is about looking at what specifically for you may not be functioning as well as it could in the gut, and then helping repair that.

The second step of the plan is really about diet. I had Lyme disease, myself – that’s really why I wrote this book. I’ve tried various diets for myself and with my patients, and what I found is what we call an “alkaline diet” seems to work best. What I like about it is that it’s really geared on eating foods that help keep inflammation down in your body, because ultimately it’s the inflammation that people really feel and that’s what triggers a lot of the symptoms. In a nutshell, what an alkaline diet entails is eating a mostly vegetarian diet, where we try and limit animal protein and fruits to about 20% of your total dietary intake. And then we eliminate any junk food, processed food, dairy products and coffee. These are foods that tend to be very acid-forming in the body and therefore are more prone to stimulate inflammation. So if we can control it that way, it helps reduce inflammation in the gut and potentially in the joints and the brain and elsewhere on the body. Coffee is the one that people will always kind of sneer at me when I say that. I love coffee, but I found for myself that even a sip of coffee, my neuropathy would get a lot worse. So I know people say, “Well, it’s just a little bit, it’s okay.” But for some people that little bit can be a bit too much. So, when people are starting any kind of diet change, I really recommend following it 100%. That way you can really feel the full impact of what that diet is doing for your body.

Allan (22:15): I think that’s a really important thing. There’s a big push out there, “Let’s do 80 / 20. If you’re doing it right 80% of the time, you’re going to be fine.” And I would say you’re going to be fine about 80% of the time if you’re dealing with something. A lot of folks that are listening to the podcast are wanting to lose weight, and I’m like, “You’re not in that 80% of your time right now. You’re in that 20%.” So we’ve got to ratchet down on things a little bit until we can find the balance, and when we find that balance we’re there. And you’re talking about a similar situation. We’re dealing with a disease here that can really wreck us if we don’t take care of it, so this is not the time to be thinking about justifying or trying to get to a point where we’re saying, “But it’s okay because everybody else is doing it” kind of mindset. Not everybody else right now is dealing with Lyme disease. If you want to get past this, you want to fix yourself, then you have to make these tough choices. You’re not going to like it, but it might not be permanent and you’ll get back into that point where you can be the 80 / 20 and everything will be cool. But we’re talking about actually trying to fix a disease. So, taking that time right now to follow this anti-inflammatory type of eating is going to improve your overall health and put you in a better position to fight this bug.

Dr. Darin Ingels (23:41): Yeah, I think you hit the nail on the head. It really is about choices. And when you’re not feeling well, you have a choice to make the change or not, but when people do make those choices, they feel a lot better, faster. And again, as you get to a point where you’re feeling better, you could be more liberal with the diet, but when you’re really feeling horrible and tired and achy, it’s better just to toe the line and follow the program, and you’ll feel much better, faster.

Then the third step of the plan is really about treating the act of infection. I walk you through a series of herbal protocols that I’ve personally used and what I’ve used on thousands of Lyme patients. And again, it’s different than just taking antibiotics. Where the antibiotics are geared to just killing the bug, herbal protocols not only will help eradicate the bug, but will also work on everything else that Lyme does to your body. A lot of these herbs are anti-inflammatory, they help improve circulation, they help boost your immune systems, they’re nutritive to your gut. We’re really encompassing a much broader scope of what Lyme has done to your body than just the eradicating the organism. Plus we don’t get all the negative side effects that you typically get when you’re on antibiotics long-term. People don’t generally get diarrhea, they don’t get this infection called “Clostridium difficile”, which can happen. All those negative things that we tend to see with long-term antibiotics, we don’t see what the herbs. There are a lot of different herbal protocols out there; I highlight the ones that I’ve seen the best success with. People can get those herbs online, the dosing’s on there, exactly how much to take, what to take. My recommendation always is when you start on herbs – six to eight weeks on each protocol to really give it a fair shake. If you get to a point where you really aren’t feeling any different, then it’s time to move on to the next protocol. That’s all outlined in the third step.

Allan (25:34): I like how you prioritize them. You say, “This one’s the one that I’ve found to be the most effective for the most people.” And then you say, “If that one doesn’t work, you can start these other ones.” Some of them you say are relatively intense; the dosing and what you’re doing are a little bit tougher to handle. But you’re trying to start someone out at one that you’ve seen good results with, that you feel is the best for the most number of people. I like the fact that you’ve organized it in a way that gives them that kind of information, because so many times it’s like, “We’ll try this protocol. Well, that didn’t work. Okay, we’ll try this one.” And it sounds like you’re throwing things at it, whereas you actually take the time to describe all of them and explain why you’ve put one protocol in front of another.

Dr. Darin Ingels (26:20): It’s been my own personal experience and what I’ve seen with thousands of patients. This is the hierarchy in which I’ve seen the best results with the least side effects. But if that’s not working for you, here’s plan B. There are some people who just happen to do better on one protocol over another for no real logical reason. But you do have to give it a fair shake, you do have to give it enough time to do what we want it to do. But at some point you have to draw a line in the sand and if it’s not working – time to move on to the next one.

So the fourth step of the plan is really about environmental control. We all get exposed to so many different things in the environment that undermine our immune system. The average American gets exposed to over 80,000 chemicals a year, and all of that is potentially damaging to your immune system and perhaps other body systems. There’s a lot of this stuff that you can do at home – you can control what you use in your home, and this includes things like Windex, Tilex, 409, lawn care products, pesticides, herbicides. All of that stuff can have a cumulative effect on your body. And we know a lot of these chemicals get stored in our fat cells, so I do talk a little bit about ways to detoxify your body to help eliminate those, to reduce your body burden. But certainly anything that you can control at home, stop using these products, stop buying these products – that just lowers the burden on your body and potentially on your immune system.

One of the big things I highlight in that section is about mold. Depending on where you live in the country – where I am, in the Northeast, mold is a huge problem. Most people have a lot of exposure, whether it’s in their home, school or work environment. Mold toxicity is probably the one thing that mimics Lyme disease the most. When I’ve been working with patients for a while and we’ve been doing their Lyme treatment and we’re not seeing the kind of success we’d like, mold is always the next thing on my list that we need to examine. I recommend if you live in most of the country that gets humidity or moisture, it’s a good idea to have your home tested and make sure you don’t have any hidden mold. You don’t have to see mold to have a problem. Most people who have these issues don’t know that it’s there, which is why it’s a problem. Unless it peeks through your drywall and you see water stains, you would have no idea. But sometimes you can get just a little pinhole leak in your roof. It’s in your attic and mold is growing and you can’t see it. You don’t know, but it’s enough there that can affect your health. So that’s something worth investigating.

Allan (28:45): We have a horror story on that. We bought a house and it needed some repairs – we knew it when we bought it. But my wife said she just knew there was a mold problem. She could just feel it, something was wrong. So we brought in an expert, they came in and he was really proud to say he was a walking mold detector. If there was mold in the house, he would know. He went up into my attic and ducked around a little bit, and came out and said, “You’ve got a moisture problem but doesn’t seem to be any mold.” And then he asked about our duct work and said maybe it’s an allergy issue. He says, “When was the last time you had the ducts cleaned?” I’m like, “We just bought the house, so probably never.” He says, “Well, we’ll clean the ducts.” And so he comes in and cleans the ducts and we pay the bill, and three days later, one of our bathroom walls is just coated with mold because he had stirred up these mold spores that were actually in the ducts. So we had to bring out someone else, because when we tried calling them, they didn’t come back.

Dr. Darin Ingels (29:52): Of course.

Allan (29:54): So we called someone else, and he comes out and he’s like, “Oh my goodness, we’ve got to pull all this duct work out.” He said we can’t keep this duct work. So he gives me a price on that, and then he starts pulling the duct work out and he’s like, “We’ve got a bigger problem. I picked up the installation underneath the ducts, and there’s mold all underneath the ducts that I didn’t see before.” And I’m like, “Okay, great.” So, all the installation, everything cleaned out. Fortunately it had not gotten into the drywall and the roof, or in that bathroom. So they were able to eradicate it. It was a very expensive problem to have, but it’s one of those things where you have to do it right. It is something that could really negatively impact your health. I was less sensitive; fortunately my wife was sensitive enough to know something was drastically wrong. To me, if I get a little bit nasally, it’s not a big deal. I don’t have to think a lot about it. But for her it was a big deal, so we did bring someone in and fortunately we did, because it could have been a much worse problem if we let it go any longer.

So, mold is a big, big deal. If you have moisture or live in a moist area similar to the Northeast – not an area where you want to play around. If you have mold and if you do find that you have mold, it is something to really go ahead and get cleaned up, because it can cause you some massive mess. I know we’re here to talk about Lyme, so I had to go off on a mold rant, but it can really wreck you too. If that turns out to be the problem, then really get that done.

Dr. Darin Ingels (31:28): Lyme disease, when people get infected, often it can alter your immune system in a way that you become more hypersensitive to environmental things like mold. I never really had a mold problem until I got Lyme disease. So I feel like it sensitized me in some way to mold. Mold is really the only allergen that still bothers me today. I’m not as hypersensitive where I can smell it when I walk in every musty building, like other people do, but it’s something that does have the capacity to really undermine your immune system. If you live in a part of the country where there’s a lot of moisture, that should be on your list to at least rule it out as a contributing factor to your overall health, definitely.

So the fifth part of the plan is really about lifestyle. One of the things I see for a lot of people after they get Lyme disease is that they don’t sleep well. And sleep is such an important part of when your body has an opportunity to restore and repair itself. We’ve got a lot of evidence that the brain repairs itself when you’re in that deep restorative sleep. And the more you miss it, the less opportunity your body has to really recover. I see so many people after they get infected with Lyme disease, they just don’t sleep well, whether it’s difficulty falling asleep or staying asleep, and sometimes it’s a little bit of both. I outline various things you can do naturally to encourage getting better sleep, deeper sleep. The problem with a lot of the sleep medications is that they might put you to sleep, but they don’t necessarily get you into that deep restorative sleep. Whereas in the natural world there are a lot of nutrients and herbs that I think do a better job of accomplishing that. So, sleep is terribly important.

I think moving your body is incredibly important. When you’re achy and tired… I know when I was in the throes of Lyme disease, the last thing on my mind was going out and walking or hiking or doing anything physically active. It actually took me many years to get to a point where I feel like I could really do it again. But I talk a lot about different strategies that are very gentle, simple and inexpensive, that I think regardless of your physical state, there’s something there you can do to get your body moving. Because as you move your body, that’s when you move your oxygen, you get more nutrients to the tissue, you get rid of all that inflammatory material. It might be something as simple as stretching, it could be walking, swimming, yoga, tai chi. It’s just a function of what you enjoy, what you have access to, what you feel like you want to do. But I think it’s important that people get in the habit of doing something. As humans, we are designed to move, and again, for a lot of people it really makes a big difference. I hate yoga with the passion of a thousand suns, but when I do it, I feel so much better. It’s one of those things I go reluctantly, I don’t particularly enjoy it, but I really feel so much better. I can just feel my body moving and my muscles stretching and that stiff. tight feeling that so many of us with Lyme disease experience, really dissipates after a good yoga session. It is important to find something you enjoy doing, otherwise you’re just not going to do it, and that’s not the goal either. So find something you like and just be committed to doing it on a regular basis.

And the last part of all that is about stress management. Of course we kind of half-jokingly say, “Well, don’t have stress in your life”, but if you live in this country particularly, there’s always stress. And being chronically ill is stressful, and it’s stressful for your partner and your spouse and your family. But having an outlet to be able to express that, I think is very important. I always felt like I had a good support network, but at some point your friends and family kind of get tired of hearing about the way you feel, and you feel bad about burdening them. And people ask, “Oh hey, how are you doing today?” And you’re just nice and you say, “I’m doing great. Thank you for asking.” You don’t really want to tell them, “I feel terrible today and everything hurts, and my brain’s not working.” Having whether a Lyme support group or a therapist or whatever it is that works for you – I think having that place where you can really be honest and discharge the way you feel, is important. I have some patients who do it through art, some people who do it through music, some people who do it through a therapist. But having that safe space to be able to express how you feel and know that it’s okay that you’re going to have days where you feel pretty terrible, and that’s okay, and understand that it will pass and it’s fleeting. But in the throes of it, it feels pretty horrible. So, we talk so much about the physical aspects of everything Lyme disease does to your body, we kind of forget about the psycho-emotional aspects, which are significant. Your brain and your body are connected, and what one does, the other follows. So I think as much as we can encourage positive imagery and happy thoughts, so to speak, that’s a way that we can start helping encourage better healing in the body. It’s the one piece I see with so many Lyme patients that really seems to be missing. And I think it’s just an important part of overall health.

Allan (36:28): Yeah. And like I said, of the five, I think there was one that might not apply to everybody, but the other four – if we’re doing those ourselves for our health, we’re going to be much better off. And I completely agree. When you get to the lifestyle pieces of the exercise, the stress reduction management, and then of course the sleep – those are three core health components that we should be focused on trying to improve all the time.

I want to pick your brain while I have you here because l get this question from time to time. There are sleep supplements out there, and they’ll be like, “Should I be taking melatonin? Should I be taking GABA?” I do tell people I take magnesium before I go to bed, and part of the reason I take it is I do have low electrolytes for the most part. So I tend to take electrolytes as a supplement from time to time. What I found is if I take a magnesium supplement before I go to bed, I get more of that vivid dreaming and feel like I’m really getting into a deeper sleep. And I’m fairly comfortable because magnesium is electrolytes and mineral. But when we start talking about melatonin and GABA… I’m not going to say melatonin is a hormone per se, but it is something our body would make by itself. And GABA is something our body has in our brain, but there are questions about if you took it orally, how to get in through the brain-blood barrier.

So I guess the question I’ll ask with those, if you don’t mind going through is, are they really doing anything, and is it safe for us to take those on a regular basis? Because with other hormones, like if you took testosterone, your body is going to quit making testosterone because it got plenty. Same thing with estrogen, same thing with some of the others. If you’re putting it in there, your body’s not going to make any because it’s going to know that there’s enough there. And I’m not sure that melatonin wouldn’t be any different. Can you talk about those, because that is a topic I get asked from time to time and I just tell them flat out I’m not a doctor, I’m not a nutritionist. But since I’ve got a doctor on the phone, I just thought, let’s ask this question. What are your thoughts about melatonin and GABA?

Dr. Darin Ingels (38:44): Coming back to your example about hormones – yes, if you take a lot of thyroid hormone or for women who take estrogen – if you take enough of it, it will actually suppress your normal production. Our hormone systems are built kind of like a thermostat, where as your temperature gets to a certain point, it shuts the heater or the air conditioning off. The same thing happens in our hormone systems. We don’t know that that’s necessarily true in our neurotransmitter system though. So in the case of melatonin, melatonin is a hormone, and when we talk about supplementing with melatonin, we’re really talking about supplementing at normal physiological levels. So we’re talking about supplementing a level that would be your normal production, not super physiological doses that are far beyond what your body would normally make. Now, there’s some research, particularly in cancer care, that certain tumors, when you take high doses of melatonin, like 20 milligrams or more a night, can actually help stop tumor production. So I know in the cancer world, a lot of naturopathic oncologists are using high doses of melatonin for stopping tumor growth. But for people who just have a hard time falling asleep, which is what melatonin is designed to do – it’s really for the people that can’t fall asleep; it’s not really great for the people who can’t stay asleep. So we differentiate when there’s a sleep disturbance, whether the issue is falling asleep, staying asleep or both.

But I think melatonin for people who can’t fall asleep – when you look at the research, which is generally between one and three milligrams at night, and certainly for an adult three milligrams is perfectly fine and safe, even with long-term use. I’ve not read anything that suggests that it suppresses your natural melatonin, nor makes you dependent on it. And I have some people who go on melatonin for a period of time until they get their sleep pattern back on track, and then they’re fine and they don’t need to take it anymore. Melatonin, without looking at other reasons why people aren’t sleeping well, would be a little bit of a miss. Melatonin deficiency is probably not the problem. There’s probably something else going on that’s interfering with melatonin metabolism, so you’ve got to find out what that thing is.

Allan (40:48): It’s probably their iPhone.

Dr. Darin Ingels (40:52): In all seriousness, we know that definitely the blue screen that comes off iPhones and iPads does interfere with your sleep pattern. They’ve now demonstrated this in research. I always tell people that have trouble sleeping, especially two hours before you want to go to bed, you’ve got to cut off your iPhone and iPad.

Allan (41:11): I cannot get my wife to do that, to save my life.

Dr. Darin Ingels (41:16): We’ve all become a very addicted society to our electronics. And of course I think it’s practical too, because by the time you get done with your work day, you cook dinner, you clean up, you get your kids to bed – that’s the time you now have to yourself to answer email and do that. So for many of us, that’s our quiet time. Unfortunately, the timing is terrible because again, that blue screen… Now they make glasses that you can buy online that block that blue light. So for people who insist that they have to do that work late in the evening – go spend the $10 and get the blue blockers that block that blue light, and it’s going to certainly help with your sleep pattern. But melatonin, again, is really designed for people who can’t fall asleep.

For people who can’t stay asleep, this is where I think GABA actually works pretty well. But you’re right, there are some forms of GABA that don’t get absorbed very well across the gut wall. There are a couple of forms of GABA that have been studied that show they do actually cross the blood-brain barrier. I particularly use one called Pharma GABA, and there’s a few supplement companies that make that particular type. Pharma GABA clinically seems to work really well for people in keeping them staying asleep. There’s another one that’s a liposomal form of GABA that also seems to get absorbed fairly well. But if you’re just buying regular GABA off the counter that’s not in one of those forms, it probably won’t work very well.

The other nutrient that I like a lot of is called glycine. Glycine is the most basic amino acid and it binds to a specific part of the brain called the “locus coeruleus”, which nobody cares about, but it’s the actual part of the brain that’s sort of the on and off switch between excitatory neurotransmitters and the ones that make you calm and quiet. So by binding to that part of the brain, it basically flips the switch and helps the brain quiet down and starts inducing more of your sedative neurotransmitters like serotonin and so forth. So glycine is very safe, it’s very cheap. You can take 3,000 milligrams of glycine before bedtime and often people report that they feel like they get a deeper, more restorative sleep.

And you mentioned magnesium. Magnesium is the one nutrient you burn through the fastest in your body. And certainly if you’re a physically active person, you’ll burn through magnesium faster. Magnesium is a cofactor in a lot of neurotransmitter metabolism, so I think feeding those pathways probably helps induce better sleep. A lot of my patients do tell me they sleep better when they take more magnesium. If you get too much magnesium, you’ll know – it’ll actually give you loose stool. But I have some people who take 500, 600, 800 milligrams a day and actually do very well with it.

Allan (43:49): Okay. Well again, Doctor, it has been so cool talking to you. The name of the book is The Lyme Solution. If someone wanted to learn more about you, get a copy of the book or just learn more about Lyme disease, where would you like for me to send them?

Dr. Darin Ingels (40:52): Yeah, if they just go to my website – it’s DarinIngelsND.com – we’ve got a lot of great information about Lyme disease, the book, and we’d love for people to follow us and get that information.

Allan (44:20): Cool. This is going to be episode 322, so you can go to 40PlusFitnessPodcast.com/322 and you’ll find a link to a Dr. Ingels’ website and the book, The Lyme Solution.

Dr. Ingels, thank you so much for being a part of 40+ Fitness.

Dr. Darin Ingels (44:37): Great. Thanks, Allan.


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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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May 21, 2018

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.




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