http://www.thekitchn.com/feedburnermain
The Target shopping experience is the subject of many an internet ode. It’s both parts relaxing and an easy way to spend a lot more money than you ever intended.
If you’d like to enjoy the Target shopping experience without the temptation of impulse purchases, however, this news may be just what you’re waiting for: The retailer now has same-day grocery delivery service in select areas, powered by Shipt.
http://www.thekitchn.com/feedburnermain
All the bells and whistles aside, the trickiest part of buying a new slow cooker is figuring out which size to buy. Because here’s the thing: Slow cookers range in size from tiny two-quart models to huge eight-quart ones, with plenty of options in between. And because slow cookers work best when they’re two-thirds to three-quarters of the way full, size really does matter.
Here’s how to determine the right size slow cooker for you.
http://www.thekitchn.com/feedburnermain
Moving is a lot of work. Well in advance, you create checklists and gather resources for the big day. At the top of most lists is collecting moving boxes. Cardboard boxes are one moving expense that can be had for free — here are our favorite spots to grab them.
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I’m excited to introduce a guest post from an elite athlete in the midst of an incredible ultrarunning career. Believe me, not many athletes can write—or do much of anything except perform and veg out on the couch recovering before the next workout. Zach Bitter, record setting ultramarathon runner, is different, as readers of his popular blog already know. Zach holds the American record for the 100-mile run of 11 hours, 47 minutes. That’s running all day—400 laps around a regulation track—at seven-minute per mile pace. Go try to run a single mile in seven minutes to gain a full appreciation for his supreme effort.
Zach has achieved some notoriety in the ultra scene as a dedicated fat-fueled athlete. (You can read his story here.) He dabbles in keto during his base building training cycles, believing that it speeds recovery and reduces the stress impact of his workouts. His fueling strategy for competition is more nuanced, and he has a lot of important things to say on the matter. His post offers insightful commentary about periodization of nutrition. Here is a quick sound bite from Zach about his big picture goals with becoming highly fat- and keto-adapted: “I strongly believe that the less you have to fuel during a race, the better.” Enjoy this message from Zach, and we hope to check in with him again in the future.
Nutrition has continued to come closer to the forefront of conversations everywhere in recent years. Certainly, this is in part due to the ease of access to information, and the seeming growth of all kinds of approaches—which all boast success stories in which the reader can place their faith. It is a fascinating crossroads for many people. When we look at things in black and white it can become quite easy to get confused. How can one nutrition approach work so well for one person, but fail for another? I am a big advocate for starting with some simple principles, and ultimately building from what you find in order to fine-tune things specific to you as an individual. People lead drastically different lifestyles. This makes following someone else’s approach difficult without some fine-tuning to your own personal lifestyle.
It is for this reason my first piece of advice for someone starting their journey into health and nutrition is to turn to whole food options. If not already done, removing fake processed food is a big first step. From there, I see a blank canvas to build from in a way that matches what your goals and lifestyle require.
With that all said, I want to zoom in for the purposes of this article. Fast forward along the journey where you have eliminated all the fake processed garbage, and move into fine-tuning things within a high fat or Primal approach to nutrition.
When you dive into the world of high fat, or keto, nutrition you often find no shortage of people advocating for nearly if not entirely eliminating carbohydrates. I don’t see anything inherently wrong with this approach, at least to start, but do think there is some wiggle room here for those of us who follow a periodized training approach that makes your lifestyle look drastically different at various points of the year. For example; my personal training plan for ultra-marathon races has me at times training for upwards to 20 hours a week when in peak training. These peak training weeks also often include speed and strength work. During these phases of training I am a bit more liberal with the amount of Primal approved carbohydrates I eat. On the other hand, there are weeks of the year when my number one goal in regards to training is to simply rest and recover. During these times of year I do not have a need for carbohydrates, and in fact, have found reason to believe they can even be counterproductive. For me, these phases of the year are met with a more clinical definition of a ketogenic diet (30-50 grams of carbohydrate per day).
This “fuel your lifestyle approach” presents a greater need to be a bit more flexible with nutrition than a typical “plug and play” approach you might find that would have you eating basically the same things all the time. I find this exciting and motivating, as I can always look forward to some change or variance in food groups when I am going in and out of different phases of training.
Where to begin? In a perfect world everyone I work with would come to me at the onset of their training plan, or priority goal—whether that be a race, event, or simply to improve their fitness and health. For purposes here I will start from the beginning. If you find yourself part way, you can look where you are, and find a logical jump-in point. The beauty of this approach is you can always revisit it from the beginning when you finish your current goal, hit the reset button, and plan your next adventure or fitness goal.
My goal with this program is not necessarily to get you to be as fat-adapted as possible, but to get you fat-adapted enough to maximize performance, and avoid the pitfalls that being a “sugar burner” can bring. If you are already following a ketogenic diet, you might not recognize much change during this phase, which is intended to flip the metabolic switch towards burning fat as the primary fuel source. This switch is most quickly done by cutting the carbs so low that your body has no choice but to burn fat. Those coming from a ketogenic background will find this phase to be smooth sailing as you have already flipped the metabolic switch. For those folks, you can see this as matching your lifestyle intensities with your nutrition.
For those on this journey for the first time patience is key. My number one piece of advice is to avoid looking at all things you cannot have, but rather take advantage of the luxury we have in modern times by focusing on the vast array of options you can have that are a grocery store trip away. If you are looking for some great recipes that fit nicely within this phase’s framework I encourage you to check out the recipes in, The Primal Blueprint Cookbook, by Mark Sisson and Jennifer Meier, and/or The Art and Science of Low Carbohydrate Performance, by Dr. Jeff Volek and Dr. Stephen Phinney.
Regardless of whether this is your first attempt at strict keto, or a continuation of what you have done, this phase is coupled with recovery from your previous training cycle, and a gradual reintroduction of building a strong aerobic base. This is good practice for athletes of all disciplines as even building strength and power is better accomplished when a strong aerobic base is in place. The short and simple way of describing this phase is to match slow burn activities with slow burn fuel sources. Rest assured, you are providing your body with the framework to build from as you continue to progress.
As you find yourself developing along the aerobic framework and your training volume is beginning to reach its peak, you’ll find yourself with less time between workouts. Workouts are longer in duration, and in some cases with highly trained athletes, you are doing more than just one workout per day. Essentially, you are shortening the window of rest between efforts as your body becomes adapted and more resilient to the lower volume phase. This shorter window marks the time when you may find it useful to introduce a few more Primal approved carbohydrate sources. Relatively speaking, this is still quite low when compared to a high(er) carbohydrate approach. You will still gather a vast majority of your nutrition from fat.
Letting your body be your guide is very useful as you move into this phase. It is during this phase where I look for some telltale signs from my clients and myself. It’s okay to enter this phase following your strict ketogenic approach, but don’t be too bull-headed if you notice feeling flat or sluggish during workouts. When you start to notice that you are feeling a little flat, it’s a good sign that a small increase in Primal approved carbohydrates is wise. I recommend starting with small increments of reintroduction as a way to avoid going overboard.
A good rule of thumb is to start by shifting up your carbohydrate intake by five percent. If you notice that you feel stronger and more energetic during your workouts, you found the sweet spot. A little bit goes a long way during this phase, because a strong fat-burning engine has been built, and the addition of a small increase in carbohydrate will provide more bang for your buck when compared to a nutritional approach that is already heavily based in carbohydrates. Rest assured, you are not sabotaging the developed fat burning engine. A heavy reliance on fat is still in place here as the great majority of fuel you are giving your body is still coming from fat. Consider it optimizing.
With a very strong aerobic base thoroughly established, and the fat engine burning hot, it is time to sharpen the spear. Sharpening the spear is a phase in training I call, “unsustainable year round.” The reason for this is not because it is bad. It is simply a phase that will eventually require a mental and physical break to be able to do it again, and to continue to improve. It is a fun, but challenging phase of training, and I personally keep it enjoyable by stepping away from it at the end of a training cycle.
During this phase, since peak work is done to reach a goal, it also marks the phase of the cycle where the highest ratio of Primal approved carbohydrate sources is optimal. Similar to the last phase, it is not a drastic change, or a change that will sabotage the ability to turn to high reliance on fat as fuel, but rather taking advantage of the phase of the cycle where benefits from a fuel source that burns hot is present. I like to describe the carbohydrates in this phase as rocket fuel. A little bit goes a long way, and gives you a big punch, but going overboard can burn you up.
Similar to the previous phase, letting the body be the guide is a great starting point. If you notice a missing gear during intensity sessions, that’s the spot where a small increase of Primal approved carbohydrates is in order. Focusing on things like berries, melons, tubers, and raw honey are some “go to” options during this phase. Enjoying this phase as a way to broaden the range of food choices, or practice a couple different cooking recipes, is a good mindset during this phase.
Individual experiences will vary, but generally speaking, this phase can benefit from around twenty percent of your nutrition coming from Primal approved carbohydrates. Training volume can play a significant role, so if you’re following a program on the lower end of volume, less carbohydrates can be brought back. If this is the case (or prior experience would indicate adhering to a strict ketogenic approach has worked well), starting with small increments of carbohydrate reintroduction is the best plan of action. If that last gear isn’t coming back with small increments, continuing to add small amounts back is the next step.
A question or fear often expressed during this phase is losing fat burning potential. Remembering the goal here is important. This is not a phase that will be in place year round. A return to a stricter ketogenic approach is on the horizon. Even with the increase in carbohydrate, a high level of fat-burning is still necessary to meet your metabolic needs, because even at twenty percent carbohydrate the majority (60-70 percent) of nutrition is coming from fat.
Coupled with this, during this phase, being mindful of rest and recovery are important aspects. Challenging efforts need to be matched with proper rest and recovery. When programming training during this phase, it is routine to build in what is called de-load weeks. This is where approximately a week of reduced volume and intensity will give the body and mind a break—and the opportunity to grow and improve from all the hard work. This also provides the opportunity to scale back on carbohydrates for a week and return to the highest of fat burning states. During this phase when a de-load week is in session, dropping back to a more strict ketogenic nutrition plan is appropriate.
Once adequately peaked for an event, adventure, or fitness goal it is time to redirect priority from some of the hardest work to resting. This does not mean shutting things down altogether, but rather a reduction in the frequency of intensity sessions and volume. Similar to the de-load weeks, this affords the opportunity to scale down on carbohydrates. This also allows you to once again remind the body that fat is the primary fuel source.
This is the phase at which high carbohydrate folks will begin chatting about “carbo loading.” I find it fascinating how carbo loading has come to be defined in recent years. For many, this means a high carbohydrate diet is coupled with a barrage of even more carbohydrates the day or two before an event. For the fat-burning athlete, it looks different. The carbo loading practice is a week long process as opposed to a final excuse for gluttony. The first four to five days is met with strict ketogenic nutrition. Again, we are programming the body to burn high levels of fat.
One final nudge or reminder… When two days out from the event or adventure, a small reintroduction of carbohydrates will be adequate for your metabolic needs. The way to view these days is similar to the intensity phase of training. It is not full-fledged high carbohydrate, but rather more along the lines of approximately twenty percent of intake; similar to the intensity phase.
What you can expect within this framework is a much lower reliance of carbohydrates to fuel activities. In an event or adventure, this means the need to constantly bombard the digestive tract with frequent refeeds and engineered fuel will be minimized. My personal experience has been a reduction of at least fifty percent in competition fueling along with a much more stable flow of energy. The peaks and valleys experienced on a high carbohydrate approach are no longer a concern.
Thanks again to Zach Bitter for sharing his experience and expertise in today’s post. You can follow Zach on his blog as well as his social media channels (Facebook, Instagram, Twitter, and YouTube).
The post Periodizing Nutrition: The High Fat Approach appeared first on Mark’s Daily Apple.
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Let’s face it: We all know that pre-assembled veggie platters at the supermarket are more expensive than buying the veggies separately and prepping them yourself. But who wants the hassle of washing and chopping and arranging all those vegetables? Could the convenience really cost that much more?
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Hello, all my beautiful star babies! It’s a whole new month, which means you have a big, blank slate in which to plan great meals. May is a very exciting time to eat across the country. We’re shaking off winter (finally) and getting into some fun produce. Depending on where you live, expect to see asparagus, radishes, rhubarb, early strawberries, and some leafy greens at your farmers market.
We’ve looked to the stars and figured out exactly what you should be eating based on your zodiac sign in May. So go ahead and put these recipes on your weekly meal rotation for the next 31 days.
http://www.thekitchn.com/feedburnermain
Pasta doesn’t need much to make it a crowd favorite at the dinner table, but it never hurts to add a salad or cooked vegetable to the situation to make the whole meal feel a bit more, well, whole.
These 10 simple recipes pair well with just about any pasta you’re cooking and come together just as easily.
http://www.thekitchn.com/feedburnermain
One of the best things I ever did for my health was to adopt a healthy (whole food) vegetarian lifestyle when I was 20 years old — more than 10 years ago. While I realize it’s not for everyone, it was a brilliant solution for me. I felt better, slept better, my skin and digestion improved, and I had so much more energy.
Several years ago, I took it a step further and decided to adopt a plant-based vegan diet, which was actually much easier than I thought it would be. I quickly learned that, with the right dishes, recipes, and foods, I didn’t even miss cow’s milk (or the dairy products made with it).
http://chriskresser.com/
In this episode, we discuss:
Show notes:
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Chris Kresser: Rangan Chatterjee, it’s such a pleasure to have you on the show. I’m really looking forward to this.
Dr. Rangan Chatterjee: Chris, the pleasure is mine. Thanks very much for inviting me.
Chris: We met when I came over to the UK last year, I think that was. It’s all such a blur.
Dr. Chatterjee: Yeah, someone said we need to speak, so we went out for a lovely dinner, actually.
Chris: Yes. I really enjoyed that. Mark Hyman introduced us via email before we came over and said, “Hey, you guys should know each other,” and he was definitely right. We hit it off immediately, in large part because we share not only a passion for reinventing healthcare and the future of medicine, but also a pretty similar perspective on how we should go about doing that. That’s what I’d love to dive into today, and I want to start by talking maybe a little bit about just your background, how you came to Functional Medicine, and this perspective that we share on reinventing healthcare and medicine, and then I want to talk a little bit about your experience with the TV show, because here in the US we don’t have access to it. And so while that’s a pretty well-known show and people have had a lot of exposure to it in the UK, some of my US listeners might not be as familiar with what’s going on. I think it’s a really interesting portal to how Functional Medicine can get a wider adoption and exposure.
Dr. Chatterjee: Yes. Well, Chris, first of all, just a bit of background and a sense of my journey and how I’ve got to where I am today in terms of my perspective. I’ve been seeing patients now as a medical doctor for almost pretty much 17 years, actually, and my career has gone through various evolutions during that time, because the reality is, you leave medical school and you think that you have been given all the tools that you need to get your patients better. That’s ultimately why you end up at medical school, is to how to do that way, and it’s not so obvious, but when I reflect back on my career, I think there was a discontentment in the way that I’d been taught to practice medicine. It was probably there right from the start, so I don’t think I quite realized it because I start off in the acute medical setting, so I was training in hospitals dealing with a lot of emergencies. I remember running the cardiac arrest team for the hospital for a period of time and doing all the things that you think modern medicine is with the defib and all that kind of crazy stuff which you see on television. As a young guy in their 20s, I think, “This is medicine,” right?
The biggest skill for a healthcare professional may not actually be scientific knowledge, but how they connect and communicate with the person in front of them. Every patient wants to be as healthy as they can. They don’t want to struggle. They want to live their life!
Chris: Right.
Dr. Chatterjee: I went through my training, I was going to be a specialist, so I got my exams. Certainly in the UK, we call it the MRCP, Member of the Royal College of Physicians, a very tough set of exams to certify in internal medicine, and I was planning to do nephrology, or kidney medicine. I just started to get a little bit frustrated, month on month, sort of year on year, I was getting a little bit frustrated. It’s the sort of thing that I don’t really want to spend the rest of my career just seeing kidneys and kidney problems. I thought that I’m going to move to general practice. To put this in perspective, I come from a medical family, and my dad was a consultant in genitourinary medicine. I think he was a bit flabbergasted that his son was going to leave the hallowed turf of being a specialist to become a generalist. But I really had this calling from inside me saying, “Look, I want to see everything. I want to see how everything interacts with everything else.” That’s why I moved to general practice. I did my exams, and then I started working and I loved it, but a few years in, I honestly sat back at the end of the day and I thought, “How many people have I really helped today?” I came up with a figure, 20 percent. I thought, 82 percent of the people that had come in, I wasn’t convinced I’d actually done that much for them. Sure I may have given them a prescription, a pill to suppress their symptoms, but I really didn’t feel that I had actually helped them understand what was going on. I don’t think I knew what was going on in terms of what was driving their ailments. I think the difficulty is, Chris, I’m sure you’ve heard this before from people, it’s very hard to know what to do with that. You know, all your training, your whole career, everything is shaped around the system the way it currently is. And then for me, as many people have an experience with illness either in themselves or with a family member, that really changes everything. For me it was when my son, who is now seven years old, but he was six months old at the time … My wife and I, we went on holiday, it was just past Christmas, it was around 27th of December. I remember it so clearly. We went to Chamonix in France for a holiday, and my son stopped moving. His arms went back. He had a convulsion, and really I panicked because I thought he might be choking. My wife had called out to me and I knew that he had a lot of mucus and phlegm throughout the day. I tried to turn him over and slap him on the back and clear his airway and nothing was happening. The truth is, in that moment, I wasn’t a highly qualified medical doctor, I was a worried father.
Chris: Absolutely. It must have been terrifying.
Dr. Chatterjee: Even now I think back to it, and it was horrible. It really was horrible, and my wife said, “Come on, we’ve got to go now. We got to get to hospital.” And we rushed into the car. I nearly killed us all. It’s just snowed there and we went on a steep road down to the main roads and the car skidded, but ultimately we got to a hospital, and many of your listeners might be familiar that a six-month-old having a convulsion is not that uncommon if there is a fever there. It’s what we here call a febrile convulsion, but he didn’t have a fever. His temperature was absolutely normal, and you could see the admitting doctors and nurses were incredibly worried because, “Why has this boy stopped moving? Why is he having a convulsion without a fever?” We were in a small hospital. He had to be blue-lighted in an ambulance down to the main hospital, down the valley through the mountains.
A few hours later, some of the preliminary blood started coming back. Now in this time frame, he already had two lumbar punctures. We are a health-conscious family. My wife had breastfed for six months as this sort of public health guidance. We’re pretty switched on, we thought, with respect to our health, and then the blood results come back, and the doctor said he’s had a seizure because his calcium levels were too low in his body. He had a hypocalcemic convulsion. To put it in perspective, the normal range for serum calcium in that hospital is the same as in the UK, which is 2.2 to 2.6. His calcium level was 0.97, frankly, barely compatible with actually life, in many ways. Everyone was scratching their head—why has he got such a low calcium level? What’s been going on there? And then again, you had to wait a bit later on, because in this time frame, initially we thought he might have meningitis. The doctors were very worried, and we were panicked, in a foreign hospital trying to figure out what the hell was going on, and it turns out that his vitamin D level was almost nonexistent.
To cut a long story short, ultimately a fully preventable vitamin D deficiency caused him to have a low calcium level in his blood, which caused him to have a convulsion. That was incredibly challenging to get my head around. I mean, of course, I was delighted that we found out what the problem was and that modern medicine saved his life. He had an intravenous calcium infusion, right? Great. Superb. You bring the calcium level back up into the normal range. That was fantastic, but nobody that taught me or told me what are the consequences of the fact that your son may have been deficient, or certainly suboptimal levels, of vitamin D potentially for the last six months, arguably in the utero as well.
What are the consequences of that? How can you go about potentially repairing some of those? My son had pretty bad eczema at that time and obviously we know now, I wish many doctors knew about then, that it’s pretty clear that vitamin D is a critical nutrient immune system. Eczema is in some way dysfunction of the immune system. Could the two be linked? Of course they could be. For me, Chris, really what happened in that moment was, yes, I’d been frustrated, but in that moment, it was like, I, by conventional measures, am highly qualified, double-board certified medical doctor, yet my son nearly died from a preventable vitamin deficiency, and suddenly it was like a switch changing me. In that moment, I’m going to find out why this happened, how this happens, and I’m going to get my son back to full optimal health. I’m going to try as if nothing of this has ever happened. That was the challenge that I set to myself.
In the age of the internet, Chris, you can spend three, four hours a day researching, and that’s exactly what I did. Week after week, month after month, year after year, the more I learned, the more I put into practice with him, the more I put into practice with my family and myself. I can see that the immense benefits for my son, I felt the benefits for myself, started applying the same principles with my patients, I was like, this is the sort of medicine I wish I’d learned in medical school. Understanding root causes of ill health. I’m figuring out how you can help people, not only improve their symptoms, but certainly, in many cases, reverse that illness, and it’s just transformed my career, Chris. It has transformed the way I look at health. It has, in many ways, shaped what I’ve done in the media for the past four or five years. I reflect back and think, had this not happened to my son, would I be doing what I’m doing? I don’t know. I can’t answer that. Potentially I would have found—maybe the frustration would have gotten the better of me in another way, but this really forced my hand. I’m pleased to say that my son is a thriving, healthy, eczema-free seven-year-old boy who I think is incredibly well and arguably healthier than many kids around him who maybe have not had this problem. It’s a slightly long-winded story, Chris, but that in a nutshell is why I do what I do.
Chris: It’s so great. It got very real and very personal for you in a way that it did for me, a slightly different way, but that’s what, really, I think at the end of the day, almost everybody who’s doing this work that we talk about, Mark Hyman and many of us thought leaders and influencers, have a similar story because when it affects you personally or a family member personally, there’s just no other motivation that’s quite as urgent.
Dr. Chatterjee: Yes, absolutely, but Chris, we need to … we started talking months before … at the moment I find that the people who are trying to adopt this approach to chronic disease, the thought leaders, but all the thousands of practitioners around the world who are also trying to do this, pretty much all of them behind that have got a personal story. I get that because I’m one of those, but we need to move beyond that. We need to move like what you’re doing with the Kresser Institute. We need this education to be that—all healthcare professionals, basically, not just those who have had a personal experience.
Chris: Absolutely, yes. Your story with your son is really, I think, revealing because it points to this principle of “we’re not looking,” or that’s my version of WNL. In medicine we think of WNL as “within normal limits,” if you do a lab test and it’s within the normal limits. But I have another way of looking at WNL, which is “we’re not looking.” Your story with your son, like the vitamin D thing, was easy to detect and easy to correct, but it wasn’t part of the standard thought process of what you should be looking for early on in his life. I had a patient last week in her late 70s who came in, and she had some of the typical complaints you might expect of someone of that age. She had kind of a mild tremor. She was having some cognitive decline and brain fog, difficulty concentrating, and her GP had just written it off as, “You’re getting older. And you’re in your late 70s. What do you expect? This is standard.” And yet when we tested, did a full comprehensive blood panel on her, we found out that she had very severe B12 and folate deficiency and very high homocysteine, and she had again a very easily correctable, at least if it had been detected in time, nutrient deficiency that was misdiagnosed as dementia and early mild Parkinson’s. There’s really no excuse for missing and not correcting that, and yet we’re not looking.
Dr. Chatterjee: Absolutely, Chris, and I’m sure you’ve got countless more stories like that from seeing patients, as I have. One thing to add there with my son’s story as I’m sure many people listening might be thinking, “It’s so obvious, why wasn’t he just giving his son vitamin D from birth?” I think it’s a reasonable question because the guidelines in this country actually do state that you should be doing that. The problem is, nobody knows those guidelines.
Chris: Yes.
Dr. Chatterjee: And they’re not being followed. As the same with all my patients, I didn’t know that. But I tell you this, I have replayed this over in my head so many times, three weeks before we got on that plane at the start of December, so son’s maybe 5 to 5 1/2 months old. I had been coming across a bit more research on vitamin D, and we had a protocol in our surgery in a different sort of part of the UK where I would start to prescribe a lot of vitamin D to certain patients. I started to think, “I think my son should be on this.” Now it’s drilled into us in the UK by the GMC, the General Medical Council, that we should not be making those kind of decisions on our own family. It is very much frowned upon here to do anything treatment-wise for your own family. I did what I thought I should do back then, and so I crossed off the protocol and I phoned my wife up and I said to her, “Hey, babe, can you just go make an appointment to the GP? Just go and ask him what he thinks about this. I think that our son should probably be on vitamin D.” And so she prints it off, she goes to see a doctor, and the doctor knows that I’m also a fellow healthcare professional, and he laughed at her and he said, “Look, this is just complete rubbish. You could have just printed this off yourself and typed it up on Word and given it to me. Look, you’re breastfeeding; you’re doing a great thing. There’s nothing more you need to give your son.” And she was a bit upset with the way it went down because I didn’t think he was compassionate, and when she reported this back to me, I thought, “Okay, fine. All right, let me do a bit more research. Let me look into this. I’ll figure it out,” not realizing the urgency of the situation. I often think back, could I, should I just put my foot down then, and it’s not a nice emotion as a dad when you get these things. Having said that, Chris, he could well have been deficient for months prior to that.
Chris: Absolutely.
Dr. Chatterjee: And arguably, have I supplemented then, supplementing just before this happens with a very low dose, let’s say, 400 IU of vitamin D or something like that or 800, arguably, it may not change anything, or it could have gone undetected for a lot longer. At least this way, and again, I wish this had never happened, certainly for my son’s sake, but by having it happen with that sort of magnitude, I was forced to confront some very difficult questions and uncomfortable realities, and I felt compelled to fix them. I do kind of believe that things happen for a reason. Maybe as humans we have to believe that in order to get through, but I had a lot of guilt for a number of years. That actually drove me to learn more and help as many people as possible, but I know you’re a father as well, Chris. I’m learning now to let go of that guilt.
Chris: Yes. I mean, we can always second guess ourselves, and there’s so many situations like that that I can think of myself with my daughter, things I wish I would have done differently. But I think this is more what you were saying before—it’s about getting this knowledge and these guidelines and this understanding out on a wider scale because it is true. There’s a saying that a doctor who treats himself has a fool for a patient, and you could possibly extend that to family members, because sometimes we’re too close to really be able to tell. But what if there had been guidelines that not only should babies be tested, but pregnant women should be tested for their vitamin D levels because guess where kids are supposed to get it? From breast milk, and if a woman is deficient in pregnancy, then her breast milk is not going to be a sufficient source of it, and I always test my pregnant women patients for that now, but that’s not something that’s really widespread now, at least in our in this country. I don’t know how it is in the UK.
Dr. Chatterjee: One of the biggest frustrations for me about the way medicine currently operates—I should say conventional or allopathic medicine, whatever you want to call it—it’s very much a black-or-white situation. You’ve either got an abnormal result or it’s normal.
Chris: Right.
Dr. Chatterjee: There has been no or very little recognition as optimal, and there is this huge gray area in between overtly abnormal and disease and deficiency versus what is an optimal level for this human being to be functioning as well as they can. A little bit like Dale Bredesen, a professor, who is sort of showing how in some cases you can reverse cognitive decline, certainly in early cases of Alzheimer’s disease. He’s managed to demonstrate that, but I love his approach, which is you’ve got to treat that person like a Formula One car. You’ve got to optimize every single parameter that you can. I love that because that really isn’t how we do things here, certainly the UK, and I know it’s the same in the US. Even if you talk about blood sugar, you talk about a common condition, type 2 diabetes, we’ve got slightly different ranges from you guys, so an HbA1c, the average blood sugar marker, is 6.5 and above, and in this country is, I think the same as you, is a diagnosis of type 2 diabetes. Our prediabetic range starts at 6, so 6 to 6.4 is what we call prediabetic, whereas with you guys, it’s 5.7.
Chris: It’s a little lower, yes.
Dr. Chatterjee: A little lower, and you know these are just arbitrary figures that we could argue about all the day. One of the practices I would tap recently, patients who come in and get their blood sugar checked, if it comes back at 5.9, I know doctors who are still reporting that as normal. What’s happening is that patient phones at reception to say, “Hey, you know what, my bloods are okay.” The receptionist will report back saying, “Yes, doc said absolutely normal, nothing to worry about.” That patient then who has come, maybe they come in for a medical or for a checkup just to see where does their health look like at the moment, in that opportunity we are reporting an HbA1c of 5.9 as normal, which is madness. I just don’t know how we got so far off track in medicine where we can call that a normal blood sugar.
Chris: Right. Just because it hasn’t reached the arbitrary … as if something magical happens when it goes one-tenth of a point higher, then all of a sudden you have diabetes, whereas it was perfectly normal before that.
Dr. Chatterjee: Yes. And even if all we did in conventional medicine, even if we did not adopt a full kind of Functional Medicine approach, is if we simply recognize that as an optimal range, and then there’s a deficiency range, and we should be striving to get our patients in those optimal ranges—just to say, with blood sugar, for example, we could start maybe once the HbA1c is 5.2 or 5.3, start to get people back in and say, “Hey, look, you’re not prediabetic yet. You don’t have type 2 diabetes yet, but actually your blood sugar is not as good as it could be. Can I show you some things that we can do to help optimize that?” So many members of the public would welcome that, and they’ll go, “I didn’t realize it. Yes. Tell me what I can do.” Rather than waiting until it has crossed that 6.5 to 6.6 type 2 diabetes threshold, when yes, sure you can still turn it around sometimes, but it’s going to be suboptimal to be getting involved then.
Chris: Absolutely. Speaking of this, we’re talking about raising awareness of Functional Medicine and preventative medicine and what you call progressive medicine. I think arguably you’ve had a bigger impact in terms of raising the public awareness of these concepts than just about anybody else because you’ve been doing a mainstream TV show about Functional Medicine in the UK for the last several years. I mean, we don’t have anything like that still here in the US, and I’ve really enjoyed following that and hearing more about the impact, and I think our listeners here would love to hear a little bit more about your experience with that show, how it got started, and then what kind of impact you feel like that’s had.
Dr. Chatterjee: Yes, Chris, thanks for asking me. That really has been … I’m incredibly fortunate and lucky to have the experience that I’ve had, and I’ll explain to you why I say that. I think the first thing to say is I never got approached to do that show because of my approach to medicine. I think it was just quite fatuousness, how it all happened. I was on my journey of learning. I was going out to America at regular med schools. I was going through all these Functional Medicine conferences, and I was literally just sucking up knowledge. One conference had finished, and I couldn’t wait to book on to the next one and buy my flight and come straight back to learn more. It’s a story with many people who once they got their head gets switched on to this way of thinking … but what happened while I was doing or was training, I’m still in my sort of conventional practice, and the practice manager sent out a group email to all their MDs in the practice saying the BBC are looking for a new doctor. They’ve got a new concept called Doctor in the House, which is what happens when you have more than 10 minutes with your patients. I remember seeing the email and thinking, “If you have more than 10 minutes, then you could do so much.” I had no ambition, Chris, to be a TV doctor. In fact, I can’t stand that term. You’re no longer a doctor, you’re a “TV doctor,” and I prefer a “doctor who also is on TV,” but that’s a minor point.
I phoned up the number thinking, what’s this about? Anyway, I ended up having like a 40-minute interview with the studio, and that turned into three months of basically interviews and tests. They’d film me with families, and they take you around an empty house and say what kind of things would you be looking for, what sort of clues would you be picking up, and it … what’s interesting to me is I didn’t prepare for a single one of those interviews, around eight of them over three months, because I wasn’t really desperate to be on television. I just thought, if these guys like me who I am, great. If they don’t, fine, get someone else who might want to say … what the right things to say in order to get on television. So I just went and did my thing. Three months later, I heard they went for about 1,500 doctors, and somehow I get picked to make the series. Just to make one show actually, but the show went so well that they made a decision for me to do a whole series, and that was a big decision for me because I thought, “Wow. This is a lot of exposure.” BBC is our main channel that gets the biggest viewing, and it is a primetime show. And I thought, “Wow, this is a lot of exposure.” But I thought, what an opportunity here to see … can I get various conditions, various families who’ve been struggling with their health for years, who’ve already been under GPs, specialists, other healthcare professionals and they still can’t get better, can I get these guys better on television? I didn’t know what it would entail at the time. Like all the things, you just you jump in the deep end and you kind of sink or swim.
Chris: Right.
Dr. Chatterjee: If I’m honest, Chris, to actually go into families’ houses and spend all this time with them, you get to … for example, we talk about nutrition. This is not what people tell you they eat in your surgery, in your practice. You’re actually watching what they do eat, what they got in their fridge, what they got in their cupboards. When they’re snacking, what are they snacking on? Because everyone filters in front of their healthcare professional. People tend to have a little filter in terms of what do you eat on a typical day. Are they going to tell you, Chris, what they eat on their best day, when they follow the principles in your book? Or when it’s Christmas holidays and they’re actually feeling emotionally vulnerable and that’s what they’re eating then? I got to see the few hours before bed what the family dynamic is like, what are those interactions. Those sorts of things actually would never probably come up in my surgery. And not only would they not come up, even if I asked about them, I suspect that they just wouldn’t come up in the same way. I was just seeing all kinds of things. I thought, “Wow, these are all playing a role in that person’s health.” And now that I can see that, I can actually potentially influence those things in a different way, and what’s interesting to me, Chris, is that a typical Functional Medicine doctor will probably have a lot longer than some 10 or 15 minutes. You may have an hour or 45 minutes or an hour and a half with the patient, and we all want more time. I potentially got too much time because the other problem I had, Chris, is that when you know absolutely everything and you see it all, it’s almost too much information because you can then literally … you don’t have the security of your surgery and your consultation room walls. You’re seeing people in their own setting. You feel quite exposed, actually, so it was an incredible experience, the results I managed to demonstrate for those families, but also in front of five million UK viewers a week, and probably the proudest results of my career because I had some of my most difficult cases on that show. As my best friend, who is not a doctor tells me, he’s like, “You’ve got five million people watching you do your job.” I’m like, “Yeah.” He told me this a few weeks before the show came out. … I was pretty nervous anyway, but now …
Chris: Thanks a lot.
Dr. Chatterjee: We can dive into a bit of the detail, but essentially I got to see different sides of people from what I see in my consultation, and that has changed me, not only what I did on the series, but I’m a different doctor now than before I filmed the TV show.
Chris: Yes. For the folks who are listening, although you can’t yet watch the full series, I think there are quite a few YouTube clips of the show.
Dr. Chatterjee: I found that there is quite a few on YouTube, and I put them all together on my YouTube channel so people can watch at least eight of those episodes free of charge on the internet.
Chris: Oh, cool. Yes. Yeah. I really recommend doing that. It’s really great to see these concepts on primetime television going out to people who are totally unfamiliar with them. I’m just curious—there are so many things we could talk about related to that show, but I’m mostly curious in this context—what was the feedback that you received from professional colleagues and also just from the general public in terms of being exposed to these concepts? What kind of impact do you think it’s had in the UK, and how has it changed the conversation?
Dr. Chatterjee: Yes, Chris. Look, I think it’s had a huge impact. I mean I get invited by the NHS to come and talk about how we implement the strategies, the things that they saw on television. How do we get that into the National Health Service and make that widespread? Clearly, having a doctor in your house for four to six weeks is not a rational or actionable national strategy. It’s a reverse from the chronic disease trajectory, but what can we learn from that human emotion as we focus on the negatives? If I get 99 with the collaborative and inspirational plus the feedback, and then one in a hundred sort of say, “What was that you were doing? There’s no evidence behind that,” etc., your mind tends to focus on that one person. Although I had learnt over the last years to get a lot better at that, but generally the responses have been very, very good.
It’s the first series to actually demonstrate on a primetime show that type 2 diabetes was a reversible condition and something that can be done in some cases, well, I’m not saying it has to be, within 30 days is really quite remarkable. I think that was very much ahead of its time because now, NICE, the National Institute for Health and Clinical Excellence in the UK is now accepting that we can code in people’s SNPs that type 2 diabetes can be put into remission, but it was very, very controversial for years here. When my show came out, it was the third episode in the first series, where I helped a lady reverse her type 2 diabetes in 30 days. The BDA, the British Dietetic Association, released the statements about criticizing the care that was given, and there are very alarmist statements advising people not to adopt the strategies they saw and go discuss with the doctor. That was a hugely … it was quite a challenging time for me because I didn’t do this to fight with people. I’m not interested in having fights with other people. I think I’ve found a better way than I used to look out to people. I managed to show that on television, and I just want to get that message out to as many people as possible, to people that agree with me, fine, but I didn’t necessarily want to fight this. I found that quite hard, actually. The thing I found the hardest was, I would have preferred the BDA to say, “Look, that isn’t the person we take. We recognize the fantastic results you’ve got. Can we get together and discuss? There’s something interesting there.” That approach wasn’t taken because I wasn’t sort of being down on dieticians; I wasn’t criticizing other people’s approaches or anything like that. I was simply going, “Okay, you’ve got this problem. I’m going to give you the best advice I can with all the experience and all the knowledge I have, and worst-case scenario is you’re no better after four weeks. Best-case scenario, I’ve revolutionized your health.” That was the only really negativity I’ve got in the first series, was the dieticians.
But from so many medical doctors around the country, from nurses, from pharmacists, from nutritional therapists, from other dietitians, I got so much warm feedback saying, “Look, just incredible to see those results. We’d love to learn more.” I got so many emails from medical students, Chris, and this made me incredibly excited. A lot of medical students contact me saying, “Look, Dr. Chatterjee, I love what I saw there, but I’m in final year now of medical school. I’m not learning about this. How can I learn more? Because that was incredible!” I think it’s been highly significant here. It’s changing the conversation here. I think a lot of people now are embracing lifestyle not only as a way of preventing getting ill, but also as a therapeutic tool to treat people when they are ill.
I recently lectured for the Royal College of GPs at a Wellbeing conference as to how can doctors look after their health, and this GP came up to me afterwards—and it really touched me—he said, “Look, I’ve just got to thank you.” I said, “What’s happening?” He said, “Look, the work that you’ve done, it set the stage for me to be able to do what I do. People give me a lot more credibility. I can now talk about these concepts in a way that I couldn’t do four years ago because of the work you do. I just want to thank you.” It was great to me to hear that because yes, I’m doing it to help the public. I want to empower the public or as many people as possible to understand that actually, no matter what your health problem is, some simple changes to your lifestyle can have a profound impact. But it’s also nice when other healthcare professionals or when other medical doctors say, “Look, I love that. I’m now using this approach with my patients and I’m getting great results. Thank you.”
And I think the culmination of that for me, Chris, was in January this year, where I sort of created with a colleague the first what’s called Prescribing Lifestyle Medicine Course that the Royal College of GPs have credited. That’s our main institution here. They have credited that course with seven CBD points, and we had nearly 200 doctors come in January and we have GPs, we had gastroenterologists, rheumatologists, oncologists all coming, learning from me and a colleague in terms of how you can apply these principles, and it was just incredible. The feedback is 95 percent of them have said they would highly recommend this course to their colleagues, 85 percent of them have already said this has significantly impacted the way that they are practicing medicine. We didn’t go the whole hog. We didn’t go in as much detail as you offer, Chris, in the Kresser Institute. This is trying to shift people from one to two rather than one to ten because I feel very passionate that … your training exists, that is very good training out there for that really detailed, in-depth look at reversing chronic disease, but I thought, “Okay, look, the public has bought into this. A lot of the profession has seen those results, but probably don’t have the time, energy, or inclination to go on and do this in depth, to dive into Functional Medicine. What are the core principles, and what can I actually teach them in one day to shift them from one to two or one to three?” The feedback has been incredible, so, Chris, what has been the impact? Well, I can tell you, four or five years ago, we weren’t having Royal College of General Practitioners-accredited courses in lifestyle medicine; in 2018 we now are. That gives me a lot of hope.
Chris: Absolutely, and that’s exactly the change we need to see. I think we all know when we’re shifting our paradigm, we expect resistance, but almost by definition, if we don’t get resistance, we’re not doing our job. We’re not really changing the conversation, and of course, we’ve seen similar things here. We’re seeing a lot right now about how the dietetics organizations are fighting health coaches because they want to be the sole providers of nutritional information, and they’re arguing that nobody other than a registered dietitian should be able to offer nutrition advice, which I personally think is just crazy. Unfortunately, this stuff, it’s not just about logic and what’s the best direction from an evidence-based perspective. We have to deal with all the messy human stuff that comes along with it, and that’s fine. We’ll get there one way or the other.
Dr. Chatterjee: We will get there, Chris. You mentioned this about dietetics in the US. It was literally last week where a big story came out on the BBC website, a new radio documentary that they did, or was featured in talking about how doctors don’t learn about nutrition at medical school or very much in this country, and my quotes were heavily featured in that BBC article. I haven’t read it. I didn’t know it was out, actually. My friends texted me and said, “Hey, look, this is out.” I thought, “Wow, this is going to pick up a lot of noise.” There was quite a lot of what I call abuse … No, I won’t quite call it abuse, but there was a lot of interaction on Twitter from dieticians. I said, “Look, we’re not getting enough.” One of the ways I have tried to make a change here is with this Prescribing Lifestyle Medicine course, which is just a one-day masterclass to teach other healthcare professionals, in particular, medical doctors how they can start to apply these principles in their current system, and this is why there is no dietician teaching that.
I very respectfully interacted back, and I said, “Look, guys, I absolutely respect your expertise. We’re teaching in a system, a framework, a new set of principles for people to apply. Everything that we taught was well within our expertise levels to teach.” And no one was responding to that. They just kept saying, “Dieticians are the only people who can give nutritional advice on medical problems. No, this is not serious because there’s no dietician there.” And I thought, when you take a step back and you set the emotion out there, I find it remarkable. What I would expect some prefer is, “Hey, look, that is great. You’re trying to make a difference here. I’ll tell you what, I’ve got some interesting things and I can answer that. Can we get together? Can I actually suggest what I’m up to add to that course?” I’d be very open to that. I don’t really understand the assumption that our course is no good when you haven’t attended it, whereas everyone who attended thought it was superb, and I thought that really just shows what we’re finding out there, which is a lot of ego, frankly, which there’s really no place for that in healthcare because ego is getting in the way of getting people better, and this is not just about one organization fighting with another. We’ve got a serious problem, Chris. Any disease you want, I mean, type 2 diabetes is one that often gets spoken about, in 2012, so that’s six years ago, we think that type 2 diabetes was costing the UK in direct and indirect costs £20 billion a year. What’s that, about $26 billion a year?
Chris: Incomprehensible.
Dr. Chatterjee: An obscene amount for a condition that by and large is an environmental illness. This is driven by our lifestyle and our environment.
Chris: That number is $250 billion in the US, by the way. This is the population differential.
Dr. Chatterjee: And instead of fighting in terms of who has got the authority to give the right advice, let’s just be more collaborative and go, “Hey, look, that’s great. That’s working or this is working. What can we do together?” Because patients get incredibly frustrated, the public gets incredibly frustrated, because they don’t know who to trust, and I think like you, Chris, I’ve just decided to just focus on doing what I do. I normally stay out those fights on Twitter, and the reason I got involved last week was because I was really trying to extend a hand of collaboration. And I would go, “Look, this is great. Let’s get together. Let’s meet for the greater good.” And I’ve learned that Twitter is not the best environment to actually try and change people’s opinion.
Chris: Yes.
Dr. Chatterjee: I think things are changing, that’s for sure, Chris. There’s no question here that things are changing and I can’t comment on how impactful my show has been, but I get told by a lot people that the show has been game-changing here.
Chris: Yes. I’ve definitely heard from lots of people and when I was over there in the UK I heard from lots of people who were turned on to these concepts from watching your show, both professionals and consumers. I think that you have had a big impact.
Dr. Chatterjee: I would say to people who do, if you do provide the links to the shows and they watch them, just to say, look this was edited for a mainstream audience. I think some viewers who may watch it might go, well, what happened there or what testing was done, you got to remember that actually this was a 9 p.m. primetime slot, so a lot of the things I did got very simplified. The narrative got quite simplified, but it was definitely a true narrative. It was definitely not inaccurate, but I would have preferred a lot more detail. But Chris, I’ve also learned, being in the media, that there are two sides to this. The show that I would want to make with all the detail in there, with all the science, we’ve probably had a hundred people watch that show, whereas the TV studios know how to edit and show in a way that actually engages the viewer, and so we have five million watching it. Initially I was frustrated that not all of my ideas and principles came across. Then I think, “Well, you know what? If 70 percent of your ideas came across to that many people, that’s better than 100 percent to 50 people.”
Chris: That’s right, absolutely. TV is that kind of medium. We’re not talking about a book here. We’re talking about a primetime TV, show so you have to customize accordingly, and I think you did a great job, from the episodes that I’ve seen.
Dr. Chatterjee: Thank you.
Chris: Speaking of books, let’s talk a little bit about your new book, How to Make Disease Disappear. It’s actually available in the US now. It was published in the UK as the 4 Pillar Plan, I believe, right?
Dr. Chatterjee: Yes, absolutely.
Chris: At the beginning of the show I mentioned that you and I not only share a passion for reinventing healthcare; we also share a similar perspective on the most important way to do that, and in your book you talk about these four pillars, and they are actually identical to the four pillars that I mentioned in my 14Four online program. Tell us what they are and why you think they’re so important for turning our health around.
Dr. Chatterjee: I’m just going to just back up a little bit just to say that on the two series of Doctor in the House I’ve done so far, I treated a wide variety of different conditions, whether it was type 2 diabetes, whether it was panic attacks and anxiety, whether it was insomnia, whether it was fibromyalgia, chronic back pain, irritable bowel syndrome, cluster headaches, all kinds of different things. And as I reflected, I thought, 80 percent of what I have done with every single family, no matter what their label is, no matter what we call that disease, 80 percent of it in its core was the same. I’ve been on an evolution of the past years, as I’m sure you have, Chris, as you’ve got more and more into this area that I love, doing all the fancy testing, and I love finding that little pathway that’s not working and giving supplements as much as anyone.
But we often forget the low-hanging fruits and those four key areas of health which I call relaxation, food, movement, and sleep. When we make small changes in each of those four areas, it completely changes our biology in such a powerful way that many people don’t realize. We’re always jumping for what’s there, you know—what’s that something that we need? What is that test that I need? And more and more, Chris, I’m realizing that actually these four areas for me are the core pillars of health, and we would get so far off the way there with many of us if we just start applying these principles. Food and movement, of course, everyone has been talking about for years, but I think relaxation, which is the whole stress piece, and sleep is very much undervalued. This book came out in January in the UK and is doing incredibly well, and I think the reason it says press is because I’ve taken the pressure off people. I have said that there are four pillars, there are four core areas to this book, 25 percent of the book is literally on each of those pillars, and in each pillar there are five chapters, and each chapter is a suggestion. That was not prescription, it’s a suggestion. That means there’s 20 possible suggestions that you can do from the entire book. Now, I don’t think anyone’s going to manage 20 in the modern world. I think it’s going to be incredibly challenging, but say, “You don’t have to do 20.” Most of my patients tend to need to do about three in each, but I don’t know for that individual, in the concepts of their life, in the concepts of their job, how many they will need to do. Some might get away with less, but the whole point of this book is about saying, “Look, you don’t need to be perfect in one area. You don’t need the perfect diet. If your diet is good enough, you’re going to get more benefit from shifting over to another pillar and going to be bed one hour earlier or actually switching off for 20 minutes each day and do a bit of meditation.”
I’ve got many patients, Chris, who come to see me who actually, they have read a lot of blogs and their diet is pretty good by the time they come to see me. And I tell you, I had this type 2 diabetic patient recently, his diet was frankly outstanding. In fact, I would argue he was almost too aggressive with his carbohydrate intake, and he was stressing himself out because he could not get his blood sugars under control. And I remember seeing him and I said to him, “I don’t think your diet is the issue here. I think the fact that you are chronically under stress and that you are a busy executive and you never have any downtime, I think these are the levers we need to turn to get your blood sugars under control.” And he was shocked because he thought it was all about carbs. He read it on the internet, he says, “No, no. I must be getting carbs from somewhere that I’m not realizing.” I said, “Look, honestly …” and I drew him this diagram—and I talk about this in the How to Make Disease Disappear book, I sort of go and say, “Look, if there are four possible things that could be playing a role and you have maxed out on your diet, if these other factors are driving your blood sugar now and you don’t tackle them, it doesn’t matter what you do with your diet since—” I won’t get into the whole detail of the story, Chris, but essentially I got him to eat more carbs, but he started to prioritize relaxation, and I just traded with him. I made a deal with him, I said, “Just five minutes a day.” He said, “I can’t do it.” I said, “Okay, what can you commit to?” And he came up with five minutes a day, we downloaded the Calm app, the meditation app in my clinic, and so he did that. He went for a 15-minute walk every day, and he had a relaxing practice before he went to bed. I’m not kidding you, Chris, but he came back maybe six or eight weeks later. He was eating more carbs and his blood sugar had come down back into the normal range.
I think even in the health sphere, a lot of us talk a lot about diets, and diet clearly is very important. I’m a huge advocate for changing one’s diet, but it’s not everything. I think we can over-obsess; we could hit a certain ceiling and forget those other big leaves that we could be turning. That’s really where my approach comes from. The approach really comes from what I’ve learned from my patients both on the TV series, but also in 17 years of practice, which is anyone could go on a seven-day or ten-day diet and lose weight or feel better. The question is, can they still be following that in two months, in six months, and in 12 months?
The approach that I sort of lay out in my book is very simple. I think it’s achievable for pretty much everyone, and I think it takes the pressure off people because I say quite clearly, “Look, I don’t expect you to get all of these things, and actually, if you read one of these chapters and you don’t like the suggestion I make, don’t do it. Choose one that does fit with your belief system and your lifestyle,” because there was a lot of crossover there and I think certainly for me, I think that’s where the magic is here, which is that if you do about two in each, two sustainable ones in each, I think you’re going to get really profound results.
And Chris, sometimes, I don’t know how you feel, but sometimes I feel very burnt out. We’re trying to go around the country and spread this message as far and wide as possible. A few weeks ago, I was really lucky. Jamie Oldman advised me to come out and have lunch with him to talk about can we really start to make an impact with the obesity epidemic in children. It was a great meeting. It went on quite a way. I’d been in London for two or three days, and I don’t live in London. I was on the train back home in the evening. I was exhausted. I got over to the station, and my wife, I texted her, she replied that she’s asleep, the kids were asleep, so I asked the cab to stop in a supermarket and I thought to kind of nip in very quickly and buy some food. I walked in, and three people suddenly stopped and turned around, and the lady said, “Oh, my God.” I was like, “What’s happening?” And she said, “Oh, my God, doctor. We’ve just been talking about your book. I literally bought this book six weeks ago. I’ve been ill for ten years. I had to give up work with fibromyalgia, and I’ve spent all my savings on private treatment, and all I’ve done is apply the principles in your book, and I’ve never been this good. I’ve been to the gym four times this week, sleeping eight hours a night, I’ve got more energy.” And her husband came and gave me a big hug, and I thought, this is why I’m doing what I’m doing, is because just for that one moment alone, it was worth the months it took me to write the book. And there’s many more moments like that.
But as you would’ve experienced, Chris, no doubt many times in your career that the point is that she hadn’t taken any supplements. Again, I’m not saying supplements don’t have a value. If she was my patient, I may well have given her some things to support her mitochondria, but even that taught me that, wow, just by applying those lifestyle principles, the low-hanging fruit, actually, we can go a long way to where we need to, and that’s really what I set out. I’m so proud it’s coming out in America because your country’s health outcomes, I think, are worse than ours.
Chris: Yes. We hold that distinction. We’re ahead of the pack with far of that goes. We’re behind on many measures of healthcare safety and efficacy.
Dr. Chatterjee: There’s a story I got, why I started the book. This is actually before I knew the in-depth Functional Medicine knowledge that I know now, Chris. I remember it was earlier on in my days as a GP. I was in a busy Monday afternoon surgery. I had three people waiting outside. This was years ago. I was trying to sort of catch up, and a 16-year-old boy comes in with his mother and ultimately, basically, there’s a letter that he basically tried to harm himself on a Saturday and he ended up in the ER. He was discharged from the ER. They thought he was safe to be discharged, but there was a letter for him to come and see me on Monday and for me to start him on antidepressants. Now, I didn’t know as much as I know today, but something intuitively did not feel right to me at all. I don’t know what’s going on here. This family seems to be, with me, well balanced. I can’t quite figure out what’s been going on here. I spent a little bit of time talking, and I said, “Guys, look, can you guys come about tomorrow at the end of my morning surgery, and I’ll spend a bit longer with you?” And they said, “Okay, fine.” I, of course, made sure he was safe to send home that night, and that’s no sort of immediate issue.
He comes back the next day and the end of it, at the end of our sort of 20 to 25 minutes of chatting, I started to feel, could it be an issue with his use of social media? Because I was really worried how much he used it and what his feelings were like after he was using it. I said to him, “Look, I’m not sure that the way you’re using social media is helping you. Would you be interested in me helping you to reduce that?” He said, “What do you think is going to help, doc?” I said, “Well, look, honestly, I don’t know, but before we put you on these antidepressants, if you’re interested, let me help you do this.” What we did, we said, can you one hour before bed switch off your smartphone? And he goes, “Do you think it’s going to help?” I said, “Look, why don’t we try it?”
He goes away and he does that for a week, and seven days later he comes back in—and just to be clear, this is within the realms of conventional ten-minute appointments. He comes back to see me, and I said, “How are you feeling?” He said, “I started to feel great. I’m sleeping better. I’m less up and down through the day. Something has changed.” Now Chris, don’t get me wrong, the guy is still not doing very well at all, not to make a small improvement. But now I’ve got buy-in that there’s something here he might be able to impact. Over the course of the next few weeks, we move it to two hours where he doesn’t go on his devices or his phone for two hours in the evening, and he’s getting better and better. He’s still not great, but he’s improving each time.
And then I was reading some research about how our diets can influence our mental health, and so I asked him, “What are you eating?” And it was a classic teenager’s diet of sugary, processed junk food, a blood sugar roller coaster all day, and I explained to him, I drew him out a sort of picture and said, “Hey, don’t you realize actually, maybe two hours at your breakfast when your blood sugar is falling rapidly, that is a stress response to your body, and it’s not just the blood sugar issue. It’s not just that you need to eat a bit more for concentration that is impacting your cortisol levels, your adrenaline levels, and all your mood hormones.” He said, “Really?” I said, “Yeah. The foods you’re eating I think are also impacting this.” And so, I drew him a picture and I said, “A few more healthy fats throughout the day …”
In the interest of time, I won’t get into the whole case, Chris, but essentially, I helped him make some simple changes to his diet, not full-on perfection, just simple changes, and he started to improve, and I don’t see him for six months. I go into my surgery, and I got a letter waiting for me, and it’s basically his mother. It said, “Dear Dr. Chatterjee, I just want to thank you. You’ve completely changed Evan’s life. He’s like a different boy. He’s happy at school. He is interacting with his friends. He joins clubs at the weekends. I just want to thank you.”
But really, that case has taught me so much, that just simple lifestyle changes, when explained clearly, when explained in a way that actually resonates with the person in front of you, can have a profound impact. I’m not claiming this happens in every case, Chris, absolutely not. But that taught me a lot how … those simple things. And a lot of people say, “Yeah, a 16-year-old will never listen to you.” I disagree. If you connect with that person and actually, we’ve spoken about that, Chris, and something I’m very passionate about is that actually I think the biggest skill for a healthcare professional is actually not scientific knowledge, but can we connect to communicate with the person in front of us? Because I find every patient wants to be as healthy as they can. They don’t want to be struggling. They don’t want to be on your waiting list or on my waiting list. Actually they want to be living their life. We assume, and certainly in my profession in the UK, we assume a lot of the patients don’t do what we tell them today. I don’t really buy into that. I just think if we can connect with them and we can it make achievable for them, they do want to make those changes. And that’s essentially what I do in my book, Chris. I make these changes seem achievable for everybody, and I think that’s why so many people are resonating with the message.
Chris: And they are. I’m in exactly the same place as you, Rangan, because after many years of doing very … sometimes going down the Functional Medicine rabbit hole, which as you know, can take you pretty deep, I‘m more convinced than ever, as you are, that in many cases the basics are what matter most. And I would also say, and this is very consistent with your book, that we often make the mistake of assuming that big problems require big interventions to make a difference. What I’ve found is actually it’s a series of small changes that tends to make the biggest impact, instead of these hugely dramatic interventions. I think that’s really the message with your book as well.
Dr. Chatterjee: And I think, Chris, we’ve all got … one thing I’ve recognized, we all got our own personal bias, because when I changed my diet, that’s such a profound impact to the way I feel that I then was assuming that it all starts with food. That’s that key intervention. Now I’m saying that isn’t the case, but I’ve learnt, I see those four pillars as like, they all feed into each other in a circle. You can get on wherever you want, but it will all feed around. If you want to start with food, that is fine. I started with food, but I had a patient we see with a mental health problem who frankly was not interested in changing his diet, but I could persuade him to become more physically active and as we ramped up his physical activity, he then wanted to start eating better, which then had an impact on his sleep, etc., etc., etc., so I kind of learnt over the 17 years of seeing patients, just do not assume anything about your patients. They may not want to start what you want to start, and that really has helped me define that very simplistic … I think the structure of my book, Chris, is actually deceptively simple because the chapter titles are actually quite a simple intervention. I sort of walk people through the science, but then bring it back to say, actually, the lifestyle intervention at the end of all that science is relatively straightforward. I don’t think we realize … I’ve got this phrase I use quite a lot now, which is, “Consciously make changes to your lifestyle to unconsciously change your biology,” and that in a nutshell is the approach I take to these things.
Chris: Well, this has been fantastic. I’m so glad you could take time out of your busy schedule to join us, and as I mentioned, How to Make Disease Disappear is out today in the US. I definitely recommend checking it out. As I said, I believe that a series of these small changes, even for people who are, and this is a key point, who are really knowledgeable about this stuff … I mean, my patients are some of the most informed, knowledgeable patients that you’re ever going to find. I mean, they are people who have been reading these books and following the blog post, and in many cases they’re healthcare professionals themselves, and yet in my work with them I often find that the biggest difference comes from making some of these changes like implementing a digital detox or tech Sabbath one day a week, or starting a stress management practice, or incorporating more time for leisure and pleasure in their life. These things might seem insignificant compared to doing thousands of dollars of lab testing and treatment, but frankly, in many cases they end up making a bigger difference.
[Crosstalk]
Chris: Yes, exactly. How could that be more powerful than—
Dr. Chatterjee: ___ real medicine. This is fine. I know about that, but is this real medicine, that’s the nub of the matter.
Chris: Absolutely. I’ve been beating this drum for many months now. I think it’s just really become even more clear to me, and it’s one of the reasons we’re launching a health coach training program. Actually, by the time this is out, enrollment will already be open for it because I so deeply believe that diet, lifestyle, and behavior change are the key, and the problem is that it sounds almost trite. We said that so many times, people are like, “Yeah, yeah. Tell me something I don’t already know.” But we don’t already know it because if we did, we’d be acting and behaving differently.
Even myself, I mean, this is something that I continually have to come back to. For example, whereas I am about the effects of technology and I do a pretty good job of limiting my use over the last several months, I’d started to slip, and so we drew a hard line in the sand, and we’ve gone back to Sunday as being absolutely completely technology-free. We just put our iPads and computers in a drawer. We don’t interact with technology at all, and it’s been absolutely transformative to go back to that, and now we’re planning a vacation soon where we’re going to have another experience where we’ve done every year where we’re completely off the grid. No technology for eight or nine days, and I can tell you that that has as big of an impact on my health as just about anything else.
Dr. Chatterjee: Chris, just before we went live in February of this year, I’ve just been … the book came out in the UK in January, and obviously today it’s out of the US, which is just fantastic, but I was burnt out from all the book promo, speaking to hundreds of people. I’ve been all around the country. You’ve experienced this before, Chris, the irony of promoting a health book is what you do to your own health once you’re doing that. And we booked a very last-minute holiday to … we went to a place called Dubai, and I made a big deal of it on my Facebook and my Instagram. I said, “Guys, you will not be getting anything from any of my channels over the next nine or ten days.” Not only did I say that, I managed to do it. We got to the hotel, and I put my laptop and my phone in the safe, and they stayed there. I tell you, that holiday was probably the best holiday I’ve ever had because I don’t think we realize how much noise technology constantly, it just nags away at you and it just drains your mental energy day after day after day.
I love tech as much as the next guy. Like you, Chris, I go through an ebb and flow. Sometimes I slip into bad habits, and we all need constant reminders. I mean, just because we are sort of preaching this stuff, it doesn’t mean we are perfect by any stretch of the imagination. It’s a constant challenge, and I think that collaboration with health coaches is absolutely the way forward, and I’m delighted to hear about that. But if you have not … some people might say, “I can’t do a whole eight or nine days without tech.” Okay, fine. Try it on a Sunday morning. Try going to the park with your kids and don’t take your phone with you. It is a different experience. As soon as I come back, I feel like I’ve got a holiday just when I’m not on my phone for four hours. It’s just incredible.
Chris: Yes. We don’t recognize how much it influences us until we get that break, and I definitely recommend starting tomorrow night. Like you said, don’t start with nine days—that’s probably going to be too difficult—but start with half a day and or even an hour and see what kind of impact it makes.
Dr. Chatterjee: I’ve always taken with myself … not always with myself, actually, I am sort of pretty strict with myself, and I’ve got myself into trouble sometimes trying to really stick to some really hard-core health regime. What I learnt what is sustainable are these small changes that are achievable because … let’s say, for example, one of the things I recommend—I talk a lot about strength training, as you do, Chris. It’s very much undervalued, when we talk about movement and exercise, people often undervalue how important lean muscle mass is. A few years ago I was telling my patients, I was saying, “Hey, guys, once you go past 30, you can lose up to 5 percent of your muscle mass every 10 years. Your muscle mass is one of the biggest indicators of your health as you get older.” And so you got to join the gym and do some…” A few weeks later they come back, and I say, “How are you getting on?” “Oh, you know, doc, I can’t manage it. It’s too far.”
I’ve always thought, okay, I’m giving advice that they are not able to follow. I never felt that actually, you know what? These guys are not doing what I’m telling them to do. I go, okay, clearly the advice I’m giving them doesn’t resonate with them in the context of their life, so I came up with a saying in my book, and I actually did it on one of the shows in Doctor in the House, sort of five-minute kitchen workouts, which is basically a very simple bodyweight workout that anybody can do of any age. I’ve literally got patients in their 20s doing it, patients in their 70s doing it. You don’t need any equipment and you can get a really good strength workout doing it. You don’t have to join the gym. You don’t need to get changed, and I’ve always looked at, how can I make these things practical for people? And what I found is when they say they don’t have time, then I say, “Well, can you give me five minutes twice a week?” “Yeah, of course I can.” You start off slow, and they do this five minutes twice a week. They start to feel the benefits, and before you know it, they’re doing it six times a week.
I talked about this in the book. There’s a couple in their 60s who I taught the five-minute kitchen workout in my clinic room, and they thought I was mad, and they were a little bit skeptical. And they said, “Okay, doc, we’ll give it a go here.” And they started it off, and they enjoyed it so much, when they came back to me see me four weeks later, they said, “Look, when we run our evening bath upstairs, on the landing we both do it for about seven minutes now, five nights a week.”
Chris: That’s great.
Dr. Chatterjee: Yes. It’s incredible. Wow. Can we really make a difference? When you set the bar low, people achieve it, then they want to do more. If you set the bar too high, people don’t achieve it, they just give up. This approach, I think, is quite different from what I’ve seen five or six years ago. And like you, Chris, I listen to my patients, I learn from my patients, and this is the approach I think works for the vast majority of people.
Chris: That’s fundamentally a coaching approach. I mean, there’s a concept in coaching called “shrink the change,” which means you take a big change you want to make, and you have to break it into smaller, more actionable steps, which is exactly what you did there. I mean, that’s why I’m so excited about the coaching program because we assume that people, when they don’t change, it’s because they don’t have enough information. We just need to give them more information, and then they’ll change, but really, that’s actually not the case. People don’t change because they don’t know how to change, and we as practitioners don’t know how to support them in making that change. Just learning about how human beings actually do change and incorporating some of that into our work can make a huge difference.
Dr. Chatterjee: Yes, absolutely. Chris, before we go, I just want to say how much I respect the work that you have done over the past few years. I think very few people have done as much as you to raise awareness of ancestral approaches, Functional Medicine approaches, lifestyle medicine approaches, and yes, I just want to give a lot of gratitude to you. I think your blog is fantastic, and I’m very much in awe of the work that you’ve done.
Chris: Oh, thank you, Rangan, I appreciate that. Everybody, How to Make Disease Disappear is available today on Amazon and elsewhere. Do check it out. We’ll put a link in the show notes to your YouTube channel, Rangan, where people can watch some of the episodes of the show. I think that would be a great thing for everybody to see, and I look forward to seeing you again next time when our paths cross, Rangan, and good luck with the book and everything else.
Dr. Chatterjee: Thanks, Chris. I’ll see you soon.
Chris: All right. Great.
The post RHR: Bringing Functional Medicine to the Masses – with Dr. Rangan Chatterjee appeared first on Chris Kresser.
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