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Micro wisdom delivered to your ears every morning in voice notes ranging from 3 to 15 minutes long. Wisdom on how to live a healthier and more fulfilling life. Every podcast will ground you in the present moment to ensure you know what's important, the here and now.
It's just a nice q and a, Nick. Nothing nothing like, I said, we don't want a seminar. We're not asking you to plug out some slides. We just wanna pick your brains, hopefully. But it'd be good if you can just, like, mention, you know, like, maybe a bit about yourself, your story.
Speaker 1:I think it's very so people can get caught up. I have said what you do Nicola, so don't worry. I should have read up about you.
Speaker 2:Well no need to do that. So I am the co director of the Institute of Metabolic Science in Cambridge and I studied medicine in London and qualified forty years ago which is quite a long time and developed an interest quite early on when I was training in after qualifying. I did general medicine and diabetes and endocrinology at Guy's and I developed an interest in prevention early in my clinical career. And then took a, alongside doing clinical medicine, started doing preventive medicine and public health. Did a Masters in public health at London School of Hygiene and Tropical Medicine.
Speaker 2:Then I was fortunate to have a fellowship to go to America for a year so I went to Harvard to study oral health there. Came back to Cambridge and I actually did my PhD in Cambridge on what we now call wearables. It wasn't called that at the time. Objectively measured physical activity in a thousand people which was a lot then and related it to metabolic risk and showed I think pretty convincingly that small increases in overall energy expenditure were related to big decreases in diabetes risk. And after that I did fellowships in Cambridge and in 2003 was fortunate enough to become a director of an MLC, Medical Research Council Unit which I've done ever since and have continued to treat people with diabetes but to do research into prevention both at the individual level which is exactly what you're doing but also more at the societal level.
Speaker 2:What are the features of the world in which we live that we can change so that fewer of us get overweight and get non communicable diseases and both in The UK and internationally as well. Big, big challenge.
Speaker 1:Big challenge. Well, fair play. Think, like, that's a lot of work, Nick. Sounds like a lot of work you've been through there.
Speaker 2:And be busy. It's the honest truth is, Scott, it's, you know, driven by the same sorts of things I think you are that that we can make change and we should make change based on evidence and if we can do that and we can help people then do that a lot of times, that's a lot of help.
Speaker 1:Saw Donna was doing the steps just now, so that little bit of extra steps I don't see. Happy days goes a long way. But Nick, do you know when you mentioned there about this is my question and other people's questions. Please leave them in the comment box. Do you think are we up against it when it comes to the environment we're in in today's world versus, say, two hundred years ago?
Speaker 1:Like, what what's your opinion on that?
Speaker 2:Yes, but some of that's good. Mean, you really want to turn the clock back know, have, pre Victorian times, you want to have a job that is extremely hard labor and no thanks. So the types of work that we do now, automation or office paperwork, it's progress but it comes at a cost. Then all the things in our everyday lives are labour saving devices. Do I want to go back to doing the washing by hand?
Speaker 2:No thanks, I quite like a washing machine. And so yes, it's progress but we've kind of engineered physical activity out of our lives. That's, I mean, it's just an astonishing statistic that I contributed to. So if you look at the change in physical activity in The UK from the 1980s to the 2010s, it has gone down but it was already pretty low. And on the basis of our estimates we'd say well that probably that would give rise to about a forty percent increase in diabetes risk.
Speaker 2:That's even that lower physical activity. And then if you go to China, across a shorter time period, across a single generation, physical activity is just massively declined and that's occupation related and transport related predominantly. And it's not made up for by recreational activity. And you know we estimated that that would give rise to about a five fold increase in the risk of diabetes which is kind of what you've seen in China. It used to be a rare disease and now it's quite common.
Speaker 2:And that change particularly in those sorts of countries in physical activities is kind of invisible. We see the obesity change and overweight. That's visible. Everyone can see that. But the change in energy expenditure due to activities an invisible phenomenon.
Speaker 1:And when you say activity, does that just mean walking or does it mean more?
Speaker 2:Well, I think when you're talking, talking, you're talking about today predominantly about weight loss and preservation of weight loss. That's one thing. Physical activity in its relationship to weight gain is another topic that we should talk about in the absence of treatment. My work has done quite a lot about physical activity in relation to diabetes risk. So my conclusion from that is that possibly it doesn't matter too much what the type of activity is that people do.
Speaker 2:It's just the total volume. Probably on top of that, if it's slightly more intense, there's an added benefit. But the thing that's a problem is the volume of activity that people do.
Speaker 1:So the guideline is like hundred and fifty minutes a week or something. Is that that in your opinion enough? Is that what we should aim for? Like what's what do you think? What's the minimum we need to do?
Speaker 2:Yeah, I think that therein lies sort of the wrong question in a sense. It implies that there's a threshold, there's a value that we should be getting to. And I think in public health terms, that's a challenge. If you're not doing anything, you know, getting to 10,000 steps or one hundred and fifty minutes a week, you know, that's pretty difficult. So I think a better sort of way of thinking about it is we should do more because there's more than we're doing now.
Speaker 2:There is an added benefit of doing more even at the top end although the benefits get incrementally smaller. But most of the public health benefit to all of us will come from actually not trying to get people to meet that threshold but to get the people doing next to nothing to do something. I'm in favor of public health goals that don't put off the small group of people who say, those changes are too big for me.
Speaker 1:Yeah. Know. It makes sense. It's just doing like 500 steps extra today or something like that. Or like what Donna's doing there, just having a few steps whilst like listening in, think, you know, getting steps in.
Speaker 1:Happy days. Yeah. Know. There's another there's a few questions if you know Nick as well. When you come across all this research and you speak to the people in the industry, so Charlotte's asking you about going on like mental health medication and some medication maybe lead into a weight gain or the mechanism of the weight gains from the meds.
Speaker 1:Is it something that still comes down to activity? Have you seen anything in regards to other factors there?
Speaker 2:No, I mean, you know, there are medical therapies for a number of things. I'm trying to read the chat while we talk. I mean people who have to go on steroids for immune diseases or whatever, That does put them at risk of weight gain and you know medically then you're with any therapy, you're balancing the challenges of that against the benefits of whatever the therapy was designed to treat in the first place. So I think there's more that we can do to mitigate the risks of weight gain under the circumstances of those therapies. And I think that's particularly challenging.
Speaker 2:Steroids is one thing and also medications that you know are there for mental illnesses is also another challenge. But my own view clinically is that we are, there's still a bit of a divide between clinical services that treat physical illness and those that treat mental illness and actually we need to bridge that divide. Because I see lots of people with diabetes which is linked to mental health problems and vice versa. Think we just need to get better at recognising the interconnections and dealing with people as you know entire in their entirety rather than as you know you've got this problem or that problem. Yeah.
Speaker 2:People are holistic.
Speaker 1:Yeah for sure. Remember going, there was something going on on social media, a study that everyone was talking about about like dancing being as equivalent to like SSRIs and all that stuff, whatever it was. I don't know what the truth is to that because they look into it but yeah, so like, so what do you think of that? Was that something that came into your view about these kind of comparisons or you're you're saying you think of it holistically and we should think of it holistically, but people will always do the the one against another, right?
Speaker 2:Yeah, I mean I think, you know, I'm not an expert on mental health conditions, but if people are able to be active and if they're able to be active doing something they enjoy and if dancing is that the thing for them and that not only gives them activity but enjoyment but also some degree of social cohesion, connection to other people, you know, that's gotta be that's gotta be a good thing.
Speaker 1:My huge yeah. 100%. Are you like cricket in your neck?
Speaker 2:I do like cricket, Scott. I have I don't need.
Speaker 1:That's your activity. That's your thing or no?
Speaker 2:Well, football, field hockey, and cricket, and everything in between, and triathlon at one stage. But I have now dodgy knees and a knee replacement so yeah. Chill out now.
Speaker 1:Well
Speaker 2:I chill out by watching the mighty arsenal take steps towards winning the premiership. I hope this evening, if there are any Manchester City fans on this call, I
Speaker 1:apologize. No, no.
Speaker 2:Thought someone's booing. This is probably a Spurs fan booing.
Speaker 1:Boo boo. Very nice. And, Nick, did you see this question? Yeah. It's an interesting one.
Speaker 1:I'll read it out to you so you don't have to try and keep up with the chat. Helen is saying, don't know if this is sort of question you want, but if it's okay to ask, if my dad developed diabetes and I am I am I more likely genetically or more likely it will be more based on my food habits? My dad was a builder, very push cal job, overweight and poor food habits.
Speaker 2:Yep. So type two diabetes, which I presume we're talking about, has a strong genetic component, it does run-in families. And we've made a lot of progress in identifying the genes that contribute to that. And there's no single gene. There are some single, what we call monogenic forms of diabetes but they're pretty rare.
Speaker 2:For most people with common diabetes there's a range of different genes that when you add them up give rise to an increased risk. But that risk is not inevitable. And there are things that one can do to reduce the risk. You know, people who have a family history but who are thin and active and eat well, the risk is reduced. If one doesn't do those things then the risk is elevated.
Speaker 2:We have done trials in people with a family history and you know it is, genetics isn't determinism. It just increases the probability and but that probability can be altered by behavior.
Speaker 1:Does the, yeah, so if the behavior was like like you said, moderated weight, active, active and all are, then does that those factors even come into play? Does that make sense?
Speaker 2:Sorry. Say that again, Scott.
Speaker 3:I beg
Speaker 2:your pardon.
Speaker 1:So, you know, when you mentioned that the risk is higher, essentially, if they just follow the same lifestyle as the their parents, I suppose. But if you do what where, like what you mentioned in their higher activity, moderating your weight and all that, what's the difference with that person?
Speaker 2:I mean plenty of people get conditions like diabetes for partly genetic reasons who are not overweight and eat well and are active. Helen says that dab was a builder, she's pretty active. So I think we have to avoid with conditions like diabetes the blame game. That's why I kind of avoid talking about it as a lifestyle disease because it's a disease that's related to behaviours in part and related to genetics and other factors. But calling it a lifestyle disease makes it sound like it's a choice and a consequence of choice.
Speaker 2:And actually in part even the behaviours that we adopt, they're partly under our control and we have the ability to change things but they're partly not. I mean we live in, we do the jobs we do, we live in the society we live in with its activity drivers or inactivity drivers and the food environment we live in. So I prefer to not call them lifestyle diseases and I think it avoids the blame game.
Speaker 1:Makes sense, makes sense. There's a question here by Sarah, a link between thyroid problems, cardiovascular problems, type one, type two? Is there a link in all of them that you've the very, very I mean, that's a hard question, but like what's the Doctor.
Speaker 2:No, very good question. I mean, lot of disorders have common antecedents. Gestational diabetes and type two diabetes are very closely linked. So gestational diabetes is diabetes that first comes on in pregnancy and is important because if you don't treat it well, there's a risk that the offspring are, well the first risk is that they're too big. You get very big babies which has mechanical problems.
Speaker 2:But it's associated with other things as well. But if a woman has had gestational diabetes, it tends to go away once the baby is born. But that individual is then at risk of diabetes reoccurring later on. So gestational diabetes and type two diabetes are closely linked. Interestingly the offspring of women who've had gestational diabetes are at risk of diabetes themselves and less in The UK but in places like South Africa where there's like a real epidemic of obesity in adolescents and adolescent girls.
Speaker 2:You get this vicious cycle. You get obesity and then diabetes at a young age, gestational diabetes and then you get the offspring getting at risk and it's part of the reason this vicious cycle of the increase around the world. So gestational diabetes and type two diabetes definitely linked. Cardiovascular disease is really one of the major risk factors, well the complications of having diabetes. It's not inevitable but having diabetes does increase your risk of cardiovascular disease and stroke and also other things, small vessel disease which affects the nerves in the legs particularly and the eyes.
Speaker 2:Thyroid problems are linked to diabetes in particular ways. So type one diabetes which is an autoimmune disease is linked to other autoimmune diseases of which thyroid problems is one. Sarah's question is a pretty good one. All those things are linked interestingly. One of the challenges in medicine comes back to that treating people holistically.
Speaker 2:It's the whole way we think about medicine is about specialisms and I'm an expert in diabetes but actually most people with diabetes have got several other conditions as well. It's what we call multi morbidity and we need to reconfigure the way we treat people to treat them as a totality rather than somebody with a particular disease.
Speaker 1:It makes sense, it makes sense. Thanks for the great answer Nick. Karen is asking or saying, I was diagnosed as diabetic at faulty. I was five stone overweight after eight years of denial. Lost three stone through very low calorie diet, no exercise, and my diabetes went.
Speaker 1:Nick, can you explain on that diabetes, the reversal or the remission of type two diabetes, like what it means, is like, it come back or like what's the
Speaker 2:advice? Yeah, I mean firstly, congratulations to Karen. That's pretty awesome. When I first started treating people with diabetes, it was like once you got that diagnosis, the natural history, what was going to happen next was you get treated, that treatment probably in itself would give rise to some more weight gain and then you would need extra treatment and that would progressively add on therapies like that. And a few years back people started to think, well what if we hit it really hard early on?
Speaker 2:And the early on is really important because diabetes is a disorder of resistance to insulin but also relative impairment of the ability to secrete insulin. And what happens if you don't treat it well is the glucose is a bit high and that damages the pancreas and the beta cells that are producing insulin. So at the beginning when somebody has diabetes, that relative impairment of secretion of insulin is reversible. But if you don't treat it well and five years, ten years later it becomes irreversible. So what a group actually in Newcastle did was say let's see what happens to that insulin secretion if early on after diagnosis, make people make big changes to their weight and you know, losing three stone through a VLCD diet, not exercise I note and we can come back to that that Karen mentions.
Speaker 2:That is exactly the right thing to do And what that does is it offloads the system and restores that beta cell deficit in the pancreas and insulin secretion goes up and actually the diabetes goes back. Now, parent says it went, you know, whether is that cure or is that remission? In other words, you know, is there still a if the weight went back on then that might reappear but hopefully not. But I think probably remission is better than total reversal in terms of terminology because it reminds us that if you don't change behaviours or maintain those behaviours there's probably a risk of it coming back on. Do you want me to say something about the comment about not exercise?
Speaker 1:Yeah, yeah, yeah for sure, for sure.
Speaker 2:So when you're trying to lose weight and it's in this, you know, in a dramatic way, like Karen was trying to do You do have to shift it through the VLCD and I think it's a Newcastle group who probably pushed this most. Actually during that acute phase of the very low calorie diet, they advise you and Karen, I can see she's there with her hand up. They actually advise you not to try and increase activity because that tends actually increase your appetite and kind of make the VLC diet quite difficult to stick to. But I think the real challenge is having lost the weight, having reversed the diabetes, you have to then start doing the exercise and the resistance training to make sure that it stays off and body composition stays favouring muscle rather than fat when you're in that period. Maybe Karen wants to comment.
Speaker 1:Yeah,
Speaker 4:I think that all I wanted to say was I still get checked at the doctors every year, they will never take diabetes off my record which sometimes I feel a little frustrated about because it feels like now that will forever be there, you know, when it comes to insurance etc. But equally I feel well cared for because it means every year my weight is checked, sugars are checked, which keeps me in check. I I recognise, I mean I did go on to lose some more weight, but I recognised more than twelve months ago, actually can't maintain a very low calorie diet, you shouldn't maintain that. It did its job, but the reason I'm here joining this group now is to learn all about the exercise. I've definitely lost muscle mass, I know that's not good long term, and I want to be able to maintain this and lose a little bit more, and know that when I go to the doctors every year that hopefully those sugar levels will stay in the normal range.
Speaker 4:All I would say to anyone who's in that pre diabetic level, if you can do something about it before it becomes type two diabetes then do, but equally I just put my head in the sand for eight years. Thankfully my sugars were never really really high, know, every year I'd go and they'd say keep doing what you're doing but they're not coming down but equally they're not going up. Yeah,
Speaker 2:really so nice
Speaker 4:to hear what you're saying, Nick.
Speaker 2:Yeah, I mean it's amazing story of taking control as you've done and it's very typical I think that some people revert back to diabetes and then think job done. I think you're doing just the right thing thinking actually now how do I sustain this? And know, periodic, very low calorie diets and then weight rebound, that's a really bad idea. That's called yo yo dieting and on average over time that gives rise to a change in body composition and actually people end up having worse fat percentage. So a sort of blitz, very low calorie diet, reverse the metabolic state but then focus on enhanced activity, resistance training, something more sustainable, I think is exactly the right thing to do.
Speaker 1:Amazing. Thanks for sharing Karen. Appreciate that. Nick, when it comes to, so we everyone did a strength test by the way before starting this challenge, because I remember we were speaking and you were like, you know, the strength is important obviously. So we're like, you know, we'll get everyone do, like, the basic strength tests, sit and stand, all our stuff, you know.
Speaker 1:When it comes to muscle mass, and we're not talking bodybuilder stuff, what's the relationship between maintaining muscle or maintaining strength and diabetes and all that stuff as well? Is there anything there?
Speaker 2:Yeah. No. I think all else being equal, if somebody has more muscle mass for their weight and less fat percentage, they will be at lower risk of diabetes. But as you know, like physical activity has got different elements to it. You know, we've researched mostly the energy expenditure element of activity.
Speaker 2:We've also researched quite a bit about load bearing. So that's really important, like for conditions like osteoporosis and bone health. Resistance and strength, probably less well studied. I would say in a research sense. I'll come back to that in a minute.
Speaker 2:And then there's the fitness element of activity which, you know, fitness and total activity, not exactly the same thing, I think cardiorespiratory fitness is also extremely important for diabetes risk. We did a study in 100,000 people in the UK biobank. Measured fitness objectively and related that so people who were fitter had less likelihood of going on to get diabetes. It's something that we don't measure clinically enough. We measure it when somebody has got cardiovascular disease problems but actually probably, you know, we measure things in medicine because they're measurable and I personally think both fitness and strength should be measured more often.
Speaker 2:So one of the measures of strength that we do is that grip strength and it's very protective of mortality risk in populations. Stronger people do better.
Speaker 1:We're all gonna get stronger here and me. We're all gonna be strong ones. Banas is those those grip calibers. Right?
Speaker 2:Yep.
Speaker 1:Do think it's worth people having that, Homan? Doing it once a month, or you think it's probably worth doing? What's the equivalent? I mean, we we try to do it without any equipment at the start, but
Speaker 2:Yeah.
Speaker 1:That's just your forearm strength and leg. But would would leg strength be more because it's a bigger muscle and it's more used or what do you think? Is it
Speaker 2:Yeah. But it's difficult to, you know, difficult to measure. I you know, one of the things I like about your general approach is it doesn't involve people spending loads of money buying fancy kit. So thinking about ways of monitoring your own strength but without fancy kit might be worth thinking about. So some of those repetition tests, you know, how many can you do though?
Speaker 2:That would be a good marker of are you getting stronger? Yeah. That makes sense to me.
Speaker 1:Yeah, for sure. Everyone's got their numbers. So hopefully in eight weeks we'll maintain at least. More questions, you make. There's a lot to get through, so let me see if I can put a few of it together.
Speaker 2:I'll try and give shorter answers. I'm sorry.
Speaker 1:No. No. It's good. These are Of course of habit. No.
Speaker 1:No. No, Nick. Please keep going with the detail out of it. Cecilia, this might be Nick, I know you love them to be in this one. What are your thoughts on social media influences AI, all of these people telling all this advice and how it is maybe changing the medical field or maybe is it annoying you guys more now than ever?
Speaker 1:Like what's the because you work on population level as well, so it must be a nightmare. All might be good because you can share more of a message, but
Speaker 2:So I've never so I've always railed against professionals who have like a cartel on knowledge, right? And medical So, profession is no different to any other professions you know. I said at the beginning, trained for six years from 1980 and then practiced for forty and there's an old fashioned group of doctors say that I have therefore a repository of knowledge and that's challenged by the internet, Google, Google doctor and everyone having more democratic availability of evidence and I think that's a good thing. Used wisely. Used unwisely, it could be challenging.
Speaker 2:AI is gonna change medicine. It's gonna change our lives. It's gonna, you know, it's inevitable and I don't think railing against it is gonna help. I think we have to work with it, have some good safeguards and railroads and work out how to use it for good.
Speaker 1:Yeah, for sure.
Speaker 2:That's attitude and that's nonsense, I know, but it's Yeah. I'm not sure we can stick our head in the sense.
Speaker 1:No. It's up to us to determine if someone in a white robe in the middle of Tesco holding up a pack of crisps saying it's gonna kill you is good advice or not. There's a lot of guy who's trying to trick me. He wants to be very worried. There's a question here by Danielle.
Speaker 1:Danielle, don't know if you wanna come on the mic and ask her so you give him all the context. I don't know if you're there. I can see you on the screen or not. It's better if you guys come and ask ask them on the mic. Where's my screen?
Speaker 1:There we are.
Speaker 2:What? Is it Daniel's question?
Speaker 1:Yeah. Lost from now. I can't remember where it is.
Speaker 2:2025? Is that it? About high family history?
Speaker 1:Yeah, that's the one, yeah. Can you see it now?
Speaker 2:I've got it, yeah.
Speaker 1:Oh yeah, yeah, yeah.
Speaker 2:Okay, so Danielle's question, if I read it right, she's also an ED registrar. She's in the emergency department so she knows more about most things than I do. The question is about starting statins. So I'm sure everyone knows statins are highly effective treatment for raised cholesterol and have been proven to reduce heart disease
Speaker 5:risk. Hi!
Speaker 2:Go on Danielle,
Speaker 6:ask your question. Halfway through my hair, sorry. So I obviously have like a lot of metabolic family history with diabetes, high cholesterol, high blood pressure. At the same time the things that I don't have which is smoking and like my dad had a variety of those things and I try and do as much as I can to avoid the ones that I know are inevitable for me. My sister is extremely fit but has just been publishing has got high cholesterol and I will expect that I will as well.
Speaker 6:I've just had a baby so I'm not going to get it checked just yet. But I think the guidelines for it are from 40 I think start statins if it's high and I just wonder what the benefit if there's benefit to start at any earlier what am I waiting toward the end of it? Like if I'm doing all the right lifestyle changes is there any effects of also taking the statin at the same time?
Speaker 2:Yeah. Have you been checked collectively for FH?
Speaker 5:No.
Speaker 2:Okay. So that's familial hypercholesterolemia. So with a family history of heart attack and your sister having a high cholesterol, it might be worth checking that. That would be one reason to get your cholesterol checked. Look statins reduce, as you know, risk, the same relative risk reduction whatever the starting risk.
Speaker 2:But in terms of absolute benefit they are more beneficial for people at higher absolute risk. So know, would you benefit? Possibly. But that benefit would be quite small because you're young, sound healthy and you have one big advantage over your father which is you're female which means your risk is lower but with a family history and unfortunately also your ethnic origin because being Asian pushes up the risk It of cardio metabolic would probably be worth checking it out. Whether you should start therapy or not is going to end up being a personal decision and about your attitude to risk.
Speaker 2:Lifestyle isn't a great way of reducing cholesterol. You know, physical activity makes some small changes to HDL cholesterol, the beneficial cholesterol. Diet makes some changes to total cholesterol, particularly LDL, bad cholesterol. But I would personally check you haven't got a familiar form of hypercholesterolemia as well.
Speaker 6:Okay, thank you.
Speaker 2:You're welcome, you should now dry your hair. Happy
Speaker 1:days, thanks for the question Danielle. Nick, here Victor, are you there?
Speaker 3:Hey guys.
Speaker 1:Hello, there we are. You can ask your question Victor.
Speaker 3:Yes, thank you. So I have hereditary risk of type two diabetes. My father died was having type two diabetes. My two brothers also have type two diabetes. So I actually have been on a on a weight control quest for it.
Speaker 3:I was overweight. I have been able to actually control my weight, but not necessarily lose it at the rate that I actually wanted. I've been plateauing at ninety two kilograms. And even though I do strength training and self resistance training three times a week, and swimming and running and many different many different things and on VLCD diet. So two meal replacements a day.
Speaker 3:And so my doctor was actually suggesting to actually go into a GLP one, so Mangira, I think it's called, to be able to actually reduce that. But I was like, I'm not convinced about it. I still haven't actually gone through it. And the last thing that was there was a low testosterone level. I'm 45.
Speaker 3:So I have actually been on testosterone increase through cream. So, yeah, I'm trying to actually get to that sort of sort of management, but, yes, it's it's a struggle to be able to actually lose weight, gain muscle at my age even though I'm thinking I'm doing all the right things. I've been doing that for over two years now. Yeah. Good stuff.
Speaker 2:If it's not a real question, how long have you been out on the meal replacement and trying to shift away?
Speaker 3:Over a year now.
Speaker 2:Okay. And it's been coming down? You say it's plateaued.
Speaker 3:Yes, it's plateaued. So I was able to at one point go all the way down to eighty two kilos. Eighty two? Yeah. And then slowly I've been gaining it even though I don't think I am doing something that different from the usual.
Speaker 3:Sometimes I was actually I was actually now changing, like, the the these milkshakes instead of actually just having water. I was actually putting milk on it. But, yeah, it started to go up. And so it was weird.
Speaker 2:So and how many people in your family have diabetes?
Speaker 3:My father and my two brothers. We are three siblings, so yeah.
Speaker 2:Okay. Alright.
Speaker 3:But yes, they definitely don't look after their health unfortunately. Exercise and the diet is very irregular. So I I know that I can put on weight very easily, like I said right now. Yeah. Increasing weight even though I don't I don't yeah.
Speaker 3:I don't feel that I'm actually doing anything out of the ordinary.
Speaker 2:Do you have a sedentary job? Yes. Yeah. Do you work from home or do you go in somewhere to work?
Speaker 3:Mixed mixed. I work from home and actually going to the office. So, yeah, it's a hybrid same option.
Speaker 2:Yeah. Yeah. Yeah. And have you tracked the your overall physical activity? I know you're doing strength exercises.
Speaker 1:Mhmm.
Speaker 3:Yes. So so, yes, I definitely do I used to do more running.
Speaker 2:Yeah.
Speaker 3:I can't do it because I'm a little bit like yourself. The knees are not as nice as shot. Yeah. Yeah. But other than that, swimming two times a week.
Speaker 1:Okay.
Speaker 3:And, yes, I use this this system that we have here in Australia called KISA. I think it is from Austria. Okay. But, yes, they have targeted machines for being able to do strength training exercises.
Speaker 2:So, know, it sounds to me like you're you're doing, you know, a lot of the things that you should be doing and you are It's frustrating. I guess it's frustrating but I'm sure sticking that at the small incremental changes that Scott's program proposes is a good thing. In terms of the GLP-one, know, maybe they do help and you know that maybe there's an argument for it. Just did a calculation. BMI is just over 30 and you have been down to eighty two.
Speaker 2:Previously in my clinical career we didn't really have therapies that were particularly effective for weight loss. I think that is different now and these treatments are effective. I think the big question is how long for, behaviors do you do alongside those treatments and how do you avoid, you know, if you went on them you would probably get back to 82. The question is how do you then stay at 82 or one year and that's trial and error I think for you about what can you do in your life to re engineer physical activity back into it given the state of your knees for which much and how can you build up the exercise and resistance training and make small sustainable changes to your diet optimize your body composition. I wouldn't regard going on to a GLP as a failure.
Speaker 2:If you get in your head that that's not natural and I've somehow failed, we all need a bit of help in life occasionally. Would cut yourself some slack and if that help is offered, know, consider taking it.
Speaker 3:Okay. Thank you for that.
Speaker 2:You're welcome.
Speaker 1:Thanks Victor.
Speaker 7:Nick,
Speaker 1:a question here. There's quite a chunky one there. Catherine, if I get the gist of that right, you know, come on Catherine Catherine Dunks and ask that question. If you
Speaker 2:are The really bad news, Scott, is I'm sorry. It's no. That No. Man City are two nil up against Crystal Palace. For those who
Speaker 1:care Part of the news is you have to leave, Nick. I've been been sad there. But two yeah. But you still you can still win by winning your matches.
Speaker 2:Yeah. Yeah. I'm going on Monday
Speaker 1:night. Still in your control.
Speaker 2:Gotta gotta keep control, and that's the main thing. I
Speaker 1:was actually I saw the the result where Arsenal were at one nil up, and I saw on my computer that who were you against the other week? I asked was Aston Villa, and they scored, and then they got disallowed.
Speaker 2:West Ham.
Speaker 1:West Ham. Oh my god. Because my friend is a Arsenal fan, but he can't watch the games now. It's too much for him.
Speaker 2:It's very it's very tense.
Speaker 1:Yeah. So we saw it on the screen go up and then off, and he's like, is it a glitch? Is it real? Oh my god. I
Speaker 2:go with my ninety year old dad who gets very excited.
Speaker 1:Stress through the roof, Nick. You're putting his stress up at.
Speaker 2:He survived it all so far.
Speaker 1:Survived the twenty years or nothing but hopefully, you'll have some minutes here now.
Speaker 2:I hope so.
Speaker 1:But I know that Kathy is Kathy is here. I don't know if she's coming on the mic or not but I don't know if you could find it but it's about medication is known to cause change in the way the body metabolizes and stores fat and an increase in hunger, disruption of satiety signals. She's mentioning that
Speaker 7:I am here.
Speaker 1:Are you there?
Speaker 2:Go ahead with your question, Catherine.
Speaker 7:Sorry, think you may have covered some of it, because it's very similar to Charlotte's question in relation to medication contributing to weight gain. And this particular one is known to change the way the body metabolizes and stores fats, but also it sort of disrupts your satiety signals. But it also is very good at doing the job it's supposed to do. So it's sort of been a balance of what you do because it has also increased my LDL cholesterol whilst I've been on it. And I do have that family history of type two diabetes and heart disease and I've gained a lot of weight.
Speaker 2:Well without going into the details of what your medication is there for, it's a balance
Speaker 7:Obviously I agree with all the things about holistic approach and I try and do all those sort of things too because I agree that that's very important.
Speaker 2:Yeah, but challenging. I mean in diabetes care, you know, we have used for many years a whole series of medications that you know improve the glucose numbers but they make the weight worse and I think that sometimes in medicine specialists treat the number and not the person and we have to see things in the round. In your case, you know, you're looking at whatever medication it is, you know, you have to balance what it's trying to do against these other things and hopefully you're being helped by people who are looking at you in totality and saying how can, yes, this one thing might be getting better due to this therapy, but how do we reduce the risks of these negative things happening alongside?
Speaker 7:I think that's often the problem because there isn't that sort of help. The answer when I asked the question was, well, just stop taking the medication that's causing the weight gain.
Speaker 2:Yeah, it's not quite that simple though, is it?
Speaker 7:No, exactly. Because then I lose the benefits of why I went on it in the first place. And it's not actually recommended to stop taking it suddenly in less than six months of starting it.
Speaker 2:Well, my you know, it's
Speaker 7:And also I've tried the sort of, you know, the calorie deficit. Obviously, I'm doing turtle and that, I know from being in this programme a long time all the sort of ways to do that, but that doesn't actually make any difference. It's almost like the medication cancels that out. So it was whether I go for an even bigger deficit, like the very low calorie diet and then maybe lose muscle or do I just switch medication?
Speaker 2:I guess it comes down to, you know- Preference. Preference and also your, you know not everyone finds a VLCD diet that easy to do or to stick to and that's okay. So you have to be kind to yourself and think what can I do, what changes can I make? But also sounds like you need some physicians who look at you in totality rather than one system at a time. Sorry it's not a very specific answer.
Speaker 7:No, no, that makes sense. Thank you.
Speaker 2:You're welcome. Alright.
Speaker 1:Claire, your question here about socials, hormones, elast are you there? Claire Shore. Maybe maybe also drying the hair neck. Maybe
Speaker 2:No comment. We should all do that.
Speaker 1:Yeah. We should. Should. Claire, if you are not available, let me know in the comment, and I can ask it for you. I can ask for you if you want.
Speaker 1:Let me find her again.
Speaker 7:Off the call.
Speaker 6:I'm gonna chat with her. She's not on anymore.
Speaker 1:Ah, okay. So tell her she's gonna get an answer, so she better listen back. So she's asking, all she sees on social media at the moment is a narrative the hormones are being imbalanced, and how that's making it harder to lose weight, and basically you should then follow this protocol to sort out your hormones or take this supplement. Is there a link to that stuff, Nick? What's the reality of that stuff?
Speaker 2:It depends what hormones you're talking about.
Speaker 1:There was one recently about cortisol going up due to drinking coffee. There was another one about, you know, that type of stuff, like acutely. Yeah.
Speaker 2:So I mean, all hormones are signals in the body to control balance, metabolic balance predominantly. And so they, you know, we have many disorders where you have too much of a hormone or too little and you know those are what we treat. And you know for cortisol for example, if you have too high cortisol due to conditions like Cushing's disease which is where you have tumour that produces cortisol. That does cause weight gain and hypertension and clear problems. So that's a disease.
Speaker 2:And then at the other end, if you have too little cortisol, that's also a condition called Addison's disease and that's associated with various problems. I guess that either within the middle there are people who would like to say, well, if you had a little bit too much cortisol, a little, you know that that's associated with various things. I think the evidence for that for cortisol is quite weak. I think for other hormones it's a bit moot. So take insulin for example, you know, clearly too little insulin, which is type one diabetes, that's very bad and you know we need replacement.
Speaker 2:At the top end, having too much insulin due to resistance of insulin at the organs where it has its effect, You know that's the liver, the muscle and the fat. That is also bad but it's rare for it to be manifest as a particular disease and it's more a spectrum. So I think it is possible for them to be there to be spectrum disorders and that relate to hormones, but not for all hormones is what I would argue. And so Victor mentioned like testosterone earlier and you know it's a growing literature that having relatively low testosterone levels is associated with, with adverse health effects. So I think there are gradations but, I think they whether you treat them or not and whether supplements help, then you have to be careful and you have to go strongly, you know, you have to be strongly evidence based.
Speaker 1:Yeah. Well, classic one on testosterone is that, you know, the testosterone boosters and they don't actually do it. You know, they can compare it to actual testosterone. It's a different ball game, right? Yeah.
Speaker 1:Completely. Vicky, you got your hand up. Yes, Christian. Come on. No problem.
Speaker 5:Just with you saying that supplements you need to watch kind of what you're taking. Are there any that you would kind of recommend or seek that are actually beneficial? As well, I know a lot of people in, like, our group are saying about perimenopause and menopause and things and weight loss. And just in general for when you're doing this, is there kind of a, I guess, an all round one or ones that you would say are actually beneficial because there's been so much on social media and things. I think it just bamboozles you and you think, I should be doing this.
Speaker 5:I should be doing so many things for your health and that, are there any?
Speaker 2:No, look it's a great, great question. Probably not is my answer actually. I think we are fortunate on the whole to live in a part of the world where if we eat a balanced and diet that actually that will contain the right minerals, vitamins, etc etc. And if we're active and we get a bit of sunlight, we probably will get enough vitamin D and probably all the supplements in the world are probably not really going to help very much. And it'd be better to focus on following the standard recommendations about eating healthily and you say in your question you do that, think that's great and that should be a priority rather than supplements and things.
Speaker 5:What about vitamin, where you say that, what about vitamin D if you live in an area that is shockingly awful and weather and dark a lot of the time in the winter? Would you say that is worthwhile? So It's big hailstone in here today.
Speaker 2:Really miserable. What's what's I mean vitamin D is an interesting one. It's vitamin D levels are, when they're low, are obviously related closely to bone health and think having enough vitamin D to have healthy bones is like the most important thing. Low vitamin D is predictive of diabetes risk actually and also weekly of heart disease. But people have done trials and they're not really very convincing that there's any benefit.
Speaker 2:So I would say