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Peter Brukner is a Medical Doctor and Sports Medicine Physician who has worked with elite national and international sporting teams. After a revolutionary personal experience, Peter shifted his career focussing on the role of carbohydrates in our bodies and how the experts got food and diet so wrong. He published a book titled 'A Fat Lot of Good' and is on a mission to better educate the western world about diet and inflammation. I talk to Dr. Brukner about the role of inflammation in relation to healthy and injured recreational runners and explore how an improved diet can help minimise pain, overcome injuries and assist in athletic performance. Defeat Diabetes Website Book: A Fat Lot of Good Run Smarter YouTube Channel Become a patron! Receive Run Smarter Emails Book a FREE Injury chat with Brodie Run Smarter App IOS or Android Podcast Facebook group Run Smarter Course with code 'PODCAST' for 3-day free trial.
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On today's episode, what runners need to know about nutrition and inflammation with Dr. Peter Bruckner. Welcome to the Run Smarter podcast. The podcast helping you overcome your current and future running injuries by educating and transforming you into a healthier, stronger, smarter runner. If you're like me, running is life. But more often than not, injuries disrupt this lifestyle. And once you are injured, you're looking for answers. and met with bad advice and conflicting messages circulating the running community. The world shouldn't be like this. You deserve to run injury free and have access to the right information. That's why I've made it my mission, to bring clarity and control to every runner. My name is Brodie Sharp, I am a physiotherapist, a former chronic injury sufferer and your podcast host. I am excited that you have found this podcast and by default, become the Run Smarter Scholar. So let's work together to overcome your injury, restore your confidence, and start spreading the right information back into your running community. So let's begin today's lesson. Thank you to all those who have purchased the Run Smarter book. You may have seen on social media last week, I posted a graphic showing that we've reached a hundred copies and you listeners that have sent me a photo of the book arriving, it means a lot to me. So thank you for doing that. I'm not sure when the audio book is coming out just yet. I have finished most of the editing and just need to find a way for it to meet. This SCX. specifications, which is essentially audible, has really strict rules about, you know, how much gain there needs to be, how much dead space there needs to be just like little specs that I just don't understand. So I'm trying to get on top of that. And fingers crossed, if all goes well, the audio book is out in the next week or two. And today we have Dr. Peter Bruckner. He is a sports medicine physician and I've followed Peter Bruckner for years and years, ever since I became a physio and watched him do a lot of work with the Australian cricket team, heavily used his Bruckner and Kahn textbook, which once you graduate from physio in Australia, if you want to work in private practice, you get his book because he mentions it in the podcast as well, but we always call it the Bible of Physiotherapy. This has all the conditions in there, what the evidence shows for management, for treatment, for risk factors, all those sorts of things. And so it was a real pleasure for me to have. Peter on the podcast. I managed to dampen my whole experience once I recorded it and realized that my microphone had actually switched over. So my audio quality is terrible. So you'll have to forgive me for the poor quality. I just bought a new webcam for YouTube and it's since like made that my default microphone and I hadn't realized it until we finished recording and then I was doing the editing process. Peter sounds great by the way, and for any interview to go wrong and for me not to talk a whole lot, it's this one because Peter is a lovely storyteller and really talked like quite well within this whole interview and just made my job really easy. But as he explains, he's focused the second half of his career onto nutrition and explaining and how that sort of relates to the overall inflammatory process in the body and what you need to do about it to settle down inflammation and help you recover, help you perform. I have since bought his book. I got it a couple of days ago and have just been reading through it and halfway through it now. Absolutely fascinating read and it sparked me to get a few other guests on in the future around this similar topic. If you're looking to learn more, I'll leave a link in the show notes to his book, A Fat Lot of Good. And also... the Defeat Diabetes website and all those things that he mentions in the interview. Okay. Hope you enjoy. Peter, thanks for joining me on the podcast today. Pleasure, Brody. Let's start off with a bit of an introduction for those who might not be familiar with you. I know the physios and health professionals that do tune in, um, would definitely have heard your name around, but a lot of the podcasts listen as a disrecreational runners. So do you mind just giving us a, an intro? Yeah, sure, sure. Basically, I'm a doctor, so did a medical degree. And then, sort of on a circuitous route, sort of finished up in sports medicine. So I specialised in sports medicine at a time when sports medicine was just starting really, and back in the 1980s. Probably half your listeners weren't even born then, but anyway. So. opened up a sports medicine clinic in Melbourne called the Olympic Park Sports Medicine Centre. It's been going strong for nearly 40 years. And yeah, got involved in different sports and different teams. Worked in the AFL for a while, initially with Melbourne years ago. Then got involved with a whole bunch of national teams, so swimming team, men's hockey, athletics, soccer, cricket. So I've done a whole bunch of different things, finished up at a couple of Olympics, did the soccer-oos, did the World Cup with the soccer-oos, then went to Liverpool in England, worked in the Premier League for a while, and then came back and worked with the Aussie cricket team for five years. So I've had a good run of interesting teams that I've worked with. And I also have an academic position at La Trobe. I'm a professor of sports medicine at La Trobe, so I have a part-time job there. I've written a textbook and a few books. The physios are probably familiar with Brooklyn and Cannes Clinical Sports Medicine. It's sort of the Bible of sports physio. And probably in the last 10 years, I've sort of pivoted a bit, that lovely word, pivoted. We didn't have that word a few years ago. And I've sort of got more interested in nutrition and helping people, trying to help people eat better. Because I believe that that what we eat is the cause of a lot of our medical problems. So I've become very passionate about that. I've set up a not-for-profit called Sugar by Half, written a book called The Fat Lot of Good, launched an app-based program called Defeat Diabetes, and yeah, spent a lot of my time now trying to promote healthy eating. So yeah, that's me in a nutshell. Great. Well, it does seem from looking from afar and observing your career, does seem like a quite a drastic shift towards nutrition advice type of things. What was the particular drive or reason behind that? Well, as often is, it's a personal experience. So 10 years ago, I'm living in Liverpool. I've just turned 60. And if you'd asked me then, you know, was I healthy, how was I? You know, I'd have said, yeah, I'm fine, you know. Hadn't had any sort of significant illnesses. I ate what I thought was a fairly healthy life, a low fat diet and regular exercise and so on. But the reality was I probably wasn't quite as healthy as I thought I was. For a start I had a family history of type two diabetes, so my father had developed type two diabetes at exactly that age and I was pretty keen not to go down that track because I saw what happened to him. I was obese, so like many middle-aged men, and I... regardless 60 years middle aged, I used to think I was old, but now I think it's middle aged. Like many middle aged men, I'd probably put on like half a kilogram a year for 30 years. Just gradually getting thicker around the waist, the kids are sort of poking me in the guts and saying, come on dad, how about it? And I'm sort of shrugging my shoulders and saying, well, hang on a minute, I have a, I eat what I'm supposed to eat and I exercise and so on. Anyway, so I was obese, not grossly obese, but certainly probably, I don't know. 12, 15 kilograms overweight. And I had a bunch of metabolic issues. I'll go into the gory details, but I'd had a fatty liver for 10 years. Fatty liver, I didn't really understand what it was at the time, I now realize it's a sign of pre-diabetes. And I'd had that for 10 years, I had blood tests for a couple of years, it always came back as consistent with fatty liver, I didn't really understand what a fatty liver was. I figured I was on a low-fat diet and that was it. So anyway, and I had high triglycerides, high insulin levels and so on. So in retrospect, I was clearly pre-diabetic, all the signs, but I didn't understand that at the time. And so I was cruising along happily and I started to hear these whispers about people challenging the concept that fat was the problem with... with our diet and people suggesting it might be most sugar and carbohydrates. And in particular, Tim Noakes, who many of your listeners would know, author of the law of running, the sort of the Bible of running. Tim's an old friend of mine and we've been buddies for a long time. And he's a super smart guy. Like he's probably the smartest guy I know, I think. And he's challenged a lot of sort of traditional ideas in sports science and he's invariably been proven right And he came out around that time and sort of said, no, you know, I think we're wrong. I don't think fat's the problem. I think it's sugar and carbohydrate. And he'd developed type 2 diabetes, despite a supposedly healthy diet and running every day and running 10 comrades marathons and 60 marathons or whatever, a huge amount of running. And he developed type 2 diabetes and felt terrible, overweight, felt shocking. and stumbled across this sort of a book and read a book and decided to try this low carb. And he said within a week, he knew he was a different person. And he reversed his type 2 diabetes and lost weight and just felt so much better. So he was starting to talk about that. And I must admit, when I heard that, I thought, oh, come on, Tim, you're really pushing it too far this time. The whole of Western society couldn't possibly have been on the wrong diet for 40 years. But because it was Jim, I thought, oh, look, I need to look into this. So I read a book by a guy called Gary Taubes, who's a science journalist in the US, the book called Good Calories, Bad Calories. And this book just blew me away. It just, not only sort of talked about the relative merits of fats and carbohydrates, but talked about the politics of how the sort of the low fat movement had won out over the low carb movement back in the 1960s. And... which I'd always assumed was due to science and evidence and so on, but turns out to be due to money and politics and the US agriculture industry. And I remember putting down this book every night thinking, no, this couldn't be right. You know, we couldn't have got this. We couldn't have got such a basic thing wrong. And yet, you know, every page I'd read, there was more and more evidence. So I then dived out, but I'm a bit, you know, OCD and I dived into every... book and journal article and review that I could and just immersed myself in this. And the more I read, the more I thought, geez, I think he's right. And so I thought, now, hang on, I'm a scientist. So I've got to do some science. I've got to do some research into this. But also as a scientist, I know that research within an N equals one is a waste of time, except when the one is you, of course, when it becomes important. So I decided I was going to do an N equals one research project. into this low carb, this weird low carb stuff. So I thought I'd do three months, strict low carb. So day one, weighed myself, got all my bloods taken and away I went. And so I basically stopped eating anything with sugar and anything starchy. So I stopped eating bread, rice, pasta, potatoes. And I went back to sort of eating probably, you know, the way my parents and grandparents had eaten. Lots of real food, so meat, fish, eggs, eggs and all that cholesterol. Full fat dairy, oh you can't have full fat, all that sort of stuff. Fruit, veg, nuts, that sort of stuff. So, real food is really what it was all about. But it all happened to be pretty low carb. Probably 30 grams of carbs a day, maybe 50, something like that. Odd glass of red wine, few veggies. But I ate really well. So what happened? So the first thing that happened was that I stopped being hungry. So instead of having my cereal at 8 o'clock and then getting to 10.30 thinking, oh, God, must be time for lunch soon. I'd have sort of eggs and bacon and avocado or something like that for breakfast, and I wouldn't eat again all day. And so I went from eating three meals and three snacks a day to eating two meals a day. And I still eat two meals a day today, and just not hungry. And then I started to lose weight. You know, every week I'd lose weight. And I thought, ah, the first week or two, you know, it's beginner's luck sort of thing, you know, but I just kept losing weight. I started to feel more energetic. My exercise levels improved. Yeah, I started to concentrate better. I wasn't sort of feeling sleepy after lunch and things. My sleep improved. I stopped snoring. Lots of things like that. Amazing difference came over me. And so at the end of that three months, I'd lost 13 kilograms in 13 weeks, and I did my bloods again, and I reversed all my metabolic abnormalities. So the fatty liver I'd had for 10 years completely disappeared. Triglycerides back to normal, insulin back to normal, lost 13 kilograms, felt great. The only negative thing was that I needed a new wardrobe because I'd gone down two sizes in everything. And I figured that was a small price to pay. So that was, you know, that was just, again, just blew me away and I wouldn't have believed that could happen. And so I guess when something like that happens, you know, you've got two choices really, you can say, right, okay, I'm a right mate, you know, and look after myself. Or you can say, look, Jesus, you know, I've sort of come across some, you know, I'm not suggesting I was the first to come across I stumbled across this, I should be telling people. And people would ask me, because they'd see, what have you done? It was pretty obvious that I'd lost a hell of a lot of weight. And so I started talking about it and started writing about it and became an advocate of this low carb, sort of healthy fat way of eating. And that led to becoming, as I said, an advocate, giving lots of talks, writing articles. set up this not-for-profit sugar by half to try and educate people about sugar and reduce the amount of added sugar. Wrote a book called The Fat Lot Of Good a couple of years ago, just putting down all my, what I'd learned over the previous 10 years. And as I said, we just started up this new program called Defeat Diabetes. So yeah, it's become my passion. I've sort of linked it a bit with sports medicine as well. Obviously, a lot of athletes now sort of... heading in that direction as well. And also my research, I've tried to sort of link the low carb sort of anti-inflammatory type of diet with osteoarthritis, we've got a PhD project going at the moment on that and so on. So yeah, linking the two different parts of my life, I guess, and trying to get joined together. It'd be nice to, I guess, dive into that particular link because when we... I had a brief phone call before this and you said, oh, let's talk about inflammation, the influence it has on the body. And I guess trying to relate diet with inflammation, what does that exactly mean? And what sort of process does that have? Yeah, that's a very good question because it's something that I had no idea about until fairly recently. Let me start by telling you a story about a cricketer. So we're in, I was with the Australian Cricket Team, we're in India in 2013. And one of the players had terrible problems with his knee. And he'd actually had to stay out of cricket for 12 months and had constant knee pain. And he'd been to see every sports doctor and all sorts of people had MRIs, had arthroscopies. No one could work out what was wrong with him. And eventually he saw a rheumatologist who decided it was inflammatory. So it was an arthritis and what we call a seronegative arthritis. So it's a bit like rheumatoid, but it's not rheumatoid. So a very inflammatory type of arthritis. And he'd put him on some pretty heavy duty medications. And by the time I saw him, he was on a, he was injecting himself with a drug that affected the immune system once a fortnight. And it was sort of under, his pain was under control. You know, so, but not fantastic. He wasn't able to train fully and he was not in the team. He was on the outskirts of the team and he was struggling a bit. Anyway, he was also a little bit overweight. Amazing how many elite athletes, despite how much they train, are a little bit overweight. But that's another issue. So he was a little bit overweight and he said, oh, look, you know, he'd seen what had happened to me and he said, look, I'd like to try this diet of yours. And so basically he went on to a low carb diet, which in India is not the easiest place to do it in India, you know, no rice, no naan, sort of stuff. And he went on this low carb diet. And he was pretty strict. The good thing about, you know, elite athletes is they're pretty disciplined. So he did it, seriously. Anyway, so three weeks later he came up to me and said, Doc, I forgot to take my injection the other day. I said, well, what do you mean? I said, well, normally, after about 10 days after my injection, my knee starts to ache. And so I get that reminder and I know it's time for my injection again and I inject myself again. Now, by the way, this drug is probably $15,000 a year drug, very heavy duty sort of a drug. And he said, oh, what should I do? Should I wait? Should I take the drug now or wait? And I pretended I expected that to happen, and knew exactly why that was gonna happen. I had no idea, of course. And I said, no, why don't you wait? Why don't you wait and see what happens? Anyway, cut a long story short, he no longer needed the drug. He'd basically cured his seronegative arthritis that required a drug that cost $15,000 a year and restricted him doing. He cured that by changing his diet, by removing carbohydrates from his diet. And he has continued on and 12 months later, he was back in the test team, in the top 10 batsmen of the world, and he still is today. So, you know, that blew me away. You know, I couldn't believe that. You know, that was the first indication that I'd had ready of the role of diet in inflammation. And as you know, Never talked about, wasn't written. I'd never read anything about it or anything like that. And so that sort of piqued my interest in the relationship between diet and inflammation. And so I guess I've been interested in it ever since. And nowadays, inflammation is the buzzword now in medicine because we're all familiar with sort of acute inflammation, the red hot swollen joint that gets inflamed and so on. But what seems to be the big factor in medicine now is what they call chronic low-grade inflammation. And it seems to be the thing behind all chronic disease, whether it's atherosclerosis, chronic heart disease, or even mental illness and so on is thought to be due to inflammation now. And that just, you set up a chronic low-grade inflammation and it just causes damage. And... Diabetes is thought to be due to that. Pretty much every chronic disease, there's this chronic low-grade inflammation is a really big factor. So what do we do about that and try and sort of get rid of this or counter this inflammation? So that's why people have started to look at, traditionally it's been drugs, as it was with this cricketer, heavy duty sort of drugs. So there's all the anti-inflammatory drugs, the simple anti-inflammatories, and the more complex sort of cortisones and things like that, and the injections and things like that. But people have started to look at, for want of a better word, lifestyle factors that might affect inflammation. And there's a fair amount of evidence that leading diet aside for a moment, that lack of physical activity, things like smoking, alcohol, stress, are all factors, maybe lack of sunshine, lack of sleep, are all factors in promoting inflammation. But the biggest one seems to be diet. And there seems to be a pretty consistent sort of group of dietary substances, if you like, that are what we call pro-inflammatory, and some that are anti-inflammatory. And so what we've been doing is trying to sort of put people with these chronic inflammatory problems on the anti-inflammatory diet, which is very similar to a low carb, sort of a healthy fat diet. So most of the inflammatory stuff is sort of sugar related and processed food related. We can talk about that in a minute. But yeah, so it's amazing, the difference it makes to people's pain and inflammation by changing their diet. So... What do you think is actually going on? Do you think the body just doesn't like processing these type of foods and so it just has some sort of reaction in the gut that produces this inflammation? Yeah, look, it's complex, but it seems that, yeah, let's take sugar, for instance, you know, that, so you get these, what they call glycated end products, so that sugar attaches itself to proteins and so on, and impairs the... the work of the protein. The gut is certainly involved. I think the microbiome, you hear a lot about that, and sugar and processed foods and so on seem to negatively affect the microbiome, and that plays a role as well. So yeah, I think it's certainly, it's a complex biochemical sort of reactions and so on, but there seems little doubt that sugars and processed carbohydrates and processed foods in general can increase inflammation. I think that's pretty well accepted now. It sort of all makes sense. If you think about the changes in our eating in the last generation, if you like, we're now eating just processed and ultra-processed foods, largely. And then... and then the increase in these chronic diseases that we hadn't heard of. When I was in medical school, we'd never heard of Alzheimer's disease, we'd never heard of ciliate disease and gluten insensitivities and all these sort of things. So it seems to make sense that these, there's a cause and effect there, that diet has played a huge role in this rise in chronic diseases and we've got to get it sorted out because we're not going to, The medical profession's response to this is just drugs and more and more drugs and fine new drugs and so on. Whereas the solution is to change those lifestyle factors in particular your diet. Is there any subtle signs for like a recreational runner that might indicate they need to make a rapid change in their lifestyle or is it more just like a self reflection on their diet in general or their lifestyle habits in general? Is there anything that might emerge as a subtle sign? to say, okay, I need to do something, I need to change something? Well, I think, you know, multiple injuries, recurrent sort of, you know, overuse type injuries. I think that's a, that's an indication that I'd certainly be trying, but I'd be looking at dietary factors there. Constant soreness, you know, poor recovery from training, you know, you saw for two or three days after, after a hard run, that sort of their poor recovery, if you like. I think that's an indication that you might have an inflammatory sort of environment if you like in your body. And I think it's just a matter of trial and error really. I've had so many athletes come to me and say, I've tried your low carb and you wouldn't believe what happened. I didn't feel sore the day after I run a marathon. My Achilles... I mean, I'd had a chronic Achilles problem for years. You know, I woke up every morning, you know, you put your foot on the ground, you get that achiness in the Achilles and so on. And at some time in that three months I went on low carb, my Achilles pain disappeared. And I remember waking up one morning and thinking, hang on a minute, you know, and I was always tender and I said, I went down and squeezed my Achilles and I wasn't painful anymore. And it was remarkable. And you know, I had so many colleagues and patients. and friends who've had similar experiences, people who have knee arthritis or have hip arthritis or something like that. And you suggest maybe they should change their diet and you can tell they don't really believe you. They're skeptical, I don't know, bloody diet. Crazy doctors trying to tell me, no, I just want to take tablets. And then they'll come back and say, no, I didn't believe you, doc, but gee, it makes a difference. So I think there's a lot to be said for reviewing. diet and the effect that diet can have on inflammation. And basically the secret seems to be, the two things that really seem to promote inflammation is, one is sugar, so carbohydrates. Because remember, it's not just sugar. I mean, even people sort of say, oh, yeah, we know about sugar, but starch is okay. You know, the bread and rice and pasta and everything, that's okay. Well, the problem is that bread and rice and pasta are starches. And they're basically just, what is a starch? A starch is just a bunch of glucose molecules stuck together. And so the body, the gastrointestinal system breaks down that starch into glucose and it's absorbed into the blood as glucose. The same as sugar is. It's just a bit slower because it takes longer to get digested. So carbohydrates turn into glucose and glucose seems to promote inflammation, as does fructose, which is the other part of... table sugar. So that's particularly inflammatory. Then the other thing that seems to cause inflammation is what we call the Omega-6 fats. So that's basically vegetable oils. So when you heat vegetable oils, they give off a whole lot of substances that become quite inflammatory. And as we've changed in our cooking from, our parents' generation are used to cook with butter and lard and... and so on and beef tallow and things like that to these sort of cheap vegetable oils or they're actually seed oils, they're not vegetable oils but vegetable oil sounds better. They're seed oils and they are very inflammatory. And without getting too complicated, you have omega-3 fats and omega-6 fats and we used to have been a ratio of one to one, omega-6 to omega-3. And now, there's about 20 times the omega-6 compared to the omega-3, which are the anti-inflammatory fats. So, our diet has changed enormously. And as a result, there's a lot more inflammation around. And I think that's a really key factor in two things. One in illness, so in all sorts of chronic illness and so on, but just in general lifestyle. soreness and response to exercise and so on. So yeah, I think inflammation is really at the center of just about everything we do at the moment. For a recreational runner, it's a common belief that for energy, an energy source is carbs. Like you carb load before a marathon and if you're halfway through a high volume training cycle, you need a lot of carbs for, that's your primary energy source. What would you say for that in terms of trying to educate runners where that energy would come from with a low carb diet? Yeah, well that's actually, it's always been the traditional thing and I've always been a proponent of carbs and as you say, the pasta party the night before the marathon and all that sort of, lots of Gatorade and Powerade and so on. But there is an alternative fuel source and that's fats in the form of ketone bodies, You've probably heard of the keto diet or the ketogenic diet or whatever. And so the body has these two, well and also protein is a third fuel source. But the two main sources of food are fats and carbohydrates. And the body will always preferentially use carbohydrates. So if carbohydrates are round, the body will work off carbohydrate. But if carbohydrates not around, so if you don't have carbohydrate, if you don't take in any carbohydrate, the body will start using fats, using ketones. And they'll use that from your diet and also your own body fat, which everyone's got plenty. So that's why a keto diet is a very good weight loss diet because you burn your own fat. But you can also exercise on ketones. And people say, oh no, but you need glucose. The reality is you don't need glucose. you can manage perfectly well on ketones. There's always a bit of glucose around. I mean, you can't be zero glucose, zero carb diet. There's always enough glucose around. And if you desperately need glucose, you can always make it from protein or carbohydrate. But there are a lot of people now playing around with using fat as a fuel source. In particular, the ultra endurance runners, so most of the top ultra endurance runners in the world are now on a... using fat as a ketones as their major fuel source. The advantage of that is that they can their performance is just as good and they don't need to keep refuelling. So you can you know you can run a marathon or do an Ironman or something like that without having to constantly having to refuel with carbohydrates. So there's advantages to a to using fat as a fuel. The other advantage, obviously, is the health aspect of it. You're not having this massively high sugar load that a lot of athletes have. And we don't know what the long-term consequences of that is. I know what I suspect they are, but they're not good for your body. Now, the counter-argument to that is that high-intensity exercise requires carbohydrate. And that's... In most cases, that's right. If you're an elite athlete or you're wanting to run fast 800 metre, 1500 metre, whatever, you're probably going to need carbohydrates. Not as much as people think you need, but you might well need carbohydrates. But there are also plenty of people, I mean, I have top AFL footballers who are on a ketogenic diet and have very little in the way of carbohydrates. So... You can certainly function very well on a low carbohydrate diet. What a lot of, say, football clubs, for instance, are doing at the moment is that they're doing this concept of train low and compete high and that during their steady state training days, and cyclists are doing this as well, on their average boring four hour training ride, they'll do a... They have a low carb day and focus mainly on healthy fats and things. And then on a big climbing day or a big sprinting day, they'll pump in the carbohydrates. So the same with footy. You'll have during the week, you might have some carbs on your big training day and the other days you're low carb and you get your body learning to use to burn fat. And then on game day, you might just supplement with some carbs to top you up. Everyone's different. There's some people who can manage on no carbs, some people low carb, some people need more carb, but it's certainly an interesting concept and one that's probably healthier in a way, because it worries me that we've had a whole generation of athletes who've had massive amounts of carbohydrates, mainly in the form of sugar. And I worry about the long-term effects of that. I've got pasta ready for dinner tonight, so it's a good thing that I've chatted to you. Maybe I'll have to substitute it out for something else. Well, the good thing is that there are substitutes. I mean, I eat pasta too, but I make it from zucchini, and zucchini noodles, and just as tasty, and probably a lot healthier. If I want rice, I'll use cauliflower rice with my curry or something like that. So people say, oh, I couldn't do without pasta. I couldn't do without, I bake my own bread and with nuts and seeds and so on. So. You know, there are alternatives and they're becoming more and more widely available. I mean, you can now get, you know, zucchini pasta in the supermarket, you know. I have my sort of little peeler thing that turns it into noodles. But yeah, I think, you know, we've got to be a little bit careful about the amount of carbohydrate and sugar that we're having. I mean for most people, for young people who are insulin sensitive and metabolise carbohydrate, well it's not such an issue. But certainly as you get older, people become more insulin resistant so they don't process carbohydrates as well and their blood sugars rise and that's when you develop pre-diabetes and metabolic syndrome and then ultimately type 2 diabetes which is a... It's a horrible disease. I mean, there's probably two million Australians with type 2 diabetes and another two million who have pre-diabetes. And it's not the diabetes per se that's the problem, but it's the most common cause of blindness, the most common cause of kidney failure, the most common cause of amputations, the most common cause of heart disease, of Alzheimer's. I mean, type 2 diabetes is bad news. And it seems that the more carbohydrates you have, the more likely you are to... cause your sort of pancreas to wear out if you like and start to fail and that's when you get type two diabetes. So yeah, it's a really interesting time I think in nutrition. It's a real time of change because sports nutrition and nutrition's generally has been pretty boring for the last sort of 30 or 40 years. You know, really it's carbs, carbs and you know, gatorade and powerade and all that sort of stuff and that's really it. And nowadays, there's some really interesting work coming out that it's not quite as simple as we thought it was. You'll find categories like injury prevention, running misconceptions, strength and performance, and of course, injury specific information. You've already learned a lot listening to the podcast. Why not kick it up one more gear through the Run Smarter app. Going back to, I guess, the recovery from running-related injuries, like you mentioned your Achilles tenderness reduced and felt a lot better. One of my passions is exploring the complexities of pain and knowing, say, with chronic pain, stress, anxiety, like thoughts, catastrophization, all these sorts of things influence the pain sensitivity. I guess... One thing I haven't necessarily explored that well is the role of... sugars and carbs and that sort of stuff in their diet and probably as you may describe acts as like maybe a pain amplifier or increases the sensitivity of pain with just more inflammation circulating throughout the body. Would that be something that an injured runner would need to look at and have it like analyze their particular diet to see if maybe that has a role in pain signals and like how sensitive a particular structure is? Yeah, I think it's worth looking at. There's a physiotherapist in Sydney called Rowena Field who you should get on your program. She's just finished her PhD looking at the role of diet in chronic pain. And she's shown that a lower carbohydrate diet can have quite a significant impact on pain. And similarly, you know, there's... There's a group at Deakin University who have looked at the role of diet in anxiety and depression and so on. And again, they've shown that reducing carbohydrates and improving diet can have as much of an effect on... those sort of conditions as any medications and so on. So, you know, there's really interesting stuff. There's stuff coming out about Alzheimer's disease and Parkinson's disease and all sorts of different, and inflammatory bowel disease and so on, and the role of diet in all these different areas. So I think it's a really exciting time. And I think, you know, I think anyone, I mean, you know, with due respect to my medical colleagues, you know, medicine doesn't have all the answers. And drugs is not the answer to everything. And I think we're gonna, over this next decade or two, I think there's gonna be more and more understanding of the role of lifestyle issues. I think the role of exercise has really become much clearer in the last little while. And I think diet is the next sort of a step, if you like, to show that you can really impact on your health and on... disease and injuries and so on by improving your diet. I think it's definitely worth a try, you've got nothing to lose. Some people will be re-amazed I think at the impact a change of diet would have. You mentioned a list of... potential causes for inflammation. You said diet's the big one, but you mentioned decreased physical activity, increased stress, alcohol, not a lot of sunlight, um, decreased sleep, those sorts of influences. And I'm just thinking of an injured runner who has like, you know, calf strain, unable to run on it. If they don't have any other cross training alternatives, they're obviously dropping in their physical activity. They increased most likely in stress because of the stress of, you trying to get back into running and just, you know, it's never pain equals misery most of the time. And so a lot of people are quite stressed. They're not likely to get that much sun because they're not exercising the same way that they used to. And, you know, all of these sorts of influences just seems like it perpetuates the inflammatory cycle and probably a lesson for those who are injured just to, you know, focus on maintaining some sort of physical activity with cross-training, you know, mental, their mental state, their emotional state. just getting out in the sun, just walking around, those sorts of things would be probably quite helpful for not only just their well-being but you know overall information in general. Yep, yeah no. Absolutely, I think it's a really interesting area. And all those factors have been shown to promote inflammation and therefore promote pain and disability and so on. So, I think like sun is a really interesting area, because I think we've gone way too far in this sort of, slip, slop, slap, sort of obsession we have in Australia with keeping out of the sun. and to the point now where kids just never exposed to the sun. In the old days, we'd be running around with our shirts off and get us out of a suntan, and you're trying to avoid getting burned, but you were exposed to sun. And as a result, vitamin D levels are going down. I mean, a country like Australia, no one should be. vitamin D deficient. And yet we've got a lot of vitamin D deficiency and sunshine seems to have an effect on nitric oxide and a whole lot of other factors. So I think that's one really interesting area. And I'm not saying go out and lie in the sun in the middle of the heat of summer and get burnt rotten and so on. But getting exposed to moderate amounts of sun for various amounts of time. I always think there's a good reason why we have spring chance to let their bodies get used to gradually increasing amounts of sun. But yeah, sure, avoid getting burnt. But let's get out in the sun and get some sunshine, 20 minutes a day, and really important if you can. What are your thoughts on fruits? Because obviously quite high in sugar and it seems like the dietary requirements are only have two pieces of fruit per day because it has such high sugar. Where do you fit on the types of fruit or how often we should be having it, if any? Yeah, look, it really depends. I mean, and I know, I don't wanna sound like it's a cop out, but I mean, if you're diabetic, pre-diabetic, morbidly obese and so on, you should be avoiding pretty much all fruit. The only fruit I have is berries, which are low carbohydrate. But if on the other hand, if you're young, healthy, and so on, having an apple, an orange, and so on, I wouldn't be having heaps of bananas because I think they're full of starch. But having a banana or a banana smoothie, or a shake or something like that is fine. So it really depends on where you're at. But I think certainly fruit is not as healthy as we are led to believe. It does contain lots of obviously fiber and vitamins and minerals and so on. But it also contains a lot of fructose. And fructose is the thing that affects your liver. It goes straight to your liver, causes fat, gets converted to fat in the liver and probably in the pancreas as well. contribute to the development of type 2 diabetes and so on. So I'm not saying don't eat fruit. I'd say if you're diabetic or pre-diabetic or worried about that, I'd really restrict. Be careful what you eat. Eat the low sugar fruit. If you're young and getting healthy, yeah, a couple of pieces of fruit, no problems at all. But again, everything depends on this. insulin resistance, you know, how, where you are on the spectrum, if you like, of insulin resistance, you know, whether your body's metabol, coping with carbohydrates or not. And, you know, that, that depends on, you know, whether you're diabetic or not. And so on. Okay. That would probably, you seem to say age had a particular factor in that as well? Is it like as we get older we become, we resistance changes? Yeah, generally speaking, but not necessarily. I mean, if you look after yourself, there's no reason why you have to put on weight and become more likely to be diabetic and so on. But that's the way things seem to be going at the moment, that people get getting fatter and sicker as they get older. But it's not necessarily due to age. It's just a period of time where the longer you eat poorly and sedentary and all those other things, smoking and drinking and so on, then the more likely you are to get sick. So I think... You know, we tend to want to sort of hand over responsibility for our health to someone else, to a doctor or to someone else. I mean, really, we've got to take responsibility ourselves. It's your body and it's your responsibility as to how healthy it is. You can be very healthy if you want to be. You just can be prepared to do it. And part of the problem is that we've been telling people the wrong thing all these years. We've been telling them to eat low fat and have lots of carbohydrates. starch and so on and that hasn't been good. I mean that's been disastrous and that's been this biggest single, arguably the biggest single health mistake we've made in history and we're all suffering as a result of that and we've got this you know we have two-thirds of the country being overweight or obese you know well I mean that's crazy you know really shouldn't be I mean we're Australia is a healthy country, we've got a good climate, we can exercise, we've got a good culture of exercise, we can afford to, most people can afford to eat well and so on, yet we're in the top six most obese countries in the world. I mean, that's crazy. I mean, why is that? And the reason is we eat rubbish. And food is cheap and tasty. and brilliantly marketed and promoted, especially to kids. And what do kids think is a treat? Going to Maccas and going to fast food and so on. And you know. we've become addicted to sweetness. You know, every, all foods now are sweet. You know, even things like, you know, it's barbecue sauce or tomato sauce, you know, it's full of sugar, you know, because that's what we expect, you know, and we've got to turn that back and turn things around or else we're just going to continue getting fatter and sicker. Yeah. Mac is his McDonald's for all the North American listeners that are out there. Yeah, that's right. You sort of, you've come out and challenged and changed a lot of the narrative around what was considered, you know, good nutrition advice. And you sort of gone against the grain. Is there any other misconceptions or any other myths revolving around diet that you sort of come across that we haven't yet covered? Um, look, I think we've covered the main things. So drinking is an issue. You know, there are people who think we should be having, you know, leaders and leaders of water every day and just fill ourselves up with water. And we pushed it. I pushed that. We all pushed that, you know, with exercise, you know, you see, you know, you watch a football match and then people are drinking all the time, you know, in between, you know, scores and things like that and so on. Um, I think that's a bit of a myth. You know, I don't think there's really good science behind, uh, you know, eating, drinking eight litres of water a day or all the sort of recommendations that are made. I think you drink when you're thirsty and I think that's a pretty good rule. It's kept people going for thousands of years. People haven't been over-hydrating until relatively recently and I think again it's a bit of a marketing tool. I mean, if you'd told my grandparents that people would pay to buy a bottle of water, you know, they'd have laughed at you, you know, and I mean, you know, we've become very, very focused on, on over hydration, I think. So I think that's another myth that, you know, and again, if you look, if you look behind all these myths, there's always money, you know, there's always, you know, the processed food industry, you know, it's, they're brilliant the way they market things, you know, I mean, and you look at Coca-Cola, you know, I mean, brilliantly marketed. And they've managed to convince people it doesn't matter what you eat or drink as long as you exercise. So they've been promoting exercise. It's very clever. Because they want people to believe that you can just have a liter of Coke and then just run it off or exercise it off. And you can't. So yeah, we have to be very careful about, I think you've got to be very skeptical about the food industry because they're not interested in your health. No one in the food industry cares one little bit about your health. They only care about their profit. Yep. Makes sense. And I remember, you know, growing up as a kid, everything started coming out as 90% fat free, 99% fat free. And like that used to be on like so many things and promoted as like healthy when it's just like a campaign to try and, you know, shift the narrative away from fats and onto sugar. Absolutely, you know, I mean, very clever, you know, I mean, that, you know, that the dodgy scientists told, you know, told the world to stop eating fat so that the food, the food industry were very clever. They said, Okay, we'll do that. So they took the fat out of food. And then they realized that there was a problem because it took all the flavor away. So they thought, well, what do we do? Ah, we'll put sugar in instead. So basically, fat free means, means high sugar. So really, what we what we've been on for the last 40 years is a high sugar diet. because everything has been, the fat's been replaced by sugar. And you look at the effect. We're fatter than ever, we're sicker than ever. Not a great experiment. We've been on this massive experiment in the whole world for 40 years. You'd have to say the experiment's been a disastrous failure. I agree, yeah. And I guess everything we've discussed today is tremendous amount of value for not only just recreational runners, but just their life. style in general, you know, increasing their amount of health. Is there any other final tips or takeaways or maybe just like, you know, some summing up messages that you might have for those as we wrap up this episode? Well I always have a, I love the expression, JERF, J-E-R-F, just eat real food. So you know, you can get into all this sort of, you know, carbs and fats and protein, you know, all that sort of science and so on. But if you just stick to real food, then you're gonna be pretty healthy. And real food is the stuff that's on the outside of the supermarket. So avoid the middle aisles of the supermarket. All right, get your toilet paper, but that's about all, okay? But the other stuff, you know, the packaged food and so on, it's all processed food. All processed food has sugar and vegetables in it, neither of which are healthy for you. So stick to the real food. Stick to the meat and fish and vegetables and fruit and dairy, eggs, you know, eggs. have been vilified for a generation. Arguably the healthiest food you could possibly have is an egg, full of protein, vitamins, minerals, and yet we've been told, oh, it's full of cholesterol. And yet we've known for 50 years that the cholesterol in food has no impact on the cholesterol in your blood. And yet we've vilified things like eggs. So we've just had it all wrong. And let's just go back to basics. food. Excellent. You've mentioned a fat lot of good as the book if people want to learn more. Is there any other resources or any other maybe websites that people can go to if they want to learn more about you and your work? Well, as I said, the fat lot of good is the book. If anyone does have type 2 diabetes or pre-diabetes or is concerned about diabetes, Defeat Diabetes is we have a website, defe but we also have an app, an app based program called Defeat Diabetes and we're in the process of producing a web based program as well which will be out by the end of the year. So yeah, that's where you find me. Excellent Peter. Well, thanks for coming on, sharing a wealth full of knowledge and you know, it's greatly appreciated. Pleasure, Roddy. And that concludes another Run Smarter lesson. I hope you walk away from this episode feeling empowered and proud to be a Run Smarter scholar. Because when I think of runners like you who are listening, I think of runners who recognize the power of knowledge, who don't just learn but implement these lessons, who are done with repeating the same injury cycle over and over again, who want to take an educated, active role in their rehab. who are looking for evidence-based long-term solutions and will not accept problematic quick fixes. And last but not least, who serve a cause bigger than themselves and pass on the right information to other runners who need it. I look forward to bringing you another episode and helping you on your Run Smarter path.