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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.
Some other patients have really quite serious problems where their anatomy has become tortured and distorted and we have to intervene with feeding tubes, talk them through, we look at the biochemistry. Yeah, so it's a busy day, quite varied. Yeah,
Speaker 2:that was hands on. That's very intense. With the feeding tubes, what are the essentials that you need to get from that then?
Speaker 1:Well again it depends on what the person can eat. Sometimes we see people that have been smoking after weight loss surgery which is a big risk factor. Smoking and weight bariatric surgery is highly ill advised. There's a problem with nicotine and the cigarette smoke. It has an effect on blood vessels around the stomach and this can cause the stomach to kink and twist, thus meaning that many of our patients are barely able to even swallow just sips of tea or food.
Speaker 1:If this is the case we put a camera down and we identify the problem. We then have to pass a tube through the nose down the throat into the stomach past the blockage into the intestine, and we'll feed a 100% of the person's nutritional requirements. So there'll be calories, proteins, vitamins, minerals, sodium, potassium, everything for normal biological function, including dietary fiber, Scott. It's a Wow. It's it's a sad scenario for folks that are in in such a situation, and it's quite often a difficult conversation to have.
Speaker 1:You know, their prognosis, there's always a solution but the pathway to recovery, full recovery can be many months and even sometimes up to nine to twelve months before we can go back in and surgically repair. Oh, it's
Speaker 2:a long time, man. I guess, very I I think then you don't really realize how in like, intense it is, didn't you? Mean, people just talk about it as if it's nothing like I wonder if anyone in this group was odd. You're obviously I'm I have to speak about it.
Speaker 1:If anyone in this group
Speaker 2:had surgery, I love everyone coming in. Any of them had any surgery, weight loss surgery, or know someone that has or whatever. I I I know people that have. I for sure. But yeah, let let us know if you're in the chat, but as as we go along.
Speaker 2:But I think, Scott, like, I think maybe we can go through maybe an introduction with you, Scott. You know what you know, I know you just did a basic insight into your day there, which is full on. But in terms of your days full on, I mean, it's hard to handle that. I would be able to handle it. But, yeah, give us an introduction on, you know, what you do, where you come.
Speaker 2:I
Speaker 1:did a a little presentation. I've got some notes here, which I'll share my screen and put up talk Yeah. Everyone through that. Here we go. Share screen.
Speaker 2:Sharon on your side? Let me make you a let me make you a host. So we got double Scott on the host. Oh, there we are. Happy days.
Speaker 2:We see it.
Speaker 1:Oh, you can see that?
Speaker 2:Yeah. So can everyone else see it? All good? Yeah. Happy days.
Speaker 1:Yeah, so Scott for inviting me on. Know dietitians often we have a reputation for being perfect creatures with perfect guides telling people what to do like the diet police as it were. Actually dietitians that work in weight loss are quite rare. I have a strong personal interest in weight loss and I'm really in my dream job. My interest in weight management started when I was a kid, when I was 13.
Speaker 1:I weighed thirteen stone at 13 years of age. My mum was particularly overweight, always on a diet, fantastic cook. We grew up well myself and my three brothers. We had an abundance of food but mum was always on a diet. In high school, when I went to high school at 13, I was bullied for my weight.
Speaker 1:Really it was the first time I'd become aware of weight being a problem. I got a little bit obsessed with eating well. As kids we were very active and I became a little bit more active. Started running, lifting weights. In time my weight came down.
Speaker 1:It came down. I grew up. Eventually I gained another stone. Right now I'm 60 my god, time goes I'm fourteen stone now. So I've maintained that fourteen stone for the majority of my life now.
Speaker 1:I was fascinated that making dietary changes and changes in my activity pattern would change my body structure so much. I got a little bit obsessed with that. I then did a diploma in sports and exercise instruction, worked in health clubs, leisure centers and in men's prisons in Australia as a recreation officer and a teacher for a university in the prison. I met a London girl. I moved to London in 2000 and decided to go back to university.
Speaker 1:Studied human nutrition and dietetics. The distinction there is dietitians we work in a hospital setting. We're a nutritionist. They do the same Bachelor of Science degree in nutrition, but they don't do the hospital part which is an extra year of placement training in the hospital scenario. So I started at St George's in 2006 and I've been with the weight management team, the bariatric team, the surgical team since 2008 and in that time I've spoken to more than 6,000 people.
Speaker 1:That's a bit of a conservative estimate. So 6,000 people listening to their stories all of them are so different how they gained weight, what the barriers are to weight loss. We prepare them for surgery, we try to identify what the patients don't know and educate them and prepare them for surgery. More recently I'm working with a medical team, so we're using Mounjaro and Wegovy. Just as a matter of interest, my colleague presents for a conference coming up on bariatric surgery, weight loss surgery in The UK and there's been a 10 time reduction in weight loss surgery in The UK in NHS and private sector.
Speaker 1:So people are now simply not interested in bariatric surgery these days. It's really dropped. But again at St George's we still undertake weight loss surgery. Many of our patients you know poor things that they are in dire situations. Some of our patients have body mass index BMIs of 50s 60s even 70s.
Speaker 1:I recently had a gentleman at three hundred kilograms which is six sixty pound man. So in a chap such as that weight loss medication we're using that to help bring his weight down so that it's safe for anaesthetic and then we will undertake a bariatric procedure which in comparison to weight loss medication the weight loss surgery does achieve a better total weight loss but this gentleman will need both surgery and medication over well the surgery initially but medication for a long period to keep driving the weight down for him. So some of the insights and things going back to that first slide, some of the insights in my experience in weight management. I could talk about this topic for days actually. Diluting it, distilling it down, just just a couple of slides.
Speaker 1:I've only got a few key points here. One of those which is really quite important is to stop the upward weight trend. This is really in clinic I hear a lot of people where they've lost weight and they've come down and they've stayed the same weight for a long time. They're quite often dismayed with that, unhappy with that. Personally I think it's a major achievement.
Speaker 1:If we think back to photographs of ourselves in our early 20s or 30s and we look at them now we might think wow I look fantastic but at the time I thought I was overweight. So if we fast forward for now another ten years, if we all stay the same weight and we don't gain from where we are, that is not a bad scenario. So looking at the bigger picture and stopping the upward weight trend, that is a nice ambition and aim and objective for people. So weight stability, not losing, not gaining, that's a good thing. And I've got it at the bottom there baseline diet.
Speaker 1:I'll come to that in a little bit more detail but what we're looking for there is a baseline diet that lets us enjoy our foods, eat the right food, but is also maintaining our weight and stopping the upward trend. So work on the baseline diet that is the key thing and baseline diet's our day in day out eating philosophy. It's our plan, our method, our timing. When we work on our baseline diet we need to learn about food. Again I'm not being patronising to everybody.
Speaker 1:I'm sure everybody that's tuned in tonight understands about food. They wouldn't have joined the Parrot Pal app if they didn't. That means everyone's interested in this. But it is an important thing that underpins understanding the baseline diet. Reading food labels, using the app, being curious, asking yourself what's in the food, what the calories are, what the makeup of sugars, fats, fibre, salts etc.
Speaker 1:What is in this particular food? Make food and fluid knowledge about food and fluid a priority. In clinic I must say I've seen so many patients who really don't appreciate the importance of understanding food. Many patients just consume something when that hunger, that drive to eat comes upon them and unfortunately when we're hungry we don't make the best decisions with food. Finally working on routine, being consistent with our diet day in day out, you know finding that baseline diet that's doing the job.
Speaker 1:Not gaining, not losing. Now again, that might not interest everybody. We might be looking for more weight. But again, getting that baseline diet is a fantastic platform and starting point. After that, then we can put in a method to enable weight to come down.
Speaker 1:So diets and the whole phrase diet there is literally 23,000 various diets according to a quick Google search. People have the perception about diets as a tool, a mechanism. I apply a diet and I will lose weight. But unfortunately if we look at that little screen down there we have before after and then after after. Using a diet if our baseline is not good and we apply a strict diet it's really hard, restrictive, no fun we can lose weight, we can look good for the wedding, look good for the photo shoot or the movie scene, but if we don't address the baseline diet we return to a baseline diet that's questionable, the weight will come back and as in that little depiction there quite often with an additional factor, an additional element.
Speaker 1:And really weight management is like this seesaw. We gain weight when our energy intake exceeds our expenditure. This is irrefutable meaning that this is exactly how it works. But what is interesting is that our food intake is highly variable from one day to the next and our activity level is highly variable from one day to the next. And it can make the picture very confusing and difficult for us to get our heads around that.
Speaker 1:So again I'm really pushing that idea of working on the baseline diet because a nice ideal baseline diet that helps prevent weight regain. I think many of the people who tune in today will have experienced this in the past. Often we are motivated to lose weight. We started at a certain point. We apply our dietary practice after a number of weeks.
Speaker 1:We reached that bottom point where we can't sustain the diet, we get the food noise, the voices in our head, we get hungry, we get annoyed and anyway in time our weight comes back to what is the set point and often again with that little bit extra on top. This set point theory this was was a phrase that was coined in the 1940s by a scientist called Ancel Keys. His studies were quite unethical but they couldn't be repeated today. But what he did find was interesting that our body preserves and tries to maintain this set point. It is it it loves this set point.
Speaker 1:So got a couple of analogies here. We shouldn't take it personal. It's just business. There is a mechanism inside us which just does its job. It regulates our heart rate, our breathing, our blood pressure, all of those systems and it also regulates our calorie intake and our activity level and it preserves our body fat and it preserves our muscle mass.
Speaker 1:And the way I explain it to a lot of patients is that it's a little bit like the mafia. We have a thing in our brain called the hypothalamus and it is like the mafia. We owe our body nutrition every day. We owe it a certain amount of fluids, certain amount of calories, a certain amount of protein and vitamins and minerals. Now on a diet what we do we cut the calories quite often quite drastically from eating well to eating very very low calorie diets around 600 to 800 calories a day.
Speaker 1:Now again with that idea that the hypothalamus, the thing in the brain that regulates our body set point, it is like the mafia. If if, I'm sure everyone can imagine if we owed the mafia, they're going to send somebody around to recoup everything that we owe and a little bit more for messing them around. And that's what happens with the set point. The hypothalamus doesn't sleep, it reduces our activity level, it talks to us, it influences our food seeking behavior. People that take weight loss medications often talk about this phenomena called food noise and it wasn't really until they started taking the majority the Ozempic before they noticed the food noise.
Speaker 1:Excuse me. But we do have a little voice in our brain that when we're dishing out our food for our evening meal, the voice sometimes says to us, oh you've had a hard day. You've lost a couple of pounds this week, you're looking good, don't go to the gym, you deserve a treat. So that part of our brain the hypothalamus it influences our thought pattern and what it's doing it is minimizing our activity level, maximizing our calorie intake until we get back to set point. So this is one of the key things.
Speaker 1:If we take care of hunger and appetite I don't know if anyone can see my mouse flying around there but humans we eat for two reasons. One is hunger and the other one is appetite. Appetite is a reward eating where we like and enjoy foods such as chocolates and sweets etc. Hunger is the need for nutrition. These two things can get a little bit blurry sometimes and one of my observations is if we take care of hunger and we pay our hypothalamus what it wants, a nice breakfast, a nice lunch, a nice dinner, and we don't cheat it by too much, then we can control appetite.
Speaker 1:So if we're we're eating regularly, appetite and our cravings for chocolate or sweets or emotional eating that is toned down quite often. So again this hypothalamus this is the boss of the human. We can't beat this guy. We need to work with it. Excuse me.
Speaker 1:I've seen a lot of drug companies pursue medications that work directly on the hypothalamus and what that does is it affects appetite so much that you know, appetite is not just about eating food it's about having fun, loving our family, going on holiday, dancing, music etc. So when we use a medication that works on the hypothalamus it down regulates appetite and the shine and fun in life just vanishes. And quite often in the past with some of the medications tried we've seen self harm and suicidal ideas in people. And there is also that risk and that warning with Mounjaro Ozempic and modern weight loss medications as well. It has been noted that people do get can spiral into depression because it's working on the appetite circuit.
Speaker 1:So as the diet guy, my sort of take on things is to pay this man, give it what it wants and don't cheat it by too much. We can cheat it a little bit but not too much. There were some wonderful studies done in 1984. Sorry I'll start again. Drastic diets this is one of the reasons why they fail and why people return back to set point as well.
Speaker 1:Again the drastic diets cheat that hypothalamus too much and it sets in motion food seeking behaviors. There's another factor here that our metabolism learns. Every time we go on a diet it threatens our very existence. As humans we're the only animal that voluntarily goes from eating plentiful to eating very little. No other animal does that.
Speaker 1:You know, a bear does it to hibernate in winter, but they do you know they are different. They store that body fat tissue during the summer and they hibernate. But there is I'm not sure if people have heard the phrase there is a thing on the internet and in popular literature a thing called starvation mode that our body learns and every time we go on a diet after the last one after the last one and so on, what happens is that our metabolic rate slows down. So in the Biggest Loser USA series they did way back in the early two thousands, they caught up with the people at ten years after that study and found that everyone had put weight back on. There was a few people they couldn't find but as it turns out all of those people had put the weight back on.
Speaker 1:So again this is the hypothalamus and the body defending its set point and bringing our weight back. So another thing about drastic diets is that when we're in energy deficiency, if that deficiency is really very high the body has a habit of reducing the muscle tissue. Because when our food supply is in question, the energy to keep our heart, liver, lungs, brains running has to come from somewhere. And if the energy crisis is so great our body will actually reduce our muscle tissue thus reducing metabolic rate. It's a beautiful adaptation mechanism and this is how our metabolism learns from every single diet that we've done.
Speaker 1:So what I'm saying here is that these drastic diets or the yo yo effect losing weight, rebound back to set point with a little bit more, we have to break that cycle. The smart science and logic says that we pay the hypothalamus, don't cheat it too much just cheat it a little. So I hope that makes sense to everyone there. Another reason why diets fail I often see this that again patients that I've seen in clinic try too hard and too fast. Of course there's fantastic diets out keto diet, Atkins diet, meal replacements etc.
Speaker 1:You know low calorie diets. Those crash diets again they do get results but the results are almost impossible to sustain. So we need to break this famine and feast cycle. I see people who've tried all of those things, their metabolism is learned, they try and set up a baseline diet that is possibly not ideal. No breakfast, no lunch, coming home in the evening very hungry, they owe their body the nutrition, overeat and then go into the cupboards looking for the snacks afterwards and what they're doing is paying back the calories for breakfast and lunch that weren't there.
Speaker 1:Other diet cycles people try and set up their baseline diet running a thousand calorie a day deficit or 1,200 calorie a day deficit which really does lose the weight but it's unsustainable. And what we see is this cycle of overeating episodes. And again the guy who did those studies who coined the phrase set point theory in the 40s was able to identify that the periods that in between the overeating episodes is around four days. So what happens on these peaks and troughs here is at the peak we repay back the calorie, the energy, the protein, the carbohydrate deficit over the last three days. After that overeating episode our bloodstream is saturated with nutrition, our intestines are saturated with food, our gut is pushing out satiety hormones or which are fullness hormones which is signalling to the brain stop eating I'm completely full.
Speaker 1:So we wake up the next day and not hungry feeling guilty and just go embark upon another two to three days of energy deficit eating very little until hunger reaches fever pitch. And at these peaks here quite often this is where our emotions are also fragile. Again when we're hungry we are we are emotionally fragile. There's a word that's recently been included in the Oxford Dictionary in 2025 that is the word called hangry which is hungry and angry which has now been recognized as a real thing. There's actually research going on into the hangry phenomena.
Speaker 1:But again at those peaks a couple of days before that quite often people have not been eating well. So we just follow this cycle of famine, feast, famine, feast. Our weight doesn't shift but unfortunately the patients that I see that are locked in this cycle are very very unhappy and really struggling to get out of that pattern. So going back to that original slide, the set point theory where we lose the weight and the weight creeps back. Can we reset that?
Speaker 1:Now there's a lot of conflicting studies out there some people some scientists say yes, some people say no, some scientists say it's irrelevant, it doesn't make any difference. However, logic says that yes between one to five years it may take at our new weight before it's ours to keep. That is a stark reality. So with nice diet, medication possibly exercise we can get our weight down but we need that baseline so that we're weight stable for one to five years before our body becomes resistant and not intent on coming back to the set point. But we also need to keep in mind that time and nature and biology will always be against us as our years tick on 20s 30s 40s 50s 60s like me and metabolism slows down we don't have that hormonal balance of our youth so our muscle mass reduces and our muscles are a little bit like the engine in a car.
Speaker 1:So as we get older we become more fuel efficient for energy. Now metabolism slows down and unfortunately we tend to enjoy the same sort of portions and the same sort of social foods with our friends and family. And this can lead to that progressive weight gain which is very common when we track people's weights through the decades. We see around forty fifty sixty. There's a there's an upward trend with that.
Speaker 1:Personally, I don't think that has to be the case. We just need to be smart. It's our food environment that is tricky and dangerous. We've never lived in a time like we do now where food is so cheap, so available, and it's thrust upon us. You know, we go to our friend's house.
Speaker 1:If we decline, you know, they're pudding, they're offended. You know, we've got workplace food traps, know, our friends bringing cakes and their bakery goodies into work to share. So, you know, our food environment is tricky. When it comes to that as well, it is a man's world in terms of food. Every restaurant when a chef puts the food on the plate he's putting a portion down for us guys, six foot men.
Speaker 1:There's no such thing as a male and a female portion so it's very easy for ladies to overdo it from time to time. So again nature, biology and our environment will always be against us. So I suppose we just need to keep on point. We need to be smart with our food choices and our activity levels. So weight stability is a beautiful thing.
Speaker 1:If we can bring our weight down a little bit and keep weight stable at that point that is a fine starting point. We then need to find an intervention which does the work brings our weight down without annoying the mafia, without annoying the hypothalamus. So this is the last slide I've got here just for today. As I said I could go on about different aspects of all of this but for me the most important ones are working on the baseline to be food and fluid wise, to be kind to ourselves also it's okay to go off track and get it wrong. I do all the time.
Speaker 1:I'm 60 now. As I said, I had a propensity like a natural genetic thing in my family. My brother is very overweight. Actually both of my brothers are. And I'm quite easy and prone to picking up weight myself.
Speaker 1:And I've been eating well, I've been eating consistent, not tight and restrictive. Anybody who knows me personally will vouch for that. Quite often people say how do you do that? How do you get away with that? And my answer is being consistent.
Speaker 1:You don't see me on the days when I'm eating quite tidy, quite healthily. So again, weight stability, great thing. So once we've got our baseline diet and we're weight stable, working from that platform, what we need to do then is initiate a plan that gets slow progressive weight loss over time, running about a 300 to 500 calorie a day energy deficit and what that translates to is losing about half a pound to one pound per week. The mafia, the hypothalamus in the brain seems to let us go and as we saw in that previous slide those blips those overeating episodes they will become less frequent and less you know less guilty feeling. Know it's nice to have a bit of an indulgence from time to time but see if they're not you know such oh my god moments and less frequent then we're on to a winner.
Speaker 1:And finally be active. I don't really advocate exercise for weight loss. I think that's a bad idea personally. Weight loss is really 90% diet. Activity in our life and being active, all that does is helps us avoid the weight regain.
Speaker 1:The activity, the exercise, it allows us to indiscretions with our diet, to overeat with our friends at the barbecue coming up this weekend. It's gonna be sunny. It's gonna be warm. So exercise can help mitigate the damage from those sort of dietary moments. I appreciate not everybody can exercise and you know people enjoy different types of exercise walking, cycling, swimming, lifting weights.
Speaker 1:For people with mobility problems just standing up spending more time per day standing up is also a good thing. There was a study done by University College London two years ago. They identified for people with mobility issues there was a weight change when we just simply asked them to stand up and watch them watch a half hour episode of their favorite TV show twice a day giving an extra hour of standing time versus sitting time and it did have an effect on body composition. So activity, yep, it is highly variable. Whatever floats your boat, whatever is your thing, try and be a little bit more active more often, but don't expect the exercise to help lose weight and certainly don't beat yourself up with exhaustive exercise programs of long duration.
Speaker 1:Again, the secret is in the kitchen. And I think that is it, Scott. I'll just come I
Speaker 2:appreciate that. Very interesting. And, again, Fizzing, thanks for that. The question to everyone is, did you learn anything new? Did it reinforce anything you know?
Speaker 2:Anyone got any kind of, experience with that kind of trajectory of losing weight and stuff? But I know one person, and she will speak because, she's one of our long term members, Scott, Vanessa. Vanessa g. Hi. That pattern of the weight what what I was thinking about when I when Scott was mentioning the the kind of result of weight management or, like, at least holding her off.
Speaker 2:You've managed to hold off weight for quite a few years now after being Yeah.
Speaker 3:I have.
Speaker 2:22,000 diets?
Speaker 3:I'm 59 now, and my first diet, I remember at 10. So I basically yo yo diet until I met Scott. I lost weight in the Octagon challenge and probably for the last, what is it, Scott, five years, I've maintained, you know, give or take little blips on holiday and stuff like that. But whether my, you know, what I would like to ask you if you have, you you dieted for, you know, I'm I'm talking what is it? Fifty, nearly fifty years of dieting.
Speaker 3:Have you totally screwed your metabolism? You know when you said it will take sort of something like five years to sort out your set point again I'm thinking I'm gonna be in my coffin before I sorted mine out.
Speaker 1:Yeah so that's a good interesting question and according to the studies that I've read recently on this, metabolic rate generally normalises after about one year. We also see that with patients when we do the weight loss surgery. After about two years their weight will come up about three to six kilograms and quite often what happens there is an increase in muscle tissue in that first period of weight loss. They lose a lot of that muscle tissue. Once their weight stabilises they re establish your healthy eating.
Speaker 1:That muscle tissue comes back on board bringing up metabolic base metabolic rate. And in the patients that they did the studies on looking at that metabolic adaptation the yo yo dieting have you ruined your metabolism? No. They said about a year they see what they do to test that they put patients in a machine which measures oxygen consumption rate so they technically put them in a plastic bag and it has a monitor monitoring oxygen intake and carbon dioxide output and it can do a mathematical calculation and give you what's called a respiratory quotient. All fancy stuff.
Speaker 1:But essentially it shows how many calories per minute the patient is burning. We use this in intensive care when people are unconscious and we have to provide calories really accurately for their recovery. I've used it in clinic with a lot of patients weight loss patients as well who've felt their metabolism has been ruined. We've put them in that device and measured it and their metabolism is exactly according to the mathematical formulas and the studied standards to date. So yeah I think with the yo yo thing it's when we try successive diets in a compressed time frame like three or four times over year after year after year we get that metabolic adaptation.
Speaker 1:But the literature suggests that it does come back to normal in time. A very good question.
Speaker 2:That's good news.
Speaker 3:That's good. Yeah. Because you know when you when you have done, and I'm not the only person here who's yo yo dieted, you know sometimes you just get to a point where you think okay I'm doing everything and it's so hard not to get into that mindset of thinking oh when I did this diet you know the Vogue white wine diet in whatever it was, I lost it for the week and it's so hard it's so hard not to go back to that if I just drop it drop it or just do this I'll lose it quicker.
Speaker 1:Yeah yeah yeah I've got you Vanessa and again on one of my slides there is to be kind you know that weight stability it's a wonderful scenario and again you're against a really powerful biological mechanism. We take it for granted that how impressive that system is of managing exactly what we are. It's almost like there's a threshold and again it is your genetics, your mum and dad, medications, environment, activity levels, food likes and dislikes it's all so interconnected. So I think you know my I suggest for you you know eating weight stable and in time it will budge again I would think.
Speaker 3:Okay so mentally is it better then to think okay I'm a little bit more than ideally I'd like but actually I'm stable are you saying it's better to stay stable with a little bit more than I'd like to say like and just work on it really chip away.
Speaker 1:Yep I agree yes because again looking at that mafia hypothalamic thing it's allowed you to get this far we don't want to push too hard it's almost like a law of diminishing returns or what they also call the thin ends of the wedge. You get that good result but in time the results take longer and longer and the drop is less and less. We're up against that biological mechanism. And I think the worst thing that you could do at this situation is start throwing drastic diets and getting back into the yo yo cycle. You'll just make your metabolism and the hypothalamus angry and everything can
Speaker 3:Yeah. Get Don't do that. It's spent his life angry. I'm done.
Speaker 1:Yeah. Or hangry. Yeah. Thank you. You're welcome.
Speaker 2:We've got a question here for you, Scott, from Sarah. Sarah, do you wanna ask her? Are you there? Sarah Jelly. I haven't spoke to you in ages.
Speaker 2:I'll give her ninety seconds. I don't know. Absolutely not. Okay. You're a teacher, Sarah.
Speaker 2:You should be, you know, doing this. You know what I mean? You should be you're a student now. She's asking Scott anyway, does my stomach rumbling always mean I need to eat, or can I sometimes or can it sometimes be my mind? My stomach is forever rumbling when I'm in a slight deficit?
Speaker 1:Yeah, that's a very good question Sarah. My stomach tends to do the same thing as well when I haven't eaten for quite a while. Does it signal hunger? Quite possibly. I see in clinic a lot of patients tell me that they're never hungry and it's an interesting thing to say.
Speaker 1:I think we pick up on our hunger signaling in our body differently from one person to the next. So your stomach rumbling, yes, probably is an indicator that it's completely empty. And again working on that baseline diet and that whole idea, one of the key things is having a nice sequence of meals. If your tummy is rumbling and your last meal was three to four hours ago then good wisdom might say that it is yes it is time to eat at that point.
Speaker 2:Makes sense.
Speaker 1:So yeah again depending on what you ate, how long ago it was, and how active you know what your activity level is yes it might be the right time to eat. We all got different cues.
Speaker 2:So let us know what your meal partner is and then maybe Scott can have more context then. Scott, I've got a question for you on the more extreme side. You mentioned the guy three hundred kilos. Yeah? So for that guy to be three hundred kilos, he has to consume on a huge amount of calories to maintain that weight.
Speaker 2:Right?
Speaker 1:He does.
Speaker 2:Why does the body what, like, what I, you know, the extra fat is like, why does the body want to want to maintain such a high weight and why does it push for that many calorie consumption when it knows it's just extra fat, if that makes sense?
Speaker 1:Yeah yeah that is also a very good question. That poor gentleman has you know had really difficult background history of you know deprivation and abuse Fell into the habit of overeating and reward eating, you know, high calorie foods as a comfort mechanism. So he eats in absence of hunger. He he's not hungry. He doesn't they know he doesn't need it.
Speaker 1:He eats just as an automatic response to general stress in his day to day life. Now the thing of overweight and obesity really if you look at the statistics and measurement, there there are has been recorded thousands of years ago. There's small models and clay models from, you know, prehistoric times from, you know, times of the pharaohs through to middle ages where overweight was viewed as a wonderful thing. But in more recent times since the second world war when food production become industrialized, the rise of overweight and obesity has skyrocketed. The marvel of the human body is that we were built for a harsh world.
Speaker 1:We've only been actually farming and systematically farming, growing crops and cycles of the seasons, storing it over winter, herding cattle and and you know systematically producing food for twelve thousand years. Only twelve thousand years it's not long. Previous to that we were nomadic hunters and yeah So we've had a difficult time to get where we are. We've had wars, famine, flood. The way that evolution has built us is that whenever there's an abundance of energy our body stores it and that is one of the human body traits that body fat tissue is limitless absolutely limitless to how much it will store.
Speaker 1:I believe the world's heaviest man was an American chap who came in at one hundred stone. That was six hundred and thirty six kilograms, and that is, yeah, one thousand three hundred ninety nine pounds. Yeah. He was a medical marvel and much the same as the chap I've seen, Yeah. Sad circumstances where food was that coping strategy.
Speaker 1:Yes, we've been developed or evolution has put us at the top of the food chain. We're the most effective animal on the planet. Some people would argue against that. But we have endured. We have survived this long, far.
Speaker 1:But essentially we're a primitive creature in a modern food environment and anytime we have a surplus of calories our body is designed to store it. It just doesn't know when the next famine is coming. It's as simple as that. It's not that possibly in time in another twelve thousand years our genes will develop in a situation of abundant energy. Our genes might develop that we don't store so much body fat tissue but it's just the way we're made I'm afraid Scott.
Speaker 1:No.
Speaker 2:It's crazy, isn't it? So when it comes to maintaining such a high weight and the the a lot of people so to be a certain weight, you have to eat a certain amount of energy a day essentially. Right? Yeah. So there's no other way around this.
Speaker 2:If I weigh two hundred and fifty kilos, I have to eat what a hundred and fifty kilos needs.
Speaker 1:Yeah. Around 7,000 calories today. Yeah. Do you how do you afford that?
Speaker 2:That's odd. But there's is it a is it a is it a possibility ever that I could be such a way to not consume those calories? So I I have to. Right?
Speaker 1:No. No. I see that in clinic a lot where patients tell me that they have a slow metabolism, where a calorie is not a calorie for them. Unfortunately it is. All the studies do prove that and again when I've done that metabolic test on patients in clinic the numbers come out the result comes out exactly as the predictive tests.
Speaker 1:We have a book of metabolic rates according to body weight, gender, height all those medical parameters it comes out as predicted. The difference between men and women is not much. We have testosterone. Ladies are made the same as me. Interestingly the digestive equipment the stomach, intestines, liver is identical male and female.
Speaker 1:My surgical colleagues tell me that as well that the female stomach is the same size as many male stomachs. Us guys testosterone just makes us taller, us a heavier muscle density, but pound for pound you know a pound of my muscle tissue has the same metabolic rate as a pound of muscle tissue from a lady. It's just that I have more of it. If you look on the back of packet of bread it will say for women 2,000 calories a day, for men 2,500. So us guys have a on average a 25% metabolic advantage compared to the ladies.
Speaker 1:Some of the other variants in metabolism are height. The taller the person the higher the metabolic rate and that really comes down to skin. The taller the person the more skin they have and skin is metabolically active it takes a lot of energy to run it. So a petite little lady you know five foot two it's so easy for that lady to gain weight because her metabolism and her height and her surface area is so small and in a world that you know we all tend to portion up generally go to a restaurant and it's a given that the portions are exactly the same for men and women so it's difficult for ladies to well it's very easy I mean for ladies to gain weight and quite challenging more so than male metabolism to lose weight.
Speaker 2:Makes sense makes sense.
Speaker 1:But essentially we're the same creatures as us guys we just got more of that that tissue.
Speaker 2:More muscle. We don't live as long. That's the downside.
Speaker 1:Yeah. Shit.
Speaker 2:Well, need to change it. We've got another one for you, Scott. Quick fire's coming at you now. What's your opinion on intermittent fasting?
Speaker 1:Yeah, again, a diet only works by inducing an energy deficit which means that the calories coming in don't pay the energy demand. When our body's not getting the energy to function it dives into its own stores, it's body fat a bit and it's muscle tissue. Intermittent fasting that's all it does it just sets up a period when there's an energy deficit and the person will lose weight. If the energy deficit is quite modest I think Doctor Michael Mosley first proposed the five:two diet which was intermittent fasting it's since become very very popular. When we did this mathematics on Michael Mosley, bless him, his 5.2 diet, we found that when over the course of seven days the energy deficit that the person was running was between 300 to 500 calorie a day energy deficit only.
Speaker 1:And again with the hypothalamus in the brain when our energy deficit is really very slight 300 to 500 calories half a pound or a pound a week weight loss then we tend to keep the weight loss going and don't have the yo yo effect. So yes, the intermittent fasting used correctly, it is a good method. Yeah. It can be a good method because all you're doing is having a baseline diet that's nice and healthy and on however you apply it, you just reduce the calories intermittently by just a modicum. So it can be a good methodology.
Speaker 1:Yeah.
Speaker 2:Yeah. Makes sense to me. I think it's just a bit easier maybe the consistency, like you say, a small deficit over time. But no one wants the slow journey. But Turtle and PowerPal, we're trying to do the slow journey, Scott.
Speaker 1:But The slow journey is really where it's at, Scott.
Speaker 2:That's that's
Speaker 1:always Yep. That's evident by the number of people in the world who are overweight and the number of people that have been successful in keeping weight off. There's a very big difference. And in my experience, the rabbit doesn't get there. They they get the rebound, the yo yo effect, and another decade goes by and that yo yo effect can contribute to an ever upward weight trend.
Speaker 1:So it's again a different psychology of getting the baseline, understanding that we can't beat the hypothalamus, we have to work with it a bit more gentle and a bit more smart and run our weight loss long and slow over a longer period. Makes sense.
Speaker 2:More feeble stacks up. We'll see. We'll see.
Speaker 1:Yeah. They have to track the calories. Wonderful. Fantastic. We recommend all apps and people you know just becoming involved and understanding the food and what they're eating.
Speaker 2:100% I think the problem with tracking in the apps now is that you can track everything and then it becomes very like okay I I get my calories right and my protein right, and then people think then, well, my carbs are a bit too high and my fats are a bit too low or, you know, they try and micromanage every single, you know, number that's possible, and then it just becomes overwhelming. Right? So when it comes to your patients and all that, you know, you manage their energy deficit, or you manage their energy in and their protein, and, like, what's the other essentials you make sure they say? Like, that liquid diet you said that comes in, what if you had to build a diet and only include the essentials what does that look like? And then the rest is not easy, you
Speaker 1:Yeah for simplicity and a methodology I firmly recommend and discuss with a lot of patients is what we call the rule of thirds which is looking down on the plate. When we have a meal we should look down on the plate we should be able to identify the three foods. There's only three foods which humans eat. That is protein, carbohydrate, and a plant food. So we get a piece of chicken, we put it with some greens, kk choy, etcetera, and some noodles, We stir fry it and it's a you know a Chinese noodle dish or you know we put some meat with some pasta and some tomatoes it's an Italian dish.
Speaker 1:So different cuisines around the world, different cooking styles. It's irrelevant how you make it, how you spice it, how you chop it. But a very simple rule of thumb is one third protein, your carbohydrate same size as the protein, and your vegetables the same size as the carbohydrate. Having three things on the plate as often as possible in one third, one third, one third. A lot of my colleagues recommend what they call the t plate, the t model, which is half the plate vegetables, onefour carbohydrate, onefour protein.
Speaker 1:For me that's too drastic and I've seen so many patients who can't sustain that. It is a good model half the plate vegetable if you've got a photoshoot again for you know wedding or a dress or looking a certain way in three months time. But half the plate vegetables is not sustainable in the long term. There's not a lot of enjoyment pleasure in eating with that and I think that's where people fail. So for simplicity one third one third one third.
Speaker 1:For instance if we go to the fancy gastropub, we order a steak with the chunky chips, always order the side of greens. Then we've got the three things on the plate in a nice sequence. Now you think what's the point of that? Part of the point of that method is that the fibre on the plate and the carbohydrate and the protein on the plate, those foods stay a long time in the stomach. It takes time for them to break down for the stomach to empty and then start gurgling.
Speaker 1:Fibre in the veggies quite often the doctors just say eat your vegetables, they're good for you, but they don't really explain as to what the magic is. The magic in the vegetables is fiber. It's dietary fiber and the fiber with a meal slows the rate of absorption of carbohydrates and we don't get the cravings for the puddings afterwards. The other thing with the fibre is that it dilutes the concentration of acid in the stomach which means it takes longer for the protein to break down. And when our tummy is fuller for longer we or, you know, has food in it for a longer period, it reduces the likelihood that we need a snack or need a pudding or need a second helping.
Speaker 1:Also, what we eat today has an effect as I showed you in that graph. What we're eating today has an effect on hunger tomorrow morning and at lunchtime, a little bit less so by the evening, but that's one of the thing of the rules of thirds. If we can do that very often, it has this rolling effect of reducing hunger, keeping us full, and reducing appetite and cravings. So looking at a specific diet there's so many out there but as a really simple measure the rule of thirds one third one third one third it's it's a very easy philosophy.
Speaker 2:Yeah.
Speaker 1:And it will take a lot of people a long way. Well,
Speaker 2:I've been getting it wrong. I've gone for the double chunky chips, Scott. So then I beat it to the grid. You know? So next time
Speaker 1:If you're running the London Marathon Scott then you deserve the double chunky chips. Which is highly active, yet increasing carbohydrate is a good thing, but I do see it you know a popular opinion of people thinking that carbohydrates are the devil and trying to have chicken salads and have meals without carbohydrates. And again I see a lot of people go a bit off track with that. They have the chicken salad two hours after dinner. They're in the cupboard looking for a chocolate biscuit because blood glucose has dropped.
Speaker 1:Dinner didn't have a carbohydrate. A couple of hours after eating blood glucose drops. When our blood glucose drops we get cravings and we get, appetite and we get food noise. So removing that carb and replacing it with a questionable carbohydrate in two hours it's not a good deal.
Speaker 2:Next time I'm going for the big broccoli don't you worry. We got a question here from Kim Scott. She's saying, basically, she worked in the pub trade for a lot of years, so she didn't really have breakfast, lunch. She would eat late after the shift. Yeah.
Speaker 2:And she hasn't worked in the trade for a while now, but she's still not feeling like she wants to eat for breakfast or lunch, and she only gets hungry at two. And then that turn takes her to dinner time, and then, you know, it's like maybe a minute a later feast. She's kind of finding it hard to find a solution to it, a habit. If you can't eat for breakfast, like you mentioned at the start, this liquid kind of consumption, is that gonna do anything? Like, what you mentioned, what's the difference between the meal being liquid form and the meal being fully kind of whole on in regards to hunger levels and all the benefits we want?
Speaker 2:Like, what's the and how can we go about this if we're not hungry, you know?
Speaker 1:Yeah. That's also a good question. I do feel for people that are in occupations which limit their chance for a break. Nursing that is notorious. So keeping to the three wheel thing can be quite a challenge.
Speaker 1:Generally I say to patients that our body well metabolism doesn't really have a clock and the first meal that we eat or the first food that we eat on any day that is technically our breakfast by definition. We're breaking the fast it's the first thing we've had since the last thing. I generally recommend for patients to have two more meals after that so for Kim you know at 02:00 having that meal whether it's a sandwich you know some bread with some protein in it cheese tomato it's got the three things it's got three things in there. That should see her through till the end of shift and then her dinner. After that, she might need a snack before bedtime, of which a high protein snack might be the thing or a meal replacement a liquid thing after dinner or even during the day quickly getting it down.
Speaker 1:Now those meal replacement things when we put them in the test tube and analyze them they do come out in accordance with the rule of thirds. They've specifically done that whether it's slim fast, lily life, herbal life, test goes ultra slim. They all have a similar amount of carbohydrate, good carbohydrate, low glycemic, similar amount of fibre and a similar amount of protein which again pays the monster in the brain, tones down that hunger. So for chemo on the shift work, yeah, a protein meal replacement drink in the morning, just on a morning break, a little sip of it, she might not feel like eating or having the whole thing, might feel a bit unwell bending down and picking up glasses, it's just there. But yeah there's there's ways of getting that in and I think the most important thing with that is again the timings.
Speaker 1:Don't don't stress too much of the timings. If you've got three inputs of quality food that is a good thing. I think I'd like to ask Kim, know, does she have those intervals like every two to three days when she will eat maybe the wrong thing or too much of a good thing? That may be what's happening for her as a result of, you know, that work obligation and not getting a break. Yeah, yeah.
Speaker 2:It makes sense. Kat, I see you there. Do want ask the question there? You want come on? You're trying to unmute the classic, the 10.
Speaker 2:I don't know where it is on Google Meet. I think it's where is it? Who's on mobile here?
Speaker 1:Right down the bottom there.
Speaker 2:Is it bottom?
Speaker 1:Bottom middle? Okay. I don't know why we are. There we go. Got it.
Speaker 1:Oh, we got you. Hi.
Speaker 4:Yeah. Yeah. Just wondering what your take is on kind of the longer term use of, GLP ones for weight control, sort of after the initial weight loss. I mean, I know- so I work in primary care and we're much more viewing this as this is going to be a long term treatment, if you like, for a lot of people, and we'll be dealing with obesity far more in the way that we would with hypertension or diabetes. It's not a case of getting to the goal and then stopping treatment.
Speaker 4:I was just wondering what your kind of experience, what your thoughts were on that.
Speaker 1:Yeah, that's a really interesting thing and very fresh in the media, Kat. Everyone's talking about weight loss medications. Technically we're really at the beginning of time of weight loss medications. We've been using them in diabetics in simple forms such as semaglutide Trulicity, xenatide and some of those other medications have been around for ten years. More recently with Ozempic which is exactly the same as Wegovy.
Speaker 1:Been using that with diabetics and my god they lost a lot of weight. Some people, what we call super responders it works so effectively. Other people just a little. It got licensed for a standalone treatment as weight management. It's now called Wegovy but it's exactly the same chemical as Ozempic.
Speaker 1:And then along came Mounjaro, which is a double peptide, double hormone. Pumpkart works around about 10% better than the Ozempic and the Wegovy. Now on the NHS the NHS is in a finance battle with the drug companies and getting weight loss meds on the NHS is very strict very hard to do. I'm sure you've got people coming into your clinic demanding that the GP gives them weight loss medications and it's a hard conversation to say I'm sorry you're not heavy enough and you're not unwell enough to meet the criteria. So then the poor patient goes and spends almost £300 a month on buying these medications themselves.
Speaker 1:I have seen that scenario a lot. Now those medications they're similar to insulin. Our body makes insulin naturally but in the lab the scientists can make insulin an analogue which means it's exactly the same as the stuff that our body makes. Our body makes Wegovy naturally. Produced in the intestine.
Speaker 1:So when we've had too much food on Christmas Day and we feel sick and we say oh my god I'm never eating again that is our intestine pumping out GLP-one. It's a hormone down in the intestine and what the intestine is doing this hormone is clamping the stomach and telling the stomach stop giving me food and you stop eating. So it's the GLP1 that the intestine puts out that makes us feel sick. So like the insulin scenario GLP-one is a naturally occurring thing. There is a lot of horror stories in the press and the media many of those are coming out of America where three twenty million people are currently on a weight loss injection at the moment.
Speaker 1:So 320,000,000 pens are given per month and a lot of people in America inappropriately using it using double injection two a week, some people three a week. They're not eating at all. They're getting dehydration. They're getting gallbladder problems pancreatitis really quite dangerous. Yeah, we're seeing the worst of the worst.
Speaker 1:So those stories horror stories are building up. They're making the popular press and it's making people very wary about using these medications. In time, I think we're about four years away before the drug companies and the battle and the price war is over and where these will drop down to around about 50 pounds and where GPs will be telling people to take the injection. Know you're costing me too much for diabetes, blood pressure medications, statins for cholesterol etc. You know the healthcare costs for those people costing the GPs too much and the GPs will be encouraging people to take the weight loss medications.
Speaker 1:But at the moment we're in a perverse scenario where the drug companies are calling the shots. It is yes it is big pharma being evil actually. The pricing structures between America, The UK, Europe and Asia they're very different. You know, the manufacturing, the medications is not that difficult, production costs are not that high, but because it's a new medication and it's so effective, the companies are milking the cow. So I think the medications have a place to come in the long term.
Speaker 1:They are safe if they're used correctly and if people are monitored correctly. Again many of the patients I see they tell me I wish I didn't have to eat. I wish I just didn't have to eat and for me that nutritionally scares me that you know if that person didn't eat they wouldn't eat and they may end up losing too much bone, becoming anaemic, losing their hair. I lost mine it's not because of nutrition. You know drugs can be very powerful if inappropriately used.
Speaker 1:When you buy the medication from the pharmacy they'll say to start at this dose give it two weeks we go up to the next level we give it two weeks we go up to the next level. So the drug company wants people going up because they proved that it was safe at maximum dose and very effective. So there's this perception in the patient taking it that they need to be on the maximum dose. As I said some people are super responders they get very good results on low doses they don't need to go up and they certainly don't need to read the stuff from the manufacturer saying oh you've got to go to seven point five or fifteen milligrams. I encourage patients if they're paying for it themselves try it at a low dose.
Speaker 1:You'll find that hunger and appetite will come down a little bit and with nice smart monitoring of the diet, choosing the foods, the meal pattern, you can get incredible results with just two point five milligrams and you have a whole margin above to go up to. Nobody's pushing people to go up there except maybe the drug companies, or people that are really really really want those results and maybe not focusing and being honest with themselves that their diet could be improved upon. So I think they're here to stay cat and this will be an evolving thing and you're cynically amusing to see how it pans out over time.
Speaker 4:Yeah. I think I just find that a lot of people who obviously have had good success on them and then of course, the media, there's all the, you know, the moment you stop this, you will gain all the weight back plus x amount. Yeah, hard to know how best to advise people.
Speaker 1:That's absolutely true and what we're seeing from America is pretty much everyone within sixteen months sixteen months is the key thing that they will be back at the start wage. That is a bit terrifying and again I'm not sure whether it's underhanded sort of misinformation to make people dependent on the medication without looking at the diet. I've seen a lot of people go up to a medium dose seven point five milligrams get fantastic results they come down and we then talk about reducing the dose coming back down to two point five milligrams and instead of injecting every week surfing it. Go to a ten day cycle or even a two week cycle, week on and a week off. When the hypothalamus mafia thing starts getting noisy, go again.
Speaker 1:And that way I've seen a lot of patients able to maintain their weight loss at a lower dose, more affordable and actually learning how to manage hunger and appetite. And theoretically in five years maybe they can come off the medication completely. Really our information's two and a half three years maximum on those meds. So it is an evolving story.
Speaker 4:Yeah. I know that's really interesting. Thank you.
Speaker 1:And there's new medications currently being developed, yeah, on the black market. People are talking about them already on social media how fantastic they are. It's a very interesting part of weight management.
Speaker 4:Yeah, definitely.
Speaker 2:Thank you. Do you think, Scott, when it comes to I saw that there's a daily pill and it comes down to like you were saying that the people will take these and then the appetite will get nuked. What, you know, what have you seen in your practice? What's the dangers of doing that? So as a person who maybe has heard that I need to eat a bit better, I don't care.
Speaker 2:I'm gonna look good. Like my sister's my sis a colleague of my sister's who was a nurse lost her gallbladder, had to get it removed, right, but still says to my sister, I don't care. I'll go back on Mounjaro. I wanna get back the weight down. Kind of seems like wow, like you've just lost your gallbladder.
Speaker 2:What would you say to these people like, you know, to not what's the danger really? All the dangers.
Speaker 1:Yeah again we have to treat our patients on an individual basis. We can't really make any assumptions on how they're going to use the medication. We can only give the warnings and monitor them. Monitor the side effects, monitor the blood work, also monitor the diet as well. Something that really terrifies me personally is the risk of osteoporosis.
Speaker 1:That is really terrifying. The gallbladder issue's really quite common. We we see that in people that have done the yoga dieting. Again, eating handsomely, going on a diet, going back to eating, you know, handsomely on a diet. What that does is it progressively kind of overworks bile production in the liver and the gallbladder.
Speaker 1:And when people then get on the mother of all diets whether it's with Ozempic or Mounjaro, suddenly the gallbladder becomes unemployed because they're not eating that much. It's overproducing bile the bile in the gallbladder can solidify dehydration as well the people on majority sometimes don't drink enough bile in the gallbladder can then build up and block the duct or tube carrying bile out into the intestine causing damage to the gallbladder necessitating removal. So it could have been you know the history of weight loss weight regain that set that up and then the Ozempic or the Majora for your sister was the final thing. But going back to my initial comment, osteoporosis. Anytime we do lose weight, we lose muscle, we lose body fat and we lose bone sadly a little bit of bone each time.
Speaker 1:Now if everyone there makes a note go on to the National Osteoporosis Society UK and on there you'll find a thing on the banners at the top you want to look for a calcium ready reckoner or a calcium checker. So with that calcium checker it'll pop up on a page it will then do an enquiry as to what you eat, what foods you eat specifically looking for calcium rich foods, and it will give you a rating. It'll tell you how much calcium you're getting in your diet each day. Calcium is the mineral that the body needs most of all. It is number one.
Speaker 1:We need a bit of iron and copper and zinc and all that which are like this whereas calcium is like that. We need seven hundred milligrams of the stuff. Calcium is important for nerve conduction. Without calcium heart rhythm breathing rhythm falters a little bit. So the body will never let the blood level of calcium drop and if our food intake is not providing enough calcium each day our body will steal it from our bones.
Speaker 1:It's better to have osteoporosis than have a heart that stops beating. So this is one of the things of cycles of diet that during that diet we should be supplementing with a multivitamin and if our diet's not providing our seven hundred milligrams of calcium per day then maybe we need an x well actually a multivitamin and mineral that's what it should say on your product multivitamin and mineral when it says and mineral it's got iron copper zinc and calcium will give you an extra two hundred milligrams and that may be what everyone needs. But for me that is a worrying thing with the medications is that in twenty years from now we're going to have a tsunami of osteoporosis and older people just breaking wrists and femurs with the slightest bump. Yeah. That that is a that is a nutritional worry, and it's something that we really closely monitor in our patients.
Speaker 2:That's, that is quite scary, but it makes sense the body does it how you explained it. That makes complete sense. The body's fascinating.
Speaker 1:Are you able to send, links to everybody? Yeah.
Speaker 2:There's links in there. There's links. Claire's sent the link out already and Amy's all on it. Yeah. So go and do it, guys.
Speaker 1:I will actually get the web page now, and I'll put that up for you so you can all see that now. It's this is how do I write in here?
Speaker 2:Is it seros is this seros.org?
Speaker 1:Here we go. Found Get the chat. There we go. It's in the chat.
Speaker 2:Oh, there we are.
Speaker 1:Yeah. So it's that's from the Scottish University. That's not from the National Osteoporosis Society, but it is a recognized calcium checker from University of Scotland.
Speaker 2:Man, I I who was it? One of our members had 15 cups of tea a day. So
Speaker 1:Fantastic. 30 mil. That's a 150. Is it? Yeah.
Speaker 1:That's really a pint of milk, isn't it?
Speaker 2:I reckon I have 20 coffees a week probably. Tops of tea or coffee with milk. Milk or drink milk.
Speaker 1:150 mil. That's almost a pint, which is around about four hundred milligrams of calcium in the tea alone. Well done. Well,
Speaker 2:happy days. Yeah. Someone does this and gets their score. It'd be interesting, and if you got if you any of got time. We'll do a few more, Scott, if you don't mind.
Speaker 2:Esther, you're there. Few pops in the chat there. Might as well come on here. How are we doing? Hello.
Speaker 2:You you mentioned I seem to yeah man yeah you just tell us about that comment I suppose.
Speaker 1:Yeah I see I see your question there. So your digestion of dairy has gone off since you've had your gallbladder out. Very very common. The liver produces bile, fills the gallbladder. When we eat, food arrives in the stomach, and the stomach is really quite a clever thing.
Speaker 1:It can sense the proteins in the meal, the fats in the meal, the carbohydrates in the meal, and it lines up enzymes and bile ready for when the meal exits the stomach. As the meal comes out of the stomach, just out, the gallbladder is like a little bottle of fairy liquid. It squirts a little bit of bile, and bile's an emulsifier. It binds with the fats in dairy food and cheese and and the meats and things that we eat. And emulsification means that it just splits the fat molecules makes them much smaller and able to cross into the bloodstream quite nicely.
Speaker 1:So when people have a defective gallbladder they take the gallbladder out, they eat, the stomach does its digestion, communicates, tells the liver make me some bile, the liver makes some bile and delivers that into the system. I've seen this where people have takes time after the gallbladder to come out for the system to coordinate. Happens in some people, doesn't happen in everybody. It is a weird thing where dairy fats will just go straight through and you get urgency and a bit of flatulence and tummy gripes. Is that how it's going for you?
Speaker 3:Yes.
Speaker 1:And when was your gallbladder? When did that come out?
Speaker 3:It was the March 9 and I think I'd been having a lot of dairy. This year. Just before then. This year, yeah. I started to realize I I was perhaps having too much.
Speaker 3:I've never been able to tolerate lots of dairy. So I think I didn't help myself by overdoing it a bit, having protein shakes, that kind of thing, you know, whey based.
Speaker 1:Yeah. I think your system will eventually learn and coordinate the production of the bile and what you're eating, but it is very very common. I do see that a lot. But, yeah, your surgery is super recent.
Speaker 3:Yeah. Yeah. Would that be the same with fats as well, digesting fat?
Speaker 1:It the dairy fat. Dairy fat is really quite an interesting thing. It is one of the problematic foods for our digestive system. It's an irritant. So you might find that you're kind of alright low fat things like skimmed milk, even oat milk although the calcium in oat, almond milk and soy milk is not quite as powerful or not quite as dense as dairy milk.
Speaker 1:Yeah it's a good question. But I advise, you know, just go easy on the dairy foods for the moment. It will come in time. You know, experiment, explore alternatives to sort Alpro soy products. Yeah.
Speaker 1:It is disgusting stuff. Anyone who's got my flat cheese, forget it. It's not very nice. We're better off just eating a little bit less of the real thing. It's I'd like to think it's gonna come good for you, Esther.
Speaker 3:Okay. Thanks.
Speaker 2:Updates. Here's a interesting question for you, Scott. Is cryolipolysis, I think I've said that right, viable for permanently reducing the fat if you are a couple of kg from your goal weight?
Speaker 1:Uh-huh. Can you spell that, Scott? C r y o. Y o.
Speaker 2:L I p o l y s I s.
Speaker 1:Ah, yeah. Cryolipolysis. Yeah. So Cryolipolysis. Lipolysis means to break down fat tissues, fat cells, lipolyse.
Speaker 1:So it's where our body rips out the fat cells, breaks it down, puts it into the a thing called a mitochondria in the cell. It's like an engine. It produces a thing called ATP which is petrol for the human. Cryo is just a thermal thing cryogenic it is a cold treatment. Does it work to break down fat tissue?
Speaker 1:The evidence is poor, really quite poor I'm afraid. So freezing those lipids breaking them down does that disintegrate them and disperse them? No, the evidence is really poor. Sure you might get a bit of you know I don't know difference in the hardness of the tissue but is that what do they call placebo effect? No.
Speaker 1:The only way that we can actually lipolyse fat tissue is to break them down through energy metabolism. There are some metabolic boosters. There's a thing called dinitrophenol, which is completely illegal. It's nasty stuff. It does break down body fat tissue and it does that by turning up the thermostat in the human.
Speaker 1:As we all know we're about 37.5 degrees. You put the thermometer in when you're sick, go to hospital they check your temperature, we monitor people's body temperature. Some of those metabolic agents can turn up the thermostat so you're running a temperature of about 38 degrees. They discovered this stuff in the Second World War when ladies the men were at the war the ladies were in the factories packing TNT into the shells to fire at the enemy. They found that the ladies working in contact with TNT which is the explosive.
Speaker 1:They found that they lost weight. They were really slim and eating fantastically. They finally cottoned on that there's a metabolic effect of the TNT. It was absorbed through the skin. The company Roche Pharmaceuticals produced DNP, the non explosive active ingredient, dinitrophenol, and they promoted that in the 1950s as a weight loss medication.
Speaker 1:And of course there was people that would abuse it take too much and they died of a rise in temperature an uncontrollable rise in temperature multi organ failure and death. Interestingly it was last used in 2010 by two boys who are wrestlers trying to drop their weight for a competition. They got it on the black market, this thermogenic medication, and killed the poor guys. Really really sad. But from the cryogenic perspective, no.
Speaker 1:Weight loss again is the holy grail. If we can find something that is very effective for losing weight it would be on the front page of the newspaper and it is it's called Mujaro. It's called Ozempic. It's there. So these cryogenic and other laser light massage, wraps, creams, they don't work I'm afraid.
Speaker 1:They promise a lot. In fact the diet industry makes a 150,000,000,000 US dollars per year. That's on a global basis for pills, potions, lotions and things which promise a lot that deliver very little. The only things that are working are diet, lifestyle changes, surgery or weight the current weight loss medications of which there's been countless medications before to get to where we are with these medications and even still they have their drawbacks and their risks and dangers with those as well. So I think you know the cryolipolysis no.
Speaker 1:I wouldn't put my money in it and I wouldn't recommend it to a family member. No.
Speaker 2:So, no, I'm freeze myself, wake up, clean six pack. But it's interesting how there's so much out there, Scott, on, like, this supplement is the missing ingredient. Everyone here has been bombarded. We had questions in the first week. The supplements here, supplements there, supplements.
Speaker 2:Yeah. We tend to get very tempted by all the claims being made as if there's a missing piece like
Speaker 1:What do we do?
Speaker 2:Yeah. What's your advice there? Just ignore it all and just it's just lifestyle and diet. Is that your stance?
Speaker 1:Lifestyle diet. There's also again with that set point and you know the theory that it's going to take a year and maybe up to five years there's a couple of things that come into that and that is time. The longer we've been overweight the more resistant our body is to preserving that weight and we've got less metabolically active tissue. So again our metabolically active tissue is our liver, heart, lungs, brain, eyes all those good things those organs that need energy to power up but also our muscle tissue. So as we age our muscle tissue tapers off and our metabolic rate slows down.
Speaker 1:So, you know, if we've been overweight for twenty or thirty years, then logic would say it's gonna take a long time to reset that set point. But I think it is a mission. Personally, I still am 100% convinced. It is a mission worth embarking upon. And I think people are too cruel with themselves and think that, you know, it's their willpower, their education, their luck.
Speaker 1:It's it's just nature doing its business. We live in again in an unpredictable world of food threats and activity threats and stress which is another interesting point as well. Sleep. If we're not sleeping well that exacerbates the hunger hormones. Again if our sleep is not good quality sleep where we're dreaming or thrashing about and don't really get good quality sleep Cortisol levels which is a stress hormone they can measure cortisol that is increased.
Speaker 1:And cortisol is one of the steroid backbones of making medications like corticosteroids like prednisolone or even inhalers for asthma or you know nasal problems etc skin problems. They use corticosteroids in many cases. I've seen a lot of patients after steroid use come back having gained weight. That steroid made them hungry as hell and it is the cortisone backbone of the steroids that does that. So sleep is also a strong consideration of, you know as a weight loss intervention it's not going to win the day but it can help prevent the weight regain by cleaning you know what what the specialists called sleep hygienists who look at people's sleep patterns and coach people to sleep better that can be a thing.
Speaker 1:Other things you know medication wise as well I see a lot of patients with depressive you know ranging from mild to severe. Some antidepressants are very orexigenic which is a word that just means increases hunger and appetite to voracious levels. Anything that ends with a 'p'ine like quetiapine, mirtazapine, olanzapine those medications are really very hungry medications. Fantastic for mental health yes but can make it difficult to become full and stay full and we see patients on those medications looking for the next snack, looking for the next snack, looking for the next hit. So what I recommend to patients if they're on olanzapine, metazepine, quetiapine, speak with the GP and ask them if they can change the antidepressant to a thing called an SSRI, sertraline or venlafaxine.
Speaker 1:These are less hungry anxiety or depression medications. That's something that we do recommend a lot. It can work and prevent, you know, the weight regain after all the good work with the diet.
Speaker 2:Yeah. I know. Fascinating. Fascinating. And here's a here's a fascinating question for you actually.
Speaker 2:Two more for you as well, the way. Hope you don't mind. Yeah. What is your view on the trend of parasites controlling weight? And I do believe I've seen those AI claymation play ads talking about this supplement would clean out your parasite and will stop you stop it will help you gain weight.
Speaker 1:Yeah. It's very interesting. I don't know. I haven't really heard that.
Speaker 2:You haven't found the parasite in someone's body gone No. No.
Speaker 1:I think, again, it's another false promise. Certainly what we do know is the gut biome which is the bacteria, the good bacteria and the bad bacteria in our intestines, they have done studies on twin studies where they found and investigated why one is overweight and the other one is not. They looked at the gut biome and found that they got different strains of bacteria in the gut and you know the question and the hypothesis is is the gut driving hunger? And the answer to that is quite possibly so. So again going back to my slide about the hypothalamus and the weight loss medication, the gut sends the information to the boss.
Speaker 1:The boss then has to talk to you, the host, to either eat or not eat. So it is possible that the microbiome or the bacterial strains and the combinations in the gut can have an influence in making people hungry and there is that hypothesis when they did the twin studies. They even went so far as doing a thing called a faecal transplant. I don't mean to gross people out but, what they're doing, suggesting with that is a bowel washout of your poo and replacing it with the poo of your twin who is not overweight and thus transplanting the bacterium and sorting that out.
Speaker 2:Bloody hell.
Speaker 1:Bloody hell. Yes. So I haven't seen any recent studies and advancements in that theory and idea. But certainly, yes, having a healthy gut biome which again is where the fiber in the diet comes from having, you know, the fruit and the veggies and providing the right fiber for the bacteria in our bowel to be happy, the happy fiber, possibly that's where the parasite theory idea is coming from that feeding the healthy bacteria and underfeeding the bad guys may send a different signal from the gut back to the brain. And I think who was it asked about tummy grumbling?
Speaker 1:Yeah. There is a possibility. I have seen patients with grumbly tummies as well where they've had a thing called H pylori. I don't know if anyone's ever heard of that or had that experience. And H pylori is a bacteria that sets up shop in the human stomach, and we get that from drinking water or having a dodgy salad on holiday out of town or, it's it's a bacteria that inhabits in the stomach.
Speaker 1:It causes a lot of heartburn reflux in the stomach so we get this nagging, gnawing feeling in the stomach and I've seen patients that have unknowingly had this parasite in the stomach and the way they treat the discomfort in the stomach is by having another nibble. When they have a little bit of food it settles it. Twenty minutes later that uncomfortable feeling's back they have another bit of food it settles it. And I've seen people get into this habit of addressing this heartburn reflex y feeling by eating eating eating and keeping at bay. So we can test for that particular parasite in the hospital.
Speaker 1:It's called a hydrogen breath test where they give you a sugary liquid to drink and they keep you there for two hours and they just measure what's coming off your breath and if there's a presence of hydrogen then that guy is in the stomach. That parasite's in the stomach and we can give an antibiotic treatment eradicate it and then the heartburn is gone the person's in the clear. Oh, goodness. Yeah. Specifically advertising something to get rid of the hunger parasite in you and here is the magic thing in the box for $29.99.
Speaker 1:I I you know, I'm a bit skeptical about that idea, but there is possibly some evidence to suggest that where they're coming from might have some tangent of scientific proof there.
Speaker 2:It just makes you worried, isn't it? Because the word parasite like makes you think I get out of them and we're doing.
Speaker 1:And actually that's another interesting thing. In the nineteen thirties, in the days of silent movies, there were Hollywood starlets who had weight problems and also in the world of horse racing, jockeys back in the twenties thirties and forties would deliberately eat type a tapeworm. I kid you not and as a weight loss intervention people were given intentionally taking tapeworms. If anyone wants to go and Google that the history of eating it ingesting a parasite to lose weight, it is a real thing. So we've got both ends of the coin there, Scott.
Speaker 1:Eradicating the parasite or introducing the parasite. So, yeah a lot of interventions have been explored for weight loss. More recently some people that can't eat we put a tube through the stomach wall into the stomach and we feed patients that way they might have a throat cancer or some other issue of getting food in. So in New York I kid you not you can today you can Google this as well possibly go there have a feeding tube put into the stomach. You go to the restaurant with your friends, you have your three course meal, then you excuse yourself and go to the loo and pull out your little pocket pump hook it up to the tube and evacuate the stomach.
Speaker 1:So this is electric bulimia so it's not coming back through your mouth and damaging your teeth. And you can Oh, wait. As much or as little as the meal as you'd like. Clean up and go back to the dinner table. That is a real thing.
Speaker 2:Holy shit. What's the
Speaker 1:yeah. Go on. Sorry. In Brazil, they use another method as well which is also very controversial. They have in when people get a tummy hernia where a bit of tissue ruptures sometimes they're very difficult to repair.
Speaker 1:So the surgeons use a thing called a mesh which is just like a biocompatible like a fly screen mesh. And they sew it in and attach it and the tissues grow into it and the hernia repair stays fixed. What they've done in Brazil is take a small piece of this mesh around about this big and sew it to the tongue. This is a real thing. So what that does is with this mesh there it stays in for a couple of weeks and it makes eating so painful and it can actually lacerate the mouth so that eating salty foods and sharp foods are so uncomfortable people just don't eat.
Speaker 1:It is it is a thing.
Speaker 2:We try everything.
Speaker 1:The history of weight loss interventions is you know it's been explored hugely and again a lot of those sort of bogus things that we see in the back page of the Sunday Times or magazines, pull out magazines, no they're not going to work.
Speaker 2:Wow no They're
Speaker 1:part of the £50,000,000,000 a $50,000,000,000 snake oil industry.
Speaker 2:They're making big bucks. They got so much ammunition to make you buy something aren't they?
Speaker 1:Yes and you know when people when it doesn't work they tell the person there's something wrong with you, it's your willpower, you know you didn't follow the program, you're a screw up and people are willing so willing to accept that there's something wrong with them I'm a bad person and to me that breaks my heart it sucks it's it's not good. No
Speaker 2:no way.
Speaker 1:It's that biochemical mechanism that's in us that's that's what we're up against which is very we can't beat it. We've got to work cleverly with it.
Speaker 2:That's amazing. It makes a lot of sense. It makes a lot of sense. Have you read the book The Chimp Paradox?
Speaker 1:I haven't. No.
Speaker 2:You'd like, because it's kind of the same concept of the the chimp mind and the human mind and the computer. One of the things that does, like, mindset chats with us, he was one of the guys that helped professor Steve Peters write the book by a similar concept. So you can't beat the chimp. Chimp will destroy you, you know? Mhmm.
Speaker 2:You gotta keep the chimp happy. So, yeah, it makes it makes a lot of sense. There's a last question here for you, Scarce. Sam is asking, what do you think about very low calorie diets for reversal or like remission of type two diabetes and obesity, and can it harm your metabolism by doing so?
Speaker 1:That's a really very good question. Quite controversial. My answer is probably controversial as well. The very low calorie diet does work as we know. It's a drastic energy reduction.
Speaker 1:Yes, when the calories are not coming in metabolism, the show goes on. And yes, our body will reduce its metabolic rate by reducing our muscle tissue in an effort to resist fading away under a very low calorie diet. When they use a very low calorie diet VLCD they are generally under 800 calories. The micronutrients are not there. Some of them do they put in vitamins and minerals into the meal replacements.
Speaker 1:You're still advised to take a multivitamin and mineral. They are monitored. They do the bloods to make sure that people are not slipping into anemia, b12, vitamin d deficiency dropping. And yes, they can improve diabetes checks which is the blood glucose long term check. They can reduce blood pressure.
Speaker 1:They can reduce cholesterol. That's not a function of the diet that's a function of weight loss. When we lose weight we're kind of really in reverse metabolism so fat and cholesterol is built up in the liver is being stripped out fat and cholesterol in the bloodstream is being stripped out. The body is producing its own glucose in view of an energy deficit so blood glucose control is improved hugely, but the results are only as durable as the weight loss. So the results are linked with the weight loss.
Speaker 1:The low calorie diet induces the weight loss but it doesn't technically bring about the changes or the improvements. I've seen low calorie diets sold to the NHS under a couple of different contractors who have gone to different boroughs with their low calorie diet and said to the borough I'm going to fix all your diabetic people in your borough. I'm going to get them off insulin for a start. Know if you can reduce somebody's need for insulin you have about a £5,000 a year saving to begin with. If you can then reduce their medications, blood pressure, cholesterol then you have an improved life expectancy of anywhere up to ten years.
Speaker 1:So everyone's happy. GP's happy, patient's happy, the taxpayer's happy. But the problem with these very low calorie diets they've rolled it out, done a two year follow-up and then said okay you're on your own and sadly people put the weight back on, the diabetes comes out of remission, it comes back active again, the cholesterol goes up and the point is did the diet achieve anything? No. It gave people a period of remission which is good but it's not a long term solution I'm afraid.
Speaker 1:And again it was sold to a lot of NHS you know the boroughs because ultimately our borough is responsible for health care in the borough. They're the people who get the money to give to the GP practices to look after the patients. So it's in the boroughs interest. So a lot of boroughs did sign up to this very low calorie diet thing and again it's not a new thing. It's been around for a long time but it's come and gone come and gone.
Speaker 1:So depending on what area and who bought it recently it might have some legend of effectiveness but again the question is can it be sustained in the long term and do the people keep the weight off in the long term and I don't mean to be pessimistic but the evidence for it is not good Not good at all.
Speaker 2:Makes sense. Slim fast, think I've seen. Slim Slimming world as well.
Speaker 1:Yeah. For the wedding photo, for the movie scene, for the photoshoot. Yeah. Very impressive. But the best diet really is the one that we can do forever and not do our head in.
Speaker 1:When a diet's doing our head in, it's as soon as it starts doing our head in, it's broken. It's over. We throw it in the bin. We hate everybody. We hate ourselves.
Speaker 1:We're going over eat and bang we're back at set point. So, you know, I think weight stability, be kind on ourselves. You know, if you're not losing, not gaining, it's still worth a huge round of applause. It's it's a good thing.
Speaker 2:I love that because it's not celebrated enough the old, maintenance within a few kilos of your Zynga. It's not celebrated at all.
Speaker 1:Yeah and just to sort of demonstrate that you know if anyone tuned in tonight come and grab some photographs of yourself a few years ago and look at them and think you know wow actually I looked alright if I could have put it on pause. Yeah. Everybody but
Speaker 2:No, no. Well I have got more questions Scott but I think we've got more calls in this challenge with you which I'm I'm thrilled about because there's so much knowledge there that we can get out of you. And, people are commenting saying it's been really informative and interesting and insightful. So, like, thank you for doing this call. I appreciate it.
Speaker 2:And
Speaker 1:You're welcome. I actually like what I do. I like the patience. I like the experience, and I like weight management. And I get a I get a half glass full approach to it.
Speaker 2:Yeah. No. It's been awesome. And it's it's good that we got guys like you because, otherwise, the other advice out there is, like we said, like we've seen on here, is a very low calorie diets, no real care long term, quick results. So everyone listening is like, we we are banging the drum on slow progress for many years.
Speaker 2:I think a lot of people get it, but the human mind is so drawn in for quick results. So maybe that is it. Maybe it's this. I'm doing something wrong. And I I'm not gonna mention names, but I'm gonna ask me going, oh, you know, when when we went a bit quiet on some challenges, they went to other other communities, and it was just, like, you know, crazy stuff and finding answers, but the answer's always slow and steady, be kind, slow, slow.
Speaker 2:So, yeah, it's interesting. But when when we we plan the next call. We'll hopefully do it in a few weeks, but everyone else is listening on on replay listening. Please have questions ready so we can next call, can do Scott, we can either cover a theme that's asked very commonly or just do a q and a.
Speaker 1:Yeah. Yeah. That would be good. Amazing. Thanks for having me.
Speaker 2:Amazing. No problem. Thanks for your time. And everyone else, thanks for spending your evening learning. These make a big difference.
Speaker 2:See you all tomorrow.
Speaker 1:Thank you. Good night, everyone.
Speaker 2:Good night, everyone.
Speaker 1:Bye bye.
Speaker 2:I gotta learn how to stop this now.