5 foods to lose fat, regulate your appetite and improve your metabolism without counting calories | Dr Federica Amati

I'm Dr. Rupi and on this show I help you feel more in control of your health through food and lifestyle medicine. On paper weight loss sounds simple, eat less, move more. But in a modern food environment that is distorting our hunger signals and food choices, it's not that straightforward. And despite what the diet in fitness industry tells you, calorie counting is not always the best option and learning to build plates that naturally regulate our appetite is a skill everyone should know. To help me unpack this is medical scientist and registered nutritionist Dr. Federica Amati. We explore why ultra-process foods disrupt our appetite. Five key foods that improve weight control and her top tips to protect your muscle, bones and prevent nutrient deficiencies if you're considering weight loss medication. And she writes about this in her new book The Appetite Reset. Today's show is a must listen for anyone who was to improve their metabolic health. Lose weight if you need to with a joyful approach to eating more food rather than restricting it. Dr. Federica, what is the healthiest way to lose weight and keep it off without counting calories or taking drugs? The best way to do it is to actually just eat more whole food. We've become obsessed with calories and counting calories and a lot of people who struggle with their weight or who try to lose weight quickly just fixate on the calorie counting and forget about what food those calories are actually bringing you. And from all the physiology we know everything we understand about appetite hormones and hunger and weight regulation. What's really clear is that the best way to achieve and maintain a healthy weight is to eat to the right foods. So a lot of the time it's really helping people to increase whole food intake because our food environment right now pushes us more towards convenience foods, drinking our meals or eating calories from foods that aren't whole foods. They're highly processed foods or they are food products as I like to call them. And so actually just helping people to edge their way back towards eating whole foods is the simplest way. And rupee it's funny because I often when I work with people one-on-one and especially sort of perimenopausal or women in their 40s and they are struggling with weight gain and they are like, please help me and I say to them, you need to eat more food. I'm like you need to eat more and they're like, I'm sorry, but literally their face, look there's a sort of slight twinge across their face which is like, is she okay? And it's really hard to embrace that when our diet culture has propagated this myth that you must eat as little as possible if you want to shrink. Why is it that switching from food like products to whole foods actually leads to people losing fat? So there's lots of mechanisms, right? So some of the work that we've been doing at say with Professor Sarah Barry has been looking at what parts or what sort of qualities of ultra-process foods are actually driving the ill health that you see in all the epidemiological studies where the highest UPS consumption is consistently associated with worse health outcomes across the board from mental health to metabolic health to fertility. So what we wanted to see is like, what is it about these foods actually? Because they're so, it's such a big bucket, right? So what is it? And the key themes seem to be energy intake rate. So how quickly can you eat them? If we take a really obvious example of, say, eating whole nuts, so say you've got yourself some mixed nuts, almonds, walnuts, you know, all this stuff and you're eating their whole. And then you buy a nut bar, right? Inheritantly, that means they might have very similar ingredients actually, but the way that the nut bar has been processed makes it so much easier to eat quickly. So your intake rate of the same calories fat is very different if you're eating the whole food. That's a really basic example. But you see that across all sorts of things, one of my favorite examples is like take a corn on the cob and then take a tortilla chip. Take some time to eat your corn on the cob and it's going to be pretty satiating, but you can go through a whole pack of tortilla chips pretty quick. So energy intake rate is important. When that relates very closely, both to energy density. So how many calories per mouthful do you get in these foods? And it tends to be higher for ultra processed foods. And also the food matrix. So the structure of the food, how are these nutrients encapsulated in the natural structure of the foods? This applies a lot to plant foods. Interestingly, it also applies to dairy foods. So food structure and dairy foods is different when you're comparing, for example, butter to cheese, which have actually pretty much the same saturated fat content. But the way the food matrix encapsulates it, saturated fats means that the impact on your health is very different. Let's dive into that a little bit. Because I think that will be quite shocking for a lot of people to think you've got exactly the same dairy product, same saturated fat, but cheese seems to be better for you than other dairy products like a new milk. Yeah. And especially I think butter is the good comparison, because it literally in terms of macronutrient is the same. And the way that the fats are encapsulated in the cheese, because of the fermentation process of the milk, means that you don't actually access the saturated fats in the same way when you digest them. On top of that, you have the fermentation products, the amino acid composition of cheese, which is different. So when it reaches your gut, you absorb it differently, but you also interact with your gut microbiome very differently. But it doesn't really do much for your gut microbiome. So this idea that back-of-pack calories, it doesn't really tell us anything about the food matrix. And it's a really critical part of how our body interacts with absorb nutrients from food. And it goes a long way in answering why whole foods have such a powerful effect on healthy weight regulation, on having a really lovely satiating meal, and not feeling hungry all the time. So destruction of the food matrix is a major issue when it comes to ultra-process foods, and combining that with the energy density part, this energy intake rate is what we clearly see as a problem, even in the RCT as like Kevin Hall's study. When he did the RCT of UPF versus Whole Foods, one of the major drivers of the weight gain in the group who sort of ate the UPFs was the speed at which they could consume about 500 extra calories a day. Which is a lot. Without feeling fuller. Right? So that's one aspect. Then the other aspect which is really important is additives. So we do know that additives in ultra-process foods have varying effects on health. It's that I reckon for me, it's like the element of ultra-process foods that is we're still uncovering. There's a new study published every week on the effect of a specific additive or the effect of what we call the cocktail effect. So actually additives that are thought to be pretty harmless when combined with another five additives seem to have a negative impact. That is something that we're unraveling continuously. So we're working with food additive experts who are continuously updating our database to see actually like this one's position has changed. This one has changed. This cocktail effect has been identified. So that's really interesting and also a bit scary. Yeah. Because it's xenobiotic effects. So these chemicals that we didn't evolve with that are created as part of the food product and the food industry. And we don't really know what they're doing. And we don't know what they're doing together either. So additives is something to keep an eye on. But again in the same breath, some additives are really helpful. If you're fortifying plant milk, that's an additive. And it's really good to have that fortification. I mean in the UK we have an issue with a lack of fortification for things like folic acid and iodine that cause real public health impact. So we mustn't conflate all additives into one big ugly bucket. Different additives have a different role to play. And they can be harmful, harmless or beneficial. So that's something to bear in mind. And then the last piece is like hyper-politability. So this is not as exact a science as energy integrates. But it's a clear signal like the science is actually I'd say it's pretty convincing that the way that these foods are processed, they are made to be much more delicious than you would find in a whole food. Basically. So this combination of fats, sugars, carbohydrate source, they interact in a way that makes them just irresistible to eat more. So they override our normal satiety signaling when it comes to what we call cephalic satiety. So our head are taste how that influences the signals that we send our brain to be like yeah we've had enough. The hyper-politability seems to override that. So once you properly just can't stop is like a biological reality. And so when you get those those things combined you have this this gradient. So what we've called it the Zoe process food risk scale and it's a like understanding of which foods are processed but actually they're likely health impact is neutral. And then which foods a process in a way where their health impact is likely to be higher risk. So, you know, food processing has this real potential to make things affordable, shelf stable and accessible on one hand. But on the other hand, it has the potential to become make food irresistible, overriding your satiety signals, and so extremely profitable. And as much as I have spoken to and I know of some amazing food companies that make great products, but it's undeniable that the underlying driver for the food industry in this country and countries like the US is profit. So, you know, there was a tortoise media report that came out maybe two years ago now, I guess, that identified that about 70% of food companies in the UK only make UPS. They don't make any sort of whole food adjacent or just convenience processing where it makes things more accessible. So, you know, policy has to play a role here. We need the government to be like, "Hey guys, let's like moderate this food environment." So, actually, we have a variety because at the moment it's actually stacked towards profit against public health. Hey, it's Rupi. We're going to take a quick break here to hear from sponsors who keep this show completely free for you. I'll lovely listener. It's a really important point you're making just to caveat this entire conversation. Whilst we are going to be talking about whole foods and move to more fiber, etc. It is easier to say than done, particularly when you're up against a marketing machine. That is constantly bombarding you with messages about convenience and price and all the rest of it. And I think in an era where a lot of people are experiencing financial insecurity, it's like the only viable option in a lot of cases. But there are solutions that we're going to talk about in a bit. So, just to sort of summarise the ultra-process food or the process food issues. Energy density per gram, there's the speed of consumption, the food matrix, which is disrupted, palatability, which I completely, I'm guilty of popping and not stopping myself and overriding the satiety signals. I want to pull on the thread of additives a little bit more because I think this is an area of confusion for a lot of people no matter how educated you are in nutrition. Which additives do we know are genuinely, you really want to stay away from them as much as possible versus some that are like, might be bad, might be alright, might be safe. And then what are some sort of rules of thumb that people can utilise when they're looking at a product turning over the pack and going through okay, I'm going to put this back versus, you know, this is probably going to be alright. Yeah, do you know what? It's such a good question and it is really hard to answer because the science is changing so rapidly. So I recently, it's a recently in Nutri-Netsante, which is a group in France that do a lot of research on additives and health outcomes. They publish the paper and in one of their cocktail effects analyses, they identified a C-tic acid as one of the additives that seem to have negative effects when combined with four added others. It's vinegar, right? Yeah. I was like, oh my god. So here's the thing, right, repeat it's, it's not about fixating on one additive because I think, whilst there are some that come up as being probably more harmful, more than not, so like CMC, which is the emulsifier. What we need to try and think about is okay, we don't know enough about these additives on an individual basis and we definitely don't know enough about them when they interact. And the evidence we have shows that people who consume the most additives in general have this much increased likelihood of cocktail effects. And it's this cocktail effect, which for me is like a red flag. It's, you know, we just don't know, not of our seat one food at a time. A meal is composed of several foods and your day contains dozens of foods and then your week, I mean, you carry on. So for me, it's more about okay, where you purchase foods, if there is a really long list of additives on the back, I mean, emulsifiers for me is a group that comes out as being mostly not great. There are some exceptions where some emulsifiers actually seem to have a beneficial effect on the gut microbiome, at least in like initial preclinical or small clinical studies. But overall emulsifiers, for me is like, they seem to be interacting with our gut barrier and I've got microbiome in the way that's not looking positive for most of the outcomes. And certainly, you know, now in the guidelines for people with IBS or IBD, like one of the approaches is to reduce emulsifiers in the diet. So like a clinical guideline. So that's a sign. But try to look at your overall consumption of foods that contain additives as a whole. And when you do that, just try to reduce that risk of the cocktail effect because we just don't know what's going to come out with these combinations. And this is very similar to how I think about supplements, right? Additives and supplements, these are bioactive compounds. So the more we kind of mess around with them and mix them all together, the more likely that we're going to have interactions that we're not expecting. So just be really like targeted with what you're doing. So if there are certain foods, I'll give you an example, I drink soy milk, I drink fortified soy milk, right? That fortification is additives, but they're for like a purpose, they're therefore a health benefit. But when I go to purchase other foods, I try to stay away from foods that are prepared for me in a way that then has a lot of additives. Now there are brands now that use less additives, less emulsifiers, less colorants, less sweetness. You know, it's these kind of what I would call cosmetic additives that say they're not there for fortification, they're not there to add any nutrition to the product, they're therefore look, mouth feel or sweetness. They're the ones that I'm going to just reduce the overall quantity where you can. And so what does that look like? It's like, well, if you're buying a sweetened yogurt, just buy the plain yogurt and then sweetened it at home. And I know that's adding an extra step, but it's those small kind of tweaks. That means that your overall intake is going to be reduced. And we're also moving you away from the industry process products to the more kind of whole food adjacent group. So my overall take is instead of fixating on one type, it's like try to reduce the cloud with the cocktail effect of the quantity that you're consuming because similar to the UPF studies, it seems to be those who eat the highest quantities of these products or chemicals have what's worse outcomes compared to those that just eat less. So like a rule of thumb. And I know that we are brushing this very broadly is to try and go for those one ingredient foods that you can actually recognize on the fresh food aisles and lessen anything in a pack. Now I know there's lots of caveats with that and there's a lot more nuance because there are some companies doing a really good job of removing them all supplies additives, etc. But generally you want to be moving in that direction. Yeah, ideally you're moving towards whole food products and then when you're moving to products that are prepared for you, whether they're frozen, tinned, canned, that's all great. Convenience is still good. Not everyone has time to soak their chickpeas last night. And then when you're buying products like a plant-based milk, fortification is a different bucket to cosmetic additives. So just try to understand like what are these additives there for? If they're there for shelf stability and to create a product that has added B12, so fortification, that's actually okay. And I'll give you a score, a cast it. I love it when people are like a score a big cast it's like yeah, that's what I'm in C. Yeah. It just gives some shelf stability to your tomato sauce, right? So there are some that are just actually derived from foods normally and aren't to worry about is the cosmetic ones that are more like let's just reduce them. Yeah, we don't need things to look bright blue or like you know you don't if you're buying a product that's like low fat no sugar, did it say it's got lots of emulsifiers, lots of other sugars like what is that product and could you just opt for the minimally processed version? And that is typically things like yogurts, desserts, it's things like I've seen low fat sugar free biscuits and I'm just well I'm not sure what we're achieving with that. So there's also this this we need to take a step back and say do we need this in our diet does this need to be a regular part of our diet? Because whilst the biscuit is great are you best off just having the biscuit you like? Yeah, when on occasion as opposed to buying the low fat low sugar biscuit thinking it's a health food and eating that more regularly and then getting this cocktail effect from the biscuit which we don't know you know how that's impacting your health. So it's also about just really reframing what the role of food in our lives and how we approach food as a tool for good health instead of an enemy that needs to be defeated with like weird modifications to it. Yeah, I think everyone's looking for a cheat and those sort of ways in which they can have their keg and eat it literally. And I think we just need to be pragmatic and realistic about removing ultra-process foods in your diet and moving towards whole foods as the strategy rather than trying to tweak something that you're already consuming because you like the flavour of those. Okay, so you've got ultra-process foods here. The reason why these can lead to weight gain and removing them all at the converse. I'm sorry to interrupt you, but it's not actually about focusing on removing is going to be really hard. Okay, so what I recommend and what seems to work well is focusing on what you need to add back in. Because if you're like, "Oh, I've got to stop eating my, you know, ready meals, I've got to stop eating this and I've got to stop, it's really daunting." And you're like, "What am I going to eat?" So instead, it's like, no, focus on what you need to eat more of. There are some whole foods that we know are lacking across our diets. Beautiful analyses that are done by extentscientists, not me, who's sort of waded through all the global disease, burden of disease data, and collated these beautiful graphs that tell us which foods are lacking from our plates that are driving disease. And it's one of my favourite graphs to show my medical students because what you see is that the impact, the biggest impact on death and disease from cardiovascular disease, cancer, type 2 diabetes is had by what's missing from our plates. So a diet low in whole grains is the number one driver in terms of dietary factors for death and disease in Europe. Isn't that amazing? That's crazy, isn't it? So what I'd love people to do is actually, I'm going to reintroduce whole grains to my diet. Let's forget about all the influences that scared you off your porridge. It's so wonderful. They're a great whole grain. Well, I Tim. Yeah, he's back on the porridge wagon. He never went too hard for porridge. No, it's literally like oats are wonderful. Let's just, whole grains are so important for human health. I can't overstress it. And we have loads of clinical trial data, by the way, where we feed oats for the breakfast in the morning. Two people were type 2 diabetes and it improves like actually it control. It's amazing, right? So like whole grains are number one. And I often say what's your favourite whole grain? People were like, I don't know, because we've lost them in our supermarket. So we've got to bring them back. I've started seeing now, parboiled spelt packets, right? Great. Spelt, quinoa, it's had a massive blow up and peyote, so it can be quite expensive. Bali, Bali is one of my favourites. I was literally going to say, "Pah-Bah is my favourite" because it's got that slight chew to it and it's like, "Volume-mercin." It's really nice. It's so great for you. So there's lots of different options for whole grains. Bring those back in. Yeah. And then again, so we're focusing on adding that back in. Add some nuts and seeds back into your diet. Add in things like fresh fruits. Again, massively demonised, fresh whole fruits are, I still see some crazy stuff online that about how the fructose and the fruit is going to kill you. Eating fresh whole fruit is one of the best ways that you can reduce your risk of having heart attack. Or having heart disease. Fresh whole fruit is so good for you. Have that back in your diet two or three times a day. People are like, "Really?" I'm like, "Yeah, really?" Like, "Berry's in the morning, an apple with your lunch, and then maybe a fruit salad with your dinner." Whatever way you like to have it. So there are some key food groups that we know are lacking from our plates. And if we can just help people to reintroduce those, legumes being the other one, which now, thankfully, are having a bit of a revival because of some cool brands that are making them really cool again. But you know, your lentils, your beans. And yeah, baked beans are fine if that's the way you like to eat them and that's your starting point. Like, let's get that in. So if you focus on that, the UPFs tend to fall off the plate because we only have a limited amount, like we have a certain amount of food all year every day. And so what I find with patients, but also with people just more generally, is if we're focusing on adding things back in, the foods that aren't serving us so well, fall off the plate. And it's a much more achievable, it's a positive nutrition mindset. Totally. About adding things back in, more achievable, more joyful, and is less fear-based because the issue with the like reducing UPF narrative is also that you can drive anxiety where you then start to really worry about is this UPF. I never forget one woman messaged me on Instagram. She was really what she'd gone really worried about shopping in the supermarket. And she was like, can I buy butter? Is that UPF? So you're like, okay, this has gone way too far. So let's just focus on what we need to eat more of. Be aware of UPFs, knowledge is power, being aware of how they're marketed, and the role they're playing. Once you see that, as you can't really unsee it. And so those two things together, like the awareness piece, the slight rage at the marketing machine, and then the what foods do I need to add to my plate together, push you towards a more healthy diet. I love it. So adding more Whole Foods to your diet, one very clear way of improving one's weight without having to count calories. Obviously when you increase Whole Foods, you're going to be increasing fiber. Yes. What is it about fiber that is so critical and impactful for fat loss? Yeah, I'm a gosh, I love fiber. So fiber has like multiple roles to play. So the first thing is what you touched on at the beginning, which is about the volume of food. So high volume foods, kale, cauliflower, broccoli. They often have a great Fibrous Food Mate Tricks. The importance of high volume, high fiber foods is that when you eat them and they hit your stomach, they create volume in your stomach, they stretch your stomach. And we have stretch receptors in our stomach, which are the second actually stop for satiety regulation. So the first is like what happens in your brain when you see food and smell food and you taste it. And we'll touch maybe on this later, but the importance of preparing your own food and actually handling it and spending time with it instead of just eating out of a packet is why that impacts that first step. The second step is the stretch receptor in the stomach. So when we stretch our stomach, it sends nervous signals back to the brain to be like, we're here, we've got some food in here, we're going to start dealing with it. And it starts to dampen your hunger signaling. And your satiety signal starts going on. So fiber is really important for that. Then as your stomach empties, that gastric emptying is actually slowed by high fiber meals. So it takes a bit longer to go into your small intestine, which means the food and the nutrients within the food take a bit longer to just pass in, which a increases nutrient absorption. So it gives your small intestine more time to absorb some of the nutrients in. And b, it means that you have that stretch receptor activation lasting longer, because the stomach isn't just emptying straight away. So if you're drinking your lunch, you can imagine that's not happening. Right. Okay, then it goes through the small intestine, did you lots of nice, nice interaction with a small intestinal wall, take some nutrients in, and then the fiber reaches the colon, right? So in the proximal colon, you then have this really lovely group of cells. And they are like the interic cells that produce hormones like DRP1. And they are waiting. They're like, what's happening? What's coming? Again, the fiber then transports fats. So especially with foods like nuts and seeds, you then have this beautiful presentation of fatty acid to the enter-interic cells. We're like, hey, here's the, and they're like, yeah, you're the reason you like your wife. So that's straight after the small intestine. And then as you go through the colon, there are specialized cells throughout that are designed to interact with both the nutrients being presented to them and to the metabolites of the gut microbes that break that fiber down. So maybe just as a quick recap, we don't have the genes that code for the enzymes that break fiber down. So humans cannot break fiber down. But we have trillions of microbes that do. And those trillions of microbes love fiber. Now, the ones that love fiber are the helpful guys. There are also a bunch of microbes that can adapt to digesting things like carnitine, fred and red meat or saturated fatty acids. They're not so helpful. Like, their metabolites are not very good for maintaining our gut health. So we want to feed the good guys lots of fiber because they'll break that fiber down and they'll poo. That poo is the metabolites and they either go to feed other microbes. So there's like secondary feeding. And then those metabolites in cells like short tape fatty acids feed the entire cells. And they sort of say, hey, look, we've broken down some cool fiber, which has given us vitamins, neurotransmitters, given us short tape fatty acids, send more satiety signals back to the brain to say that we're still working with this food. So from the moment you eat, see, smell, eat, taste, through the dystamic number two, small intestine number three, colon number four, you have a four stage appetite system that is wired to make the most of fiber foods and to give you satiety signaling from fiber foods. Why? Like, why have we been built in a way that if you eat a high fiber diet, you're basically full for three hours after that meal? That's because of evolution, right? So we evolved as a species that [BLANK_AUDIO] and eight roots and berries and nuts, and really the majority of our diet was this very tough, very fibrous foods that we had to work quite hard to find. And so our entire physiology is there to support us, being able to do that for quite a long time. So like, we also extract really useful energy from the fermentation of that fiber, right? And to make sure that we can live and function and reproduce, with access mostly to high fiber foods. So when you think about it in that context, right? You realize that fiber has such an important role because we literally evolved to survive with quite a lot of food scarcity, but the majority of that food being very fiber-rich. And that is why we have these strains of gut microbes. We co-evolved with them so that they can provide us with some of the nutrients that we're not getting from not being able to break the fiber down ourselves and make those metabolites. I mean, you know, things like vitamin K and vitamin B12, they're made in the gut for us. How cool, right? So it's like, when you start to think about fiber that way, it's got so many actions in the way that it actually physically changes our digestion, the rate, the speed at which food passes through. And then importantly, also the rate and efficacy at which it lets us excrete the products we don't want. So if you have a low fiber diet, your gut can get very sluggish at actually excreting the things you don't want, including cholesterol, right? That's one of the major ways to lower cholesterol. But how food is, how nutrients are presented to our inter-exels that absorb nutrients and respond to nutrients? And generally, like just so physically, biochemically and microbiome, all have a role to play with wi-fi-vera-stone potent. And it's often, for me, it's often the most satisfying thing is when you help someone adopt a higher fiber diet. Not only do they say like, how much better they've got feels like being constipated ain't cool. Doesn't feel good, right? But then they also talk about how much, how much more energy they have, how they just don't need to snack anymore. But it's liberating. When you eat a higher fiber diet, it opens up a new world of how you can feel as a human being. And so for me, it's like, it's a magical thing to witness when someone makes that change. And I mean, my mom, I love my mom. She's a legend. And she was, she's my best patient, right? So she used to have a really low fiber diet. And then she had a health scare and I was like, right, that's it. Your patient's zero from it. Let's go. She transformed her, transformed her diet like night and day. And she was scared of eating most vegetables and then she was like, I would never eat lentils and I can't eat mushrooms. So she was one of those like she just couldn't tolerate it. And now when we go and stay with my Italian family, she'll like make herself like, lelental and kale and keel for like breakfast. Yeah. And my aunt is like, what? That's great. And she's just transformed her health. She is in such better health now in her 70s than she was in her 60s. And the pivoting to high fiber was an absolutely fundamental part of that. Yeah, it sounds like such an unlock for so many people. And if someone's listening to this and thinking, look, Dr. Federica, you've convinced me, I'm going to up my fiber. A, should we be aiming for more than 30 grams? And it's so how much? And what are some of those key foods that are lacking in a typical person's diet that can actually move the needle considerably for fiber? Yeah. Okay. So really important point to start with is that the majority, vast majority of the care adults are not getting anywhere near 30 grams. So the statistic that came out from last year's survey, 96% of British don't achieve 30 grams a day. But crucially, most people are getting around 15 to 18 grams a day. So the start, we've got to think about the starting point because if you go from 15 to 30 overnight, it ain't going to be pretty. So start, think about where you are and increase gradually. So start by adding five grams a day. Now that might be through a supplement or it might be by introducing foods like lentils, but quite a small amount so that you can get used to it. So typically with patients of mine who have very low fiber intakes, I, I have a dual approach. I'll say to them, take the supplement and then start with these foods and then let's see and then we'll remove one and add the other. You have to do it gradually. Now the reason you have to do it gradually is because if you've got microbes are not, haven't been fed. So if you think of your gut microbes like a zoo and you haven't fed them frages, right? They're really tired. They're dwindling. They might be dead. And then you chuck loads of food at them. It's just going to sit there. Yeah. Right. You have to start feeding them solely again so they can repopulate and multiply and then handle the lentil. If you just chuck a load of lentil down, you're going to get constipated. You're going to get flatulent. No one likes that. So gradual increases. If you have a sensitive gut, I think what I hear a lot is people who really stress about not getting enough fiber who have sensitive guts. There are ways that you can introduce fibers and focus on specific foods that are gentler for those kinds of guts. So if that's you like it's worth speaking to nutritionist or a dietitian who can help guide you, a low-fod-map diet is a short-term intervention. It's not a long-term dietary approach. So important to point that out. But there are ways that you can do it even if you have a sensitive gut. And so start slow. Know where you are. Remember that things like coffee and dark chocolate contain fiber, which is always joyful. And then once you get to 30 grams a day and you can track it by using a logging app. I mean, of course Zoe, we have a photo logging app that helps you track fiber and plant intake. But there are others and you could do it manually if you wanted to if you had the time. And then once you get to that, actually the study is that look at dose response for fiber 50 grams. You're still seeing improvements. And there's one study that had 90 grams. 90 grams a day and you still saw improvements. So I don't we don't know or I certainly haven't seen data to suggest an upper ceiling for it, which is crazy. But what we have done, what Tim's research shows is that 30 plants a week, it seems to be a really good point, inflection point for improvements for gut microbiome composition. And that starts to sort of flatten around 45 plants a week. So whether you're looking at grams per day or plants per week, both of them are delivering on a fairly similar effect in terms of like introducing diverse to that feed in the gut microbiome. But I think the foods to focus on because this is where a lot of people get a bit stuck. They're like, well, if I'm eating an apple, some cucumber, some pepper, some salad every day, like surely I'm getting close. And maybe I have some broccoli for dinner. It's like, well, no, because actually some plants don't have that much fiber in them. It doesn't mean they're not good for you. Important to point this out. But it just means that you'd have to a large volume of them to get a decent serving. So the five food groups that really contain a really nice punch of fiber, and it's funny because they're also at the base of the Mediterranean diet. And they're also the five food groups that are lacking from our plates and driving disease, our whole grains, nuts and seeds, legumes. So that's the entire like the pulses in legumes family, fresh off fruit, specifically things like berries, pears, kiwis, that are higher in fiber. And then brassicas. So like your broccoli, your cauliflower, your broccoli sprouts, if you're like really going for it. If we can increase them every day, so if we try to get some of those five every day, you'll be getting your way to 30 grams of fiber in no time. You know, like half a cup of lentils is 18 grams of fiber. Yeah, a lot of hay. Yeah. So it's like, once you get those foods in your diet and you're used to adding them all the time. So whether you have mix nuts and mix seeds, I just have them on my kitchen counter. And I just add them to everything or just grab a handful and snack on them. The nuts, not the seeds, it's quite hot. You know, they, it's just, once you start adding them in, it's, you don't have to think about it so much anymore. Yeah. Because you're automatically saying, okay, well, I'm just going to grab that mixed bean tin and I'm just going to chuck it into my pasta dish. Yeah. And then from Rome, so pasta and beans is like my comfort, that is my food. Totally. Yeah. And then it's just, and whole grains are fine. Are the ones that need the most prompting. We need to remember they're there. Remember they're a really important part of our diet. Some people it is just experimenting with porridge and then doing mixed porridge, it doesn't have to just be oats. Totally. You can have an oat, barley and quinoa porridge. Yeah. So, yeah, it's like just once we get those food groups in, then we're really, it's easy to get to 30 grams a day all beyond. And as I said, the studies and the data we have more than 30 is good, that 30 is kind of the. This is the minimum to our health, isn't it? Yeah. I mean, like, it's interesting. We develop recipes every month there. We do about 20 or 30 now. And we have sort of developed hacks or strategies around introducing fiber at every opportunity for all meals with respect for stuntry dinner. And I think ensuring that you're getting that core fiber source, every meal is really important and the simplest ways to do that are some of the ones that you've mentioned here, really experimenting with the diversity of grains, Pobali is one of them, Freakers up there, Keenwa, pseudo grain, but you know, everything's adding. And then the lentil and bean strategy, we're trying to get, I mean, we just did the salad yesterday. And it's a chicken salad, which is generally quite low in fiber, but when you start introducing like a whole grain into that and then pylentals, you've increased it to like, you know, half of what the recommended amount is per day in just one meal. And so it's, you know, and it's satiating because of all the mechanisms that we've just talked about in terms of stretching the stomach and the hormones as well that are secreted from the from the digestive tract. So it's yeah, it's incredible what you can do by just adding a few key ingredients to your meals. Exactly. That bump up the fiber. And once you have them ready to go. Yeah. You just, it's, you just add them and you don't have to think about it. And the parboiling for me is an unlock. So people who really don't like to cook or don't know how to cook, having parboiled lentils and parboiled spelt. I haven't seen parboiled barley yet. I love that. I haven't, I've seen that in a mix grain. So there's like a product where they have a mixture of like four different grains. I think it's Merchant Gourmet. Yeah. No affiliation with them, but it's perl barley, it's like rice is something else and it's like, oh great. So you know, having that there, yeah, if that's going to help you to achieve this amazing. And when you combine whole grains with pulses, magic happens in terms of amino acid profiles, right? So all plants contain all the essential amino acids, but the profiles are different according to the food group. And when you combine pulses with whole grains, you get that balancing out of the amino acid groups. Yeah. Stunning work. And it's why so many traditional diets combine them. Yeah. Yeah. You know, across the world wherever you go, it's like, oh, you're whole grain and pulse because it delivers on this brilliant amino acid profile protein, protein quality, right? Which is where my heart is at now. It's like, how do we help people achieve the best protein quality in their diet? And that is one of the ways where it's just so health promoting. It's brilliant. Hey, stop to rupee here. I hope you're enjoying today's conversation. Now, I know a lot of you want to eat better, but you're constantly overwhelmed by what to actually cook. And that's why I built the doctor's kitchen app. There's a drumming library of over a thousand science back recipes that are high protein, guts and porting and anti-inflammatory plus a meal planner and a handy shopping list to keep you eating well consistently. It's our mission to inspire you weekly with delicious food that genuinely makes you feel better. And if you love what we do here, a doctor's kitchen, consider becoming an app subscriber and try it for free by clicking the link in your podcast description. To keep this show completely free for you, a lovely listener, we're also going to hear from some sponsors that help make that possible. So we're talking about Whole Foods as it relates to fat loss fiber as it relates to fat loss. You mentioned amino acid profile. How important is protein and getting core protein in your diet when someone is trying to lose weight? Yeah. So I think protein is of course essential for good health. It plays so many critical roles, right? Not only in muscle maintenance, bone mineral density maintenance, but also like our entire immune system relies on protein. If you're someone who struggles with chronic inflammation, your protein needs are going to be higher because you're constantly using protein. There's lots of different things to consider with protein. I think where the issue with protein is that most of us are getting enough. So like the average UK adult gets around 1.2 to 1.3 grams per kilogram of protein per day for their body weight per day. And so it's less about, are we getting enough of it? And it's more about where are we getting it from? So it's this quality I didn't know with weight loss specifically though. Hopefully after the conversation you won't be restricting your food too much. But if you are restricting your food or if you're taking medications, which means your appetite is suppressed, then getting enough protein becomes paramount. Because if you're drastically reducing your caloric intake, and you're not getting that protein amount, then you do run the risk of losing muscle mass. And muscle is essential for metabolic health. And your bones are pretty important too. You don't want to age with lower bone mineral density because that then puts your higher risk of breaks. So there's a new once conversation with protein where if you're somebody who's looking to achieve healthy weight loss and you want to retain your muscle mass but lose fat, because when we talk about weight loss, that's what we're talking about. Nobody wants to lose muscle mass and bone. That's why I'm you're being specifically right now. It's about fat loss. And maybe we'll touch on this but like you know fat is an organ and it's a very live endocrine metabolic organ. And so it is really about eating in a way that helps us to get rid of the fat excess fat that we don't need to store right now. But maintain the other tissues that we want. So when we get to like this reduced appetite, reduced food intake, then we actually need to focus on those higher protein foods because we need to get them in before you stop eating. Otherwise we don't have a store for protein and your body will just use your muscles. And losing muscle is actually fairly easy. Regaining that loss muscle is actually quite hard. So we need to balance the, this is where nutrient density comes in really. And I think for me, protein is part of nutrient density. Now also we are exceptionally good at absorbing protein, especially before the age of 65. Our body, our system is really primed to like be efficient at this because it's so important. So I think it's also important to remember that as long as you're eating enough of the foods that are a good quality protein source, your body is going to do a good job of absorbing and using it. So what I see a lot, especially in younger people, it's like the obsession with protein where protein is above all else. So the reason why I am careful with how I speak about protein and I want to reinforce the fact that unless your appetite is suppressed or unless you're drastically restricting your food, you probably don't need to worry about it is because once people start fixing on protein, everything else falls off. And it just becomes, I want to make sure I'm getting enough protein. Also I think it's important to point out this is very important. If you want to maintain your muscle or grow your muscle, the biggest lever is resistance training. So there's, do you know Professor Stuart Phillips? Yeah, I adore him, right? And he's probably like the leading expert on protein at the moment in the world, right? And his, all of his research, he's like, if you're, if the resistance training is the cake, the protein is the cherry on the cake. So if all you're doing is eating protein and you're not doing any resistance training or lifting weights, you're not doing anything to preserve or grow your muscle mass, basically, right? So that's really important. And also we need to remove this sort of weird fiction that there are protein andabolic windows that you have to get 20 grams of the for breakfast, 30 grams of lunch. We have like, oh, and our window for proteins about 36 hours. So as long as you're getting your protein throughout the day, you're going to be good. And as I said, unless you're restricting, you're probably already getting enough of it. So let's focus on the quality. Yeah. Legumes, nuts and seeds, whole grains, tofu, soy products, tempeh, fantastic for protein. And then when we think about animal drive proteins, I've, I created like a protein pyramid for my teaching where we talk about sort of, you know, next level up is a fermented dairy. So you have the yogurt, you have things like cheeses, hard cheeses, fermented cheeses and oily fish. They're really, oily fish three times a week, really good for you. And within that, you can include some shell fish as well, which has some omega-3s and has some really great micronutrient profiles. Then there's eggs and chicken, like, rent less frequently. I mean, I can't believe how popular eggs have become. I love an egg. They can be like, actually, one of my research projects was on how eggs can help to reverse malnutrition in children in a pool. Like, yeah, yeah, yeah, yeah, yeah. No one needs six eggs a day. No one does. So eggs and chicken, like, a couple of times a week, you're good. And then right at the top, you've got red meat. And I think, you know, we could talk about red meat and it's a fact, it's not necessary for human health. You don't have to eat it. But if you do want to, there are different types that are maybe going to be a little bit better for you or a little bit better for the environment. But it really shouldn't be like a central part of our diet. Sure. Weeks a week. And that's just according to the data. And I'm sure there's people out there who feel that it's great for them. And they want to eat it more often. So, you know, as a reminder, this is just, this is population advice. Yeah. But certainly for the data we currently have, like a diet that's very high in red meat, does increase your risk of type 2 diabetes, cardiovascular disease, and endometriosis in girls, which I think is an important one that is often missed. So that's my sort of protein pyramid. So let's focus on the combination of plant proteins that we spoke about. Yeah, yeah. I think just a rich rate, I think. Yeah. You know, I mean, as a profile, you can absolutely get from plants, particularly from diversity, big fans of sorts. and tofu and tempeh here, there's fermented bean or lagoon based products, there's tempeh and fermentation process, you can tempeh anything. And the density of protein that's available as well is really comparable to that of chicken, so you don't need to have any of those animal based products. It's great to get some variety in there, I think day-to-day people would struggle in some cases, just relying on soy and tofu, but getting a good mix I think is great. I agree, I think there's a real focus and missmarketing around protein to the point where if you look at the protein number on a packaged item, you immediately think that it's healthy when it's not got any fiber in and it doesn't have any of the extra nutrients that we've been talking about which are really good for fat loss and it's lacking that nutrient density. So I think there needs to be a re-education about what a quality protein is and how you can have high protein, high fiber, high whole food diets as part of your daily strategy. Is the protein package right? What are you getting with that protein? So when we're thinking about some of the foods we've been, let's take oily fish. That protein package is delivering omega-3 fatty acids, it's delivering iron, it's delivering protein, good quality protein and micronutrients like iodine zinc. So that protein package is great. Then you go to a high protein ice cream, high protein chocolate whatever. I'm like, Guy, it's just health-washing and there's data, people will pay 20 to 60% more money for the same product with a high protein claim on the product. And in terms of behavioural research, people will take a high protein claim on front of pack as a sign of healthfulness of the product. This is something I am very passionate about. If there's a product that has a front of pack claim that is either high in protein, only 99 calories, any of those fancy, they usually colour fall in a wheel and those are marketing tools. They're not health promotion tools. People sometimes get them conflated with things like the traffic lights system which is supposed to help with healthier food choices, problems there, but whatever. People think that the front of pack marketing claims are guides for their health. No, no, they're guides for profit. Ignore them. If you buy a floret of broccoli in the supermarket, there is no like high-micro-negative, low-in calories. But that's how we can distinguish them. Maybe they should, but there's not enough of a profit margin for them to bother. There isn't. And I think in defence of some foods and some package foods that are probably utilising some of those tactics that have been misappropriated by foods that are trying to masquerade themselves as health foods. I think some of the newer brands out there are actually using that labelling technique. But when you look at the back of pack, they're actually really, really good. Or they're doing the best thing. I think there is attention now because I saw a pack of lentils recently that finally said high in fibre. I was like, "Hallelujah!" And I was like, "Low-ds-of-brans like M&S and other own brand labels that actually have done a good job of increasing nutrient density, increasing fibre." But then also using the same sort of rings and this is high fibre, high protein, all the rest of it. So it's a murky word. And this is where I think we need to help people distinguish what is a health for product versus a less health for product and have that health reflex of looking at the back of the pack and recognising labels. But also look at it. At its core, is it a junk feed? Is it a biscuit, a chocolate bar? Is it some sort of cake? Or ice cream? If it is, it does. Then the front of pack claim is just trying to give you the illusion. I mean, there's so many ice cream brands that do that now. And you just have the nice ice cream. Just buy the stuff. So because it is an illusion, it's not helping. So there is, that you're right, it's about empowering people to take a step back and be like, "Okay, this is confusing my decision making. We know those data it confuses us." So just take a step back and be like, "What is this product? What role does it have in my life to improve my health or help me achieve my fat loss goals, help me achieve a healthier way overall?" Like, what is it going to play a role in that? Or am I just being misled by this pack claim? Tony. And then don't give them that power. Take it back. Put your money back in the pocket. Yeah, like a high protein cereal, still cereal or high protein ice cream, still ice cream. So don't be misled. Okay, so we talked about the sort of food first approach about calorie counting to help people with fat loss, making sure that you get in good quality of whole foods, full complex of proteins from good quality sources, fiber, anything else that we've missed. I think healthy fats have to, yeah, are really important for this. So fats do play a really great role in satiety and also in health. We need, we do need healthy fats in our diet. You feel pretty rubbish, you don't? Yeah, yeah. So, and we are moving out of this low fat era that was pervasive, like 80s, 90s, early 90s. So remembering that fat is not all equal, healthy fats from, it is mostly from plants, so things like avocados, nuts and seeds, extra virgin olive oil, olive themselves, and then oily fish. They play a really important role in our health overall, in making sure we absorb my conneutients that are fat soluble. So if you don't have the fats in your diet, it's actually hard to absorb enough micronutrients. And also in ensuring that we can create the adequate amount of hormones and that we can create like the oils we need for our skin, for example. It's amazing how many people that have a low fat diet don't realise that, that low fat diet is actually exacerbating their skin conditions. It's really interesting to me. So we do also have a pretty big problem in the UK with deficiency in omega-3 fatty acids. So the estimates range from maybe 50-60% of the population to as high as 80% of us, it turns out which, and I assist you to look at, may not be getting enough omega-3 fatty acids. And they are essential fatty acids. We can't make them ourselves. Our liver is really cool. It can make lots of things. The essential thing, essential amino acids, essential fatty acids, we can't make. And so there is this like, we'll hopefully a person are drive to encourage people to get more omega-3 fatty acids. Now, there's a big concern around sustainability of fish. So it's worth saying there's really good algal supplements. And there are fish brands and companies that do source their fish responsibility. You don't need lots of it. Two to three portions a week. And the fat, they make a three fats, the ALAs that are available in nuts and seeds. They're also great. They're just the conversion of ALA to DHA and EPA. It's just not that efficient. So that's why you kind of need to have either both the oily fish and the nuts and seeds or the algal supplement and the nuts and seeds. So that's something really worth pointing out. And there's some really cool research that has come out of a group of scientists at Queen Mary's that have found that specific long chain fatty acids directly interact with the interac cells that produce GLP1 and PYY. And if you feed those preferentially feed those cells with a combination of long chain fatty acids, it increases endogenous your own production of GLP1. It's so cool. So fatty acids, healthy fats need to be part of the picture. And which is also really important because of their anti-inflammatory effects. So omega-3 fatty acids in the liver love each other. And we, you know, we haven't really talked about the mechanisms of fat loss, but chronic inflammation really dampens our body's ability to lose fat, to let go of fat from fat cells. So and also for our fat cells to switch between white and brown. So we need to help reduce generalized inflammation. And by the way, what we just talked about fiber, yeah, high-quality protein, whole food diet helps with that already. But I have to say like omega-3 fatty acids play a special role for that as well. So worth worth looking at that. Definitely. And in terms of other quick or not quick wins, but other wins for people who perhaps don't have the capacity to change their diet entirely, meal timing. What role does meal timing play for fat loss? So I'm going to wrap two things up together. Meal timing is important, but not in the way people think I think. So I think a lot of people think they have to fast for like, I don't know, 18 hours and then only six hours. Actually, a lot of the research we've done, but also other people's research shows that eating, shifting your eating window to earlier in the day is helpful for fat loss. So if you're somebody, now this, I have to sort of say this, if you're someone who really hates breakfast and doesn't want to eat breakfast, please don't force yourself. But if you're experimenting or you like breakfast, for example, shifting your eating window earlier to finish eating earlier and eating window of 10 to 12 hours. There's nothing crazy. We don't want four hour eating window six hours. It's really hard to maintain. And it's very anti-social, which social health and reducing anxiety and stress is an important part of that loss. Really important. So if you can shift your eating window to a bit earlier and you can You can have a really nutritious breakfast. Oh my gosh, those are too magical unlocks for fat loss. A lot of people skip breakfast, hoping it would help them lose weight and we lose fat and their metabolism. No, no, no, it's actually the opposite. So especially in the first half of our lives, we are much more insulin sensitive in the morning, our circadian clocks wake up. And one of the first things that, you know, once your cortisol's gone up and you've got out of bed, your blood pressure's high enough not to faint, it's great and insulin's being released. We are most insulin sensitive in the morning. So eating a nutritious meal in the morning, and the first morning is like loose, pre-med day, right? It depends when you wake up. So we do have to tell you this advice to people's individual lifestyles, but if you think about your 24 hour clock and when you wake up and go to bed, the first half of your day is the best time to have a really nutritious meal. You're going to absorb the nutrients better, you're going to get that protein into your muscle better. You're going, because also insulin is not just about sugars, okay, it's an unlock for nutrient absorption into tissues and you're going to store those sugars, store them away more efficiently. So try to shift your eating window earlier. Certainly from the analysis we've done on eating window, pre-9 pm dinner is kind of ideal for most people. So if you can finish eating by then, great. And then have your breakfast when it makes sense for you and your lifestyle and what you're doing. Try to keep that eating window 10 to 12 hours. So it might be 99, or in my case, it got young kids. We are leaving. I'm sort of having breakfast by eight and I'm finishing my dinner by six, it's 30. And really begin with breakfast. Overhauling your entire diet is quite daunting. So break it down. Start with your breakfast, make that your win of the day. Most of us, 20% of our caloric intake comes from breakfast. So it's quite a big chunk of your diet. Get that right. Experiment with your whole grains and adding in healthy fats, nuts and seeds. Get that sorted. Get that really well. And then once you have that in place, you're probably going to have more energy. You're going to be more satiated in the day. You're going to find it easier to think more consciously about your decisions on lunch and snacking because you're not starving. And you've already started your day with some really good nutrient density. Because I guess one of the big concerns with the kind of inflection point right now where we have access to these drugs that lower our appetite. And we have this food environment, which is full of not very nutrient-dense foods, is that we have this kind of underlying micronutrient efficiency for a lot of things in our population. The fiber deficiency is like the massive red flag because it shows us that we're not eating the nutrient-dense plant foods that contain a lot of these micronutrients. And then when you start to look at the layers, it's like 40% of menstruating women under the age of 26 are iron deficient. That's a bad thing. Oh, and between 60 and 80% of us are omega-3 deficient. Then you look at folate and it's a disaster because we don't fortify with folic acid in this country yet. Although it's supposed to be happening soon. Then you look at iodine because again, we don't fortify our table salt. And it's like, so public health interventions have been a bit lacking and we have a diet that's not supporting these micronutrients. So we have this, we have to be really mindful that if we're trying to lose fat, whether with drugs or not, we need to make sure that our micronutrient intake from nutrient-dense foods is actually supporting our health as well. But we don't need to panic and go to boots and buy all the supplements. Because these micronutrients are in our food if we eat nutrient-dense foods. And then I'm not anti-supplementation if you have a deficiency-- Sure. --or if you follow a vegan diet, please take B12. Like there are certain things. But there is this real double burden of van nutrition, as we say. It's like you have people, the majority of the population out of population is overweight. But at the same time, quite a large majority of the population is lacking in key nutrients. So we're overfed and undenourished. But if we go down the route of increasing our nutrient-dense whole foods, we tackle both. Yeah. Yeah. And I love what you were talking about earlier when we were talking about whole foods in that to lose weight or lose fat specifically, it's really about eating more of the nutrient-dense stuff. So the nuts and seeds, the dried fruit, as well as fresh fruit, the greens, the whole sources of fiber and protein that we've been talking about, and healthy fats. It's super important. And more people need to recognize that as a solution, which is kind of counterintuitive, as it means to actually improve their weight. I want to switch gears now. And to perhaps some of our listeners thinking, Dr. Fed, I've done all these things that you've told me to do. I've eaten my whole foods. I've got lots of fiber in my diet, I eat healthy fats. I'm still overweight. I'm being offered a weightless drug. What do I need to know before, during, and hopefully after I stop said drug? Yes. Really important question. Thank you for asking. So 95% of the millions of people who access to help you once in the UK do so through private prescriptions. OK. This is an important point because if you access it through the NHS, you have a full tertiary service. You get psychological support, you get nutritionist or dietitian support, and you get excise support. So those 5% of patients who are accessing the drug through the NHS are within a real lifestyle medicine structure. Gotcha. OK. These drugs offer an adjunct to the lifestyle changes we've discussed. So they are really powerful medicines that are really transforming metabolic health care, right? But in all the guidelines, in all the clinical trials, they are delivered alongside a full nutrition, exercise, and psychological support intervention. The reason I wrote the book, the appetite reset my new book, is because of that 95% of people who are accessing these drugs without any of that infrastructure for success. Even more worrying are those who are accessing like TikTok compounded versions, which aren't even safety checked. OK, so please don't do that. It's not the same thing. It's really dangerous. Now, why is it important to think about this before, as well as during and after? So it's not just about changing your diet once you've started the drug, OK? What's really clear from the evidence and what we understand from the physiology and we've discussed with the gut and the gut microbiome role is that patients or people who prepare their gut, prepare their liver, and prepare their pancreas for these drugs have much better outcomes. OK. So the pre-treatment is really critical. If you're thinking about taking these drugs a bit like back in the day when bariatric surgery was the only option, right? Yes, yeah, yeah. You wouldn't-- you're not allowed to get bariatric surgery without pre-hab, because just wouldn't work. You can't do that. And of course, surgery is very different. Invasive, and there's a physical recovery to it. But think about it in the same way. So if we are taking a drug like a GILP1 or the dual agonist, soon to be triple agonists, when these drugs are acting in a system in your body, if the system in your body, specifically the gut liver pancreas axis, which then feeds back to the brain, because really it's all about brain signaling. That's the crux of it, for the food behavior anyway. If that system is broken or is damaged or is really struggling, the drug is not going to be as efficient, like simple as that. So if you want to give yourself the best chance that you're going to have the desired outcome of the drug, at the lowest effective dose, because that's the goal. The goal is to make your effective dose as low as possible. It reduces the side effects risk. And we think-- so according to the clinical trials published so far, it helps to maintain treatment, sort of the happy people's state treatment. So pre-hab for your gut, your liver and your pancreas, the advice is the same for all three. They're basically symbiotic. They work together. So if you're feeding your gut well, your liver's going to be happy. Your pancreas is happy. Everyone's happy. And when the drugs intervene, when the drugs are added to that picture, they're added to a system that works. So the analogy I use in my book is-- and because my husband, he loves cars. I always think about cars. If you have a race car, a Ferrari or something, and you're like, that's the drug. It's all ready to go. It's shiny. It's new. And your road is like, pot-hold and unpaved. It doesn't matter how good your car is. It's going to be a tough ride. It's going to allow you this. Thank you. I'm enjoying this. Thank you for that. So the smoothing of the road ahead comes from you preparing yourself your body. Now, also, it's very good to get these dietary habits in place before you start the treatment. Because when you start treatment, and you may suffer side effects, and it may impact your mood as well, you already have the framework in place. You don't want to be reaching out for framework and setting it up when you're not feeling right. So do that beforehand. It can increase the temperature. the drug having the desired effect, it decreases that risk we spoke of of having micronutrient deficiencies worsen. So if you're someone who has been offered these drugs and your diet is quite poor at the moment and you're maybe already micronutrient deficient, we really don't want you to take a drug that then lowers your food intake further and puts you a real risk of micronutrient deficiencies that have health consequences, right? So we need to level the playing field before we reduce your appetite to make sure that nutrient density is already part of your playbook and that we've corrected any micronutrient deficiencies that were there. Hey it's Rupi, we're going to take a quick break here to hear from sponsors who keep this show completely free for you, our lovely listener. Just to reiterate a point you've made, a situation that we have in this country and others is this double burden of disease where we are overfed and undenourished. So we have excess weight, excess fat and we have a low amount of nutrients in our diet. What these drugs could be doing is exacerbating that situation if you're reducing your appetite such that yes, you might lose weight but you're not losing fat preferentially, you're actually losing it from muscle and other areas of your body that you want to maintain. And so getting into the habit of having a nutrient dense diet that's for the fiber and quality fats and good quality protein and whole foods is the best way to smooth out that road. Exactly. And so because you know the drugs are going to deal with the overconsumption of energy, they're going to deal with the excess energy piece but they're not going to deal with the under nourishing. The behavior and the lack of nutrients. So if anything they can exacerbate the lack of nutrients because that little food you were getting that maybe had a little bit of nutrients is even less. So I can't stress enough. I like the pre-hab for me also. What's interesting in some of my clinical experience is the patients that come to me before they start and I have work with a full team of medics. So just to be super clear, I can't prescribe these drugs. I'm part of the adjunct of the overall treatment plan. The ones that come to me beforehand are my favourite because they say sometimes they do the pre-hab and they're like, "Actually, do you know what? I feel good." I'm done. And actually I'm losing some fat and my body composition is changing and you know I have to say the team I work with that well founded health. Our patients are so lucky because they have the nutrition, the psychological support, they've got a brilliant ex-cius physiologist who's a magician and they've got these doctors who are super. So sometimes what happens is actually they're like, "Well, I'm going to just do this for a bit longer." And then revisit the pharmacological intervention if needed later. Great. During treatment, so the people who do then choose, I think the number one thing to remember during treatment is that overwhelmingly the side effects are gastrointestinal. So it's your gut that's going to give you issues whether it's constipation, nausea, vomiting, pain, like gastrointestinal issues, the biggest issue, heartburn. And guess what? The best way to treat them is with your diet. So the best way to reduce gastrointestinal side effects is to modulate the diet. And a lot of people don't know that. So they're like, maybe I should take some reflux meds and tacits over here. And I'm not saying sometimes pharmacotherapy is good. But actually the best way to reduce all of them is to look at your diet and your hydration. We have a really touch on hydration here but it's funny because people worry about water. They're like, "I'm a Drachy enough water and you see them walking around with these huge cups." It really isn't a problem for the majority of the population. But in GRP1 receptor agonist medication, actually hydration is something to think about on top. Make sure you're getting enough water because your thirst response is dampened too. So you've got. I don't think people realize that. No, no, they don't. Hydration is one of the main pillars for during treatment. So making sure you're getting enough water, or green tea, or whatever. Like whatever you're floated of choice, as long as it's not as sugar sweetened beverage. Because then really what are we doing? But hydration is important. So during treatment, your diet is your best tool to reduce your gastrointestinal side effects, which are the main ones. And also your diet then becomes incredibly important at achieving what you're trying to achieve, which is this change in body comp. We're not trying to lose our muscle and our bone and our fat. We're really trying to preferentially lose fat mass, retain muscle mass, and retain bone mineral density and bone strength. And it is doable. So there's a lot of fear mongering online. I have to say, I saw last week it was like, I was and picked dissolves your bones. And a few months ago it was like, I was and picked kills your muscles. The thing with these drugs is that they are medical malnutrition. They cause the same effects as a famine, but with drugs, which sounds terrible, if it's mismanaged. That is a real risk, is that if it is mismanaged, that's what we're doing here. So any kind of starvation malnutrition will result in a loss in fat mass, muscle mass, and bone mass. That's what happens. Your body is doing what it can to get what it needs. Now what's really cool is during treatment with these drugs, if you have this real 360 approach and you understand the importance of pulling the levers, that means that you lose the fat, but you retain your muscle and your bone, you do it. Now, again, resistance training is the biggest lever. If you're not resistance training and you're eating adequate protein, you will still lose muscle mass. So unfortunately, if you don't like resistance training, this is going to be hard. Because it's three times a week, three to four times a week, resistance training, structured resistance training, to retain muscle mass. And this was the regimen that we're using in some of these studies. Yeah, and also it's the official guidelines from all of the medical boards across the US and UK. This is how you do it. Three times a week. It's not like an hour of hardcore crossfit. It's just structured. It can be resistance training. It can be fairly lightweight. It really depends where you're starting, but you have to do it. You have to stimulate the muscle growth. And then the protein comes in. So during treatment, that nutrient density, that prioritizing the protein package foods that contain protein plus other nutrients that we want, like fibro omega-3s or micro-neutrons, whatever it is, are critical during the treatment phase. And then another thing that's really important is to make sure you're working with your doctor or your provider of the medicines to find your lowest effective dose. I think this is becoming much more usual now. So just not just up the dose for the sake of upping the dose. When you get to an effective dose that is seeing the change you want, stop there, because you're then going to run a lower risk of side effects that really stop and hinder your progress. Now I got a lot of detail on this in the book, but during treatment, having a very structured meal time approach as well, because the problem is, people are like, finally I'm not hungry. We haven't talked about food noise, but the real unlock with these drugs, for people who have been struggling with their weight or their lives. And to have, there is of course a genetic component to obesity, and the genetic component to obesity is in the brain. And when these drugs suddenly silence the food noise that is happening, people are, it's transformative. And so because of diet culture, the trap is, oh well, I don't think about food, I don't need food, I'm not going to eat it. Finally, I can just go through the day without eating. Which can feel like a when, if you have been struggling with that or your life, but actually it's not in terms of metabolic health and log term health outcomes. So structuring your meal times, making sure you've planned ahead, making sure you know like, okay, I'm going to have breakfast at this time, lunch at this time, and dinner at this time. And these are the things that need to hit in terms of nutrient profiles, making sure I get this food right, is really important at this phase, especially if you're someone who has had this unlock of freedom, thinking about food, the risk is that you just don't eat enough at all. So really important that you that that part of the approach during treatment is a very structured approach. It also helps reduce things like reflux. So if you're making sure that your eating window is earlier in the day, and you have plenty of time between your last meal and bedtime, because JRP1 receptor agonist, slow gastric emptying, there's slowly actual mutility of the gut. If we're eating too close to bedtime, you know, reflux is much more like to happen. So structured nutrient dance and then post treatment because we know that about half of people, 60% of people that are on the drugs come off. And the reasons for that is a variety, so access, people just can't afford to keep paying for them. And side effects, they just don't really like side effects. And we've talked about gastric, but I've worked with people who have terminated them because of the side effects on their mood and their pleasure of life. So there's some signals that unhedonia is part of this. So you start to enjoy things less and people actually don't want that. So those are the two main reasons people stop taking these drugs. And so then the thing is is that when you stop taking these drugs, appetite returns and your homeostatic system, your body's like, "Whoa, we need to like get this weight back because our weights that point is still over there, especially if you haven't been on them for very long. And now we need to, another famine is over, we need to replenish." So two thirds of patients regain the weight loss. Two thirds. Yeah. And then the final third regained some, but not all of the weight. But then some of the longer-term studies are now indicating that there is like a sizable portion of patients that never regain the full weight, which is good. So and then of those who regain the weight about half of them then go back on the GLP ones. So whilst these drugs aren't intended as a on-off, on-off, on-off, they sort of are intended as a lifetime prescription for people with obesity and metabolic conditions like type-2 diabetes. And now increasingly complicated cardiovascular disease, the reality of how people take these drugs in the real world is that they do come off them and then they might come back on them later. So in the post-treatment phase, we have to focus back on a key. Let's really amp up our natural satiety signaling. It's not going to replace you. The drugs, okay, the drugs are like 100 times strong. But let's do the best we can to eat high-volume, high-fiber foods that are going to activate our endogenous satiety signaling as much as possible. Keep us satiated and feeling fuller for longer. And then making sure that we're still really focusing on the resistance training. And you know, often with the post-treatment phase, that's where increasing your walking, your like, but your energy expenditure for daily daily life. So also not the gym basically. That's where you get a bit of an unlock in maintaining the healthy body composition. Sometimes there is, as I said, like weight regain and fat regain. But I've certainly seen and you see success with individuals who can titrate off gradually, ideally, that is so much better for maintaining the weight loss and the fat loss. So if you can, titrate slowly off and then adopt this post-GRP1 sort of nutrition approach, which focuses on highly satiating meals, that seems to really help with then maintaining a healthy weight body composition and not having this yo-yo effect between treatments. Or I mean, I've got a handful of patients who have successfully titrated off, stayed off for two years now without the need to take the medications again. So it's doable. It's not impossible, but it needs a real structured approach. And it needs a commitment to continue that lifestyle. But you know, weight set point can change. Yeah. So it just takes some time. Takes a long time. Yeah. I think it's really important because pre-herb, I think, within the sort of vernacular of biorexic surgery, like you pointed out. But I only think a lot of people are thinking about preparing themselves for going onto a drug that is comparable in terms of the impact to surgery. How long should that pre-herb period be for? Yeah. Ideally, 6, 6, 9, 2 days. So like, yeah, 2 to 3 months would be. And again, it depends where you're coming from. If you're somebody who has a really poor diet, very low fiber, erratic eating schedules, it's going to take a bit longer. Sure. If you're somebody who already has a really good diet, actually, it might need less time, and it might be more around the structure of like meal timing and exercise. But the pre-herb is there to get you into the routine that's going to see you succeed through treatment. So how long depends on where you're starting from? Okay. Yeah. In terms of supplements, is there a role for supplements when people are on these meds? Yes. I think that targeted supplementation is a tool, right? So what I would say is that in some populations, like older adults, and in people who have vegan diets or have to restrict their diet for any other reason, a micronutrient supplement can be a really easy way to just give them a helping hand. Now, if you follow a vegan diet anyway, you'll be supplementing with some key nutrients. So I think there is a role for supplementation, but it needs to be targeted. And a big red flag here is these sort of GRP1 supplements, which are just popping up like my shrimp. Right. Okay. You know, just there are evidence-based supplements. I have in my book I go through like a table of the ones that are evidence-based and you can get from your pharmacy. Please don't fall for sort of the marketing of special GRP1-based supplements. Like they're unregulated, not tested in the population that they need to be tested for. So targeted micronutrient supplementation that is evidence-based, there is always space for. But don't fall for magic potions that are being sold as a miracle. Okay. They're not. Yeah, yeah. I think what you said right at the start of this segment around 95% of the medications being private is really worrying. And I think that's why exactly your book should exist to help a lot of people that can fall prey to the supplement marketing machine as well as the lack of the lifestyle interventions that are super important when people on these medications. Thank you so much. That was great. Oh, wow. You know, just you're awesome. I love your books. I love the energy you bring and you're part and everything. So it's been a pleasure having you. Thank you, Pavy. It's been really fun. Thanks so much for listening to this episode of the Drs Kitchen podcast. Remember, you can support the pod by rating on Apple, follow along by hitting the subscribe button on Spotify. And you can catch all of our podcasts on YouTube if you're enjoying our smiley faces. 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