Dr. Curran's Insights on Modern Health

I'm Dr Curran an NHS surgeon and in this podcast we cut through the BS of Modern Health advice and tackle the biggest issues in science health and Medicine we know 90% of what people should be doing to be healthy and we know what the unhealthy foods are if your goal is to get on the television sell a book sell a product you can't just say have you know fresh fruit and veg a lot exercise cuz people are like okay boring you've got to come up with some new science why are people using cgms I mean is there any role for using cgms if you don't have any issues with glucose control we don't basically know what the glucose means and it is causing so much anxiety that I see and so much confusion it's wild to me there's no evidence at all out there that this is harmful there's lots of indirect evidence it's absolutely fine and normal and I think it's people trying to sell cgms so what is the science behind ultr processed foods I think based on the evidence yes you can in fact have ultr processed foods in the diet and remain absolutely healthy I would I would die of shock if Supermarket bread is ever shown to be remotely related to negative Health outcomes ever Nica thank you so much for joining me not at all pleasure I've I've used to you know follow your substack and read all of these articles that you wrote about all this misinformation in pseudo science online but it seems now we really are in a new golden age of pseudo science and misinformation particularly when it comes to podcast and there seems to be a plethora of Health podcasts out there at the moment that exist purely for the sake of farming likes and engagement by you know saying very controversial things polarizing opinions and it just seems to be a complete mess out there and for the average person who's maybe not MediCal at all who just wants to improve their health it can be very difficult to separate what is the truth from what is pseudoscience and what is Flatout misinformation so why are we in this state at the moment where there's so much misinformation and number two how can someone listening to any bit of Health advice online actually know what seems legit or what seems untrustworthy I mean I think there are three things why we have this I I think firstly I mean social media has often opportunity to make people a lot of money in a fairly easy way like if you think if you're a doctor you go through all of this training if you go into clinical trials it's Decades of work before you get any attention which brings me to my second point is we have an attention economy everything is about eyeballs and clicks and so if you're able to exploit social media to get attention that is a great way of making money and I think the third thing and maybe we'll touch on this the thing that disappoints me the most is that a lot of the misinformation isn't necessarily coming from the crazy people who bought their PHD online it's actually coming from people who've received training the right kind of training and should know better and I wonder whether it's because I mean I do research I don't know if you've ever been involved in clinical trials but my goodness it's a hell of a lot of work it's a lot of you know drudge work being awake until 2 a.m. writing the finances out it's solving problems it's bureaucracy it's not particularly glamorous or exciting and two frankly the money is not that great and so I can see how now that there is this opportunity to earn a lot of money without having to sit awake until 2 am writing a grant that people take that opportunity and they're able to use their vocabulary and their credentials to make a lot of money really quickly to pick up on that point you made about the misinformation a lot of that coming from medical professionals Healthcare professionals with credentials and who've been to University and done research and studied for many years to achieve a level of respect in Academia or beyond that brings me on to the point about capillary in the continuous glucose monsters right and the cgms and you know obviously you know being a doctor in the hospital I've seen diabetics where these over the years have seen friends and family who are diabetics have you know these devices and they're very useful we know their game changes for people who have pathology but then I've seen so many of these influences or medical content creators or Educators online who should know better who are then advocating for normal people to use these and that's when you know a few a few years back when I saw this I was optimistic and I thought hang on there there may be some value here and let me look into the research and the more I read things from reading Twitter threads from the likes of yourself and your substack and doing my own research I realized hang on there really doesn't seems to be much argument here for normal people with no diabetes no you know pre-diabetes or insulin resistance to be using these unless you're a ultramarathon runner or an athlete looking to get that extra .1% so really why are people using cgms I mean is there any role for using cgms if you don't have any issues with glucose control I on the balance of the evidence I don't think so so it's really important to note that firstly glucose almost certainly in in people without pre-diabetes or type two diabetes ever gets to a concentration that is directly causing harm so of course in diabetes there's value in these devices because glucose can get to a level that directly causes harm and so enabling people to take action to reduce that is a good thing that isn't the case in people without pre-diabetes or type two diabetes so if glucose not isn't pathological you don't need to intervene to lower glucose acutely and the second Point related to that is in people without diabetes and indeed with type two diabetes glucose is a simp symptom of everything that's going on underneath so even if you were to say oh I just want to catch pre-diabetes early you know pre pre-diabetes well actually the glucose is a symptom of the underlying damage and you need to fix that underlying damage which if you're relying on your glucose level to tell you what to do it's going to mislead you and let me give you an example like I've seen the glucose goddess and others kind of say oh dress your carbs so this idea I mean I've seen it even with fruit like my goodness if you have mango or blueberries dress them in Greek yogurt to lower the glucose Spike like again like I said the glucose isn't getting into a concentration that causes you harm but if you are adding some calories and all saturated fat to the to the fruit what you're doing is possibly increasing your likelihood of getting some insulin resistance the effect is probably small but two you're adding calories in unnecessarily when the absolute primary thing that most people should do is manag their weight to prevent type two diabetes so it's giving you very perverse and misleading and possibly even damaging advice by this glucocentric approach to nutrition say someone is healthc conscious and they believe these online influencers and they buy themselves a a subscription to one of these CGM glucose devices a little circle on their arm and they're looking at the readings what is a glucose for someone who has no idea about glucose physiology what is a spike and what difference does it make to a normal person without diabetes and then to a person with diabetes and why is it harmful in that case so I mean the thing is about Spike there's no definition basically my understanding and I think most people's is it means when your glucose goes up quite a lot after you eat um if you have a carbohydrate containing food it's natural your glucose goes up and it should come back down again because the pancreas responds with releasing insulin and the difference between people without diabetes and with is number one the concentration that glucose gets to so the magnitude of increase but number two the duration of that glucose Spike so you are exposed to a much higher concentration of glucose number one but you will be exposed to that higher concentration of glucose for much longer and this is what people Miss I mean the thing that really annoys me and I'm sure many consultants in the hospital are also seeing this when a glucose Spike has been defined as my glucose got to a diabetic level that is a fundamental misunderstanding of what diabetes is diabetes is chronically elevated blood glucose if you have type 2 diabetes your fasting glucose May well be above seven the whole night when you eat something it might be going up to 11 12 13 14 15 it might never get below seven so you are chronically and constantly exposed to a high concentration of glucose and based on pretty much most of what we understand that is a lot of the damage because glucose at that concentration for a long long time can be toxic to the cells now people do talk about oh what about the Peaks and troughs surely that adds some extra damage and we think there might be in diabetes so if it's going up and down and up and down independent of what your overall glucose level is just the oscillating glucose itself might be damaging but this surprises people even in diabetes we are not absolutely sure whether that is the case whether oscillating glucose explains much more than overall exposure to chronically elevated glucose so I always emphasize that because what are we talking about with a glucose spike in an otherwise healthy person it's going up for high for 20 minutes not even as as high as You' getting diabetes and it's coming back down again it's it's it's wild to me there's no evidence at all out there that this is harmful there's lots of indirect evidence it's absolutely fine and normal um and I think it's people trying to sell cgms and you mentioned there that I think you alluded to the point earlier that there are some people who are trying to use this as an asymptomatic screening tool and that's how they're justifying the use of these explain why why that doesn't make sense for someone who maybe has had some baseline blood tests you know a few months ago and they HBC hba1c a mark of their long-term glucose control is normal their fasting blood sugars is also normal and they've decided to wear this device to just pick up chronically elevated spikes why is that not a good screening tool for pre pre-diabetes or even pre-diabetes to make these better health choices the short answer is is because we don't know what normal looks like we don't know what any of these spikes mean and there's also in general a lack of validation of these tools in measuring glucose there's a lot of error there's a lot of things that can go wrong and they're not standardized so of course there are limitations to any blood test but your doctor will have your medical history so they'll be able to choose the right glucose screening tool for you whether it's hemoglobin A1c which is the like you said the long measure whether it's taken a fasting glucose on the day or a glucose tolerance test they're standardized we can compare your data to hundreds of thousands of other people and put it into context with what it means we simply don't have that with the cgms so there's error between the there's variance between the devices depending on a multitude of things you might have done in the previous couple of days or the day before that's going to affect your glucose so so that we don't basically know what the glucose means it is causing so much anxiety that I see and so much confusion and I see patients in my clinic so I see people who've been diagnosed with pre-diabetes or even type two and so when I get on you know in in the clinic appointment with people and I sort of say okay so I can see that you've been diagnosed with pre-diabetes and we talk about it and then I always do a screening so I'm like okay what's your A1C and they've said like 31 35 like normal right so pre-diabetes starts at 42 and people are coming to me and it's it's this super low or normal um hemoglobin A1c and so I'm like okay that sounds like you've got normal blood glucose why do you think you've got pre-diabetes oh well I wore a CGM and my glucose gets to pre-diabetes levels and it doesn't and maybe that's worth going into is is what pre-diabetes and type 2 diabetes levels are for example on a standardized test like a glucose tolerance test so this is what I see is when you have a glucose tolerance test we diagnose if diagnose is the right word pre-diabetes if your 2hour glucose is like 7.8 so 7.8 millimes per liter or above but that's two hours after you take a glucose drink and of course if your glucose is still that high two hours after a glucose drink it's an indication something's wrong because in healthy people it would have come down and it's the timing there that's really important and instead what I see is people have this misunderstanding and it's not their fault they are being told I think by folks trying to sell these CGM devices oh my glucose got to a pre-diabetic level when I had toast it's actually utterly normal and healthy for your glucose to get to 7.8 if you have toast or carbohydrate within 30 to 40 minutes of eating that food that's utterly normal and healthy the point is it comes back down again and I think that's the problem really I mean we have got people now pathologizing glucose similar to how people have historically pathologized cortisol and I think these chemicals in our body are neither good nor bad they serve a function and in extreme low States and extreme High States they can be problematic for some people and we've got homeostasis and normal physiolog physiological mechanisms which can balance it in the average person and I actually tried to CGM for myself myself to show people why you know it's it's so Superfluous for the average person and I I ate a chicken wing you know which is 100 100 calories for one chicken wing and it's full of fat and I ate an apple a mediumsized apple which is around 80 or 90 calories full of sugar you know obviously the Apple spiked my blood sugar on my CGM device more than the chicken wing and I think it would be wrong to say that the apple is inherently worth for you than a fried chicken wing but as according to CGM if we just look at the glucose spikes the Apple spiked my glucose more than the chicken wing and if you listen to these CGM zealots and glucose zealots online they would make you believe that that is decaying your body or disrupting your body in some way purely because of that glucose Spike and and I wonder like you mentioned as well how it's causing anxiety this obsessive tracking of glucose I have seen anecdotally some patients with gou stones in clinics who have actually got a worsening of their symptoms because they're wearing cgms and and I just asked them incidentally uh you know your history online doesn't suggest any evidence of diabetes is there a reason why you're wearing these devices and they're saying they're trying to be healthier and tracking what they eat and actually their symptoms with their ghou Stones were worse because they were increasing the amount of fat in their diet to artificially blunt their glucose response like trying to manufacture a flat line of glucose so their readings look great but that's impacting their overall health and other conditions are you seeing a lot more of that in the patients that you see as well and in general yes yes and if I were to say if there's one thing that I am most concerned about and in fact that I see the most it is a rise in LDL cholesterol in people who are trying to follow this glucos Centric approach because like you say they are focusing on oh healthy eating means lowering my glucose and so naturally they tend to follow a higher fat diet a lot of high fat foods have more saturated fat in them and some people only need a small amount of extra saturated fat in the diet to push their LDL cholesterol up and I think the really important thing to note even in type two diabetes which is a condition diagnosed via high blood glucose we don't just pay attention to glucose because in diabetes what sadly kills people is heart attacks and strokes so it's high blood pressure and LDL cholesterol it's lipids that we need to pay attention to and I always think how perverse that is that we have this glucocentric approach in people who don't need to be concerned about their glucose and it's leading them to take steps that could actually be worsening their other risk factors um because across the population I think around half of people depending on how you define it have a cholesterol level that's high enough to be a contributing factor to cardiovascular disease and other things and I think it's probably around a third even higher who have hypertension so those are the things my goodness we should be focusing on but we're not because someone hasn't developed this tiny very convenient sexy little device that is going to be giving people this by a feedback and I think that's that's very very worrying and so yeah that's what I see in my clinic it's it these things I think could be doing harm do you think that there are things that people ought to be tracking even if not on a daily basis maybe on a weekly basis and this is assuming you don't have any chronic health conditions for the average person looking to better their health are there any variables or metrics worth keeping an eye on that's a great question and I think actually it really speaks to your point about galston that people are worsening other aspects of their health like health is lots of thing things and focusing on just glucose is is very misleading even in diabetes like I said and just to add that a lot of these CGM companies will say get insight into your metabolism now glucose in people someone without diabetes tells you actually very little if negligent amounts about your metabolism so that's really important in terms of what though is valuable what I want to know about as as a reasonably healthy person who wants to stay healthy um my blood pressure cholesterol so LDL cholesterol particularly um resting heart rate because it means I I've got a strong heart and hopefully that's going to help me to live a long time um muscle mass so being strong and functional over a long period of time and maybe insulin like if you wanted something that's going to tell you about your metabolism and how metabolically healthy you are insulin is far better than glucose in that regard yeah I mean for me I mean even though there's no guidelines to suggest that this is the case I believe that probably over the age of 30 I mean this is again purely an arbitrary number it's probably worth most people if they've not in their lifetime had it getting a a baseline set of blood tests just to check some of those metrics that you mentioned like your cholesterol etc for men potentially something like testosterone uh just to see at what range it's in is there factors in your life that you could change to improve that such as your sleep Etc and on your point of people obsessing over glucose and thinking that is the reading that matters a lot of these CGM companies claim that their benefits can be extended towards your sleep and your focus and your energy and they're actually forgetting that your focus and energy and concentration Etc that's all because of high glucose usually you get those benefits of improved cognition because your glucose is probably normal SL High because it needs to be high your body is making it high so you can function better when my glucose is low I know I feel lethargic and I feel a bit grumpy and my reflexes and energy are not quite right so I think it's almost false advertising for these companies to suggest that lowering your glucose bike or being aware of that has anything to do with all of these wide reaching facets of everyday biology yeah like I see where they're talking about it very often it's the Peaks and troughs so it's like this roller coaster of glucose that I was talking about and like I said even in in diabetes we are not entirely sure how important that is or whether it matters so very likely it doesn't in people without diabetes but the the thing that worries me even more is the evidence that's being used to make these claims so for example there's a company that have cross-sectional data and they've used this cross-sectional data to find a relationship between Peaks and troughs so that roller coaster and things like hunger and energy but cross-sectional data is the weakest type of data we have this is the kind of data where you get those spurious associations of if you buy an iPhone on Tuesday you're more likely to have Crohn's disease it's sort of meaningless and I I going back to the first point you made about this misinformation what bothers me is that it's coming from scientists who have this product they want to sell they've got all of this data and people are paying them paying this company to give them their Health Data the company are then analyzing this data doing trash science frankly to publish these spirous associations to say aha look there's a relationship between these roller coasters and energy and all of those things so buy our product whereas in fact the stronger evidence the randomized experimental evidence has not shown relevant relationships between Peaks and TR of glucose and things like appetite hunger energy and all of those things so I think you know some of that data dredging um you know as you can call it just looking at random observations and correlations is being used to almost to prove a causation which it's not and I think ultimately there will be a lot of people watching this who you know are sort of really fixated and love their cgms even if they're not diabetic and they might be resistant to hearing some of these myths being broken here but also for people listening who maybe are diabetic or have some issue with glucose regulation what are some actual actionable things that someone can do to actually regulate their glucose levels whether it's during a meal or during a day nutritionally or any hacks that someone can do so I would make a distinction here between someone with and without diabetes because I think there are some hacks that actually are really useful for people with type 2 diabetes so for example meal ordering there is very good evidence that just simply changing the order of how you eat lowest blood glucose so if you're having a meal having particularly the protein before so that might be the chicken the tofu or whatever you're choosing to have as your protein even having maybe some salad or vegetables and then consuming the carbohydrate that is really effective at lowering glucose it's a great thing to do because you haven't to change what what you eat it's the order with which you consume it but why don't I recommend that for people without pre-diabetes or type two diabetes it's simply because you don't need to worry about your glucose and I worry that we are turning meals into scientific experiments and food is meant to be enjoyed the socialization aspect and I like like we talked about with other risk factors I would much prefer if people are going to pay attention and you know give their brain energy to something do it to things like blood pressure where having fruits and stuff like that is going to help lower your blood pressure and do it with having healthy fat so pay attention to that I worry about encouraging people to do things that are simply not necessary so that's one hack that I think is really good great for people with type two diabetes I also um in my practice a lot I kind of use a high protein diet that seems to be very effective for managing glucose and it can lower glucose a lot um without needing to lose weight which is very useful but again why don't I recommend that for people without diabetes because it's not necessary and you should simply have a healthy diet that you enjoy the the high protein diet and its role in regulating blood glucose do you think that's because the higher protein foods are more voluminous and more satiating so thereby you might consume less calories or less likely to overc consume calories or is there mechanism by which so mechanistically what they do and actually some of the food order Studies have shown this is when protein gets broken down into amino acids in the blood and what we know is amino acids are great at getting the pancreas to produce insulin and this is really necessary and important in type 2 diabetes because as you develop type 2 diabetes particularly if you've had it for a couple of years or longer the beta cells of the pancreas are less sensitive to to glucose in your blood and what that means is so in a healthy person if you have like some toast for breakfast your glucose will go up you have a sensor on your pancreas that recognizes oh gosh glucose is going up let's produce some insulin that's happens in healthy people that sensor doesn't work as well in people without type 2 diabetes and it works terribly in people who've had type two diabetes for a long time what happens is you eat those two slices of bread your blood glucose goes up your pancreas doesn't recognize it because the sensor doesn't work but the pancreas and the sensor remain sensitive to amino acids even if you've had type two diabetes for we think quite a long time so if you have a lot of protein with your meal or you have protein first those amino acids tell the pancreas produce some insulin and you can really help lower particularly the after meal glucose so that's what we think the primary mechanism is well that's really interesting actually I think that's useful hacking I guess for diabetics as well if they combine that with resistance training and the high protein more muscle increase muscle protein synthesis potentially which can then also sensitize cells well the muscle cells can uptake glucose a bit more and it also helped to you know contribute to that regulation of the glucose so I guess it's like a a win-win scenario in that case yeah absolutely your muscles are a massive reservoir reservoir for glucose so the bigger they are and the more they work the more glucose suck out of the bloodstream so absolutely and I would just add I'm not a a carnivore advocate in the sense that it's a a high meat High saturated fat diet you can have high protein and I encourage lots of plants in there even if they're low carb plants having nut seeds lots of fiber in there so even though you're getting the high protein I always focus on all of the other cardiovascular risk factors as well so you want to keep your saturated fat intake low lots of of veggies and fruits so so that you're keeping your blood pressure low as well what are your thoughts on this kind of trend of I say it's a trend but it's just it keeps having its Peaks and troughs and it's currently having its moment again I guess where people are advocating for the use of apple cider vinegar to blunt glucose spikes as well and looking into the literature there seems to be some minimal data to suggest that there may be something there but clearly you know this is a small win if it exists at all yeah so I think it I think the effect is real um it's I mean it's not massive but I just think of all the other things that you could do to to lower your glucose it's one unpleasant two I mean I'm not I don't know I'm not a gastro expert but I can't imagine having something that acidic going down your esophagus frequently is a good thing and the the other point as well and it comes back to does lowering glucose acutely so does taking steps to blunt this this glucose spike in the short term have benefits over the long term and again I go back to the fact that your if your glucose is getting too high it's because you have underlying damage so you have insulin resistance and your beta cells are probably failing and to fix those things you can lose weight that's that's effective in anyone even people who are relatively lean if you have large waist circumference or fat around the middle losing weight is going to fix your beta cells it's going to fix your liver fat it's going to fix your insulin resistance it's going to lower your blood pressure and all of the other things exercise is a better choice to lower glucose acutely and it's going to improve the underlying damage having more fruits and veggies is going to make you more insulin sensitive so you put all of the different things that you could do that are hopefully Pleasant enjoyable fun to lower your glucose and you compare it to Apple side of vinegar I I mean I've never in my ever in my clinical career ever ever recommended anyone have apple cider vinegar to to blunt a glucose bike and I never will I think this CGM trend is emblematic of The Wider problem of people wanting and the people wanting personalized Health Care is not a problem in itself but I guess it's the owners of the companies to then outline the limitations of these things and I think the next thing I worry about is something which revolves around the gut health space in the microbiome we've seen an uptake in the number of people promising atome microbiome testing like stool sample testing now as a surgeon the NHS the stool testing that I'm used to you know seeing patients have is a fecal occult blood test at home for the you know bowel cancer screening program you get a bit of uh you know a kit sent at home you you poo onto this stick essentially and that gets analyzed for blood that's a very easy loow hanging fruit to test potentially for bowel cancer or at least a suspicion index for bowel cancer and then you've got lab grade assays for microbiome testing which are quite expensive used for you know feco microbio to transplants poo transplants Etc and those cost thousands of pounds in a lab but then you've got consumer grade poo testing and I must admit I haven't looked in detail at the evidence behind this but I cannot imagine how someone can take a a lab grade test which costs a lot of money and then make that available for you know1 pound or dozens of pounds at home and then tell you we can an analyze your entire microbiome based on this and not only that we can then tell you what specifically you can eat based on this 00 home test surely there is no you know solid science behind that so I can't comment on how valid the kind of shotgun metabolomic type approach is for analyzing the microbiome people I trust who do that kind of work tell me no it can't it cannot do what people are claiming it can do but I can speak to whether these kinds of tests are able to personalize your diet and the answer is no that there's two academic groups who also have a commercial product who do this and they simply haven't published any data whatsoever showing that their um offer is able to personalize diets so when I think about this when I read about this like five years ago and they said oh we're going to analyze the microbiome to see what diets people should have and I remember thinking oh okay so like maybe if people have more of the kind of bacteria that can metabolize carbohydrates the algorithm would recommend a higher carb diet maybe other people they're better able to metabolize protein you know like I I was expecting to see meaningful dietary recommendations that were different and then one of the first groups and it was a big paper published in cell in 2015 this idea that oh we've personalized diets and hidden deep in the supplementary data was the dietary breakdown of what their algorithm recommended and it was a low carb diet and it that made sense to me because if you look at what they're doing and lots of these companies are now similar they kind of say oh we're going to take your microbiome data and we'll take your glucose data and we'll put it all together in machine learning and it sounds very Cutting Edge and we'll give you these these recommendations and I think all their algorithm did is look at what people's glucose responses to food was acutely and guess what carbohydrate Foods push the glucose up and high fat and high protein foods don't so it recommended a high fat high protein diet to everyone that's not personalization um and more recently there's there's a company in the UK that published some data and it looks like their algorithm recommended a pretty healthy diet I mean it's it's plant-based it's reducing Ultra processed food like great but it's not the promise of this personalized um nutrition and it's not a surprise to me and I'm a real cynic that none of these companies have ever tried to test the reproducibility of their product so I don't know if you remember like 10 years ago where food intolerance tests were all the rage you know you test your skin or test your hair with things and it would give you a long readout of foods you can and cannot tolerate and I think it was witch magazine or someone else did a like a secret shopper so they went and had this food tolerance test twice and one time the test said you absolutely cannot have tomatoes and the other time it didn't and I I would bet quite a bit of money that these tests are equally unreproducible that someone Mak your microbiome on a Monday and says these are the foods you can and can't have and do it on Tuesday and I think it would tell you something different yeah I mean I can't I can't buy the personalized nutrition aspect when you know you recommend essentially a healthy diet nothing wrong with that as you suggested more plants more fiber Etc and a range of different things and then naturally if the average person increases their fiber intake and we know in the western world most people probably have a fiber deficient diet if they increase their fiber content because of this money they've spent thus they're you know heeding to the recommendations at least for a few weeks or a few months and they even increase their fiber intake by 10 grams a day they're going to poo better they're going to probably lower their cholesterol they're going to have all of these extra benefits of Simply increasing their fiber and eating more plant-rich foods and the antioxidants Etc and they're probably going to account those health benefit improvements and those metric improvements to XY Z company which offers this personalization rather than just realizing I've just eaten more fiber and I'm pooing there um I mean I I think so and it's very difficult when you're a consumer because all the things that you're talking about like confounding factors and things so you know if you have a trial and the group that gets the personalized nutrition gets a bunch more coaching and the group that has the generic advice doesn't obviously the group that got the personalized advice is going to get better outcomes because they've got more coaching they're going to stick to a healthy diet better and it's really sexing up like you said it's just nothing wrong with having a a healthy diet have more plants um have less Ultra processed foods fabulous but it's this packaging up of this science in a way that you kind of know the public are probably not going to notice you just say oh we did a randomized control trial it's the gold standard and most of the public are going to go wow they've actually tested their personalized nutrition intervention in a gold standard program whereas actually if you look at the data it's it's coaching like you said people are paying either either they're paying more money they're getting more coaching um and they're just sticking to healthy dietary guidelines better and something that's personalized nutrition adjacent and also in the gut health space is probiotics 20 30 years ago the whole chat about the microbiome and probiotics was probably Fringe hippie science and people are taking it seriously now as they rightly should but there's also open the door for charlatans and people trying to make a quick Buck off selling probiotics and I remember as a kid I used to religiously drink yakult every single day I love the taste of it and for a while people just assumed it was a good thing to do and didn't even question the science of probiotics and these natural bacteria found in these little you know tasty drinks but now there there should be some skepticism and cynicism rightly so because none of the data suggests that for the average person who doesn't have any specific bowel conditions IBS or diarhea Associated disorders would benefit from a off-the-shelf off the chilled section probiotic drink or powder or pill so what does the evidence say about probiotics I mean I I can't understand or how a one- siiz fits all probiotic can be beneficial for everyone and why people still continue to take it I mean so I should say this this is not my area of expertise so I should add that as a major um disclaimer there I mean I guess if I offer my broader views on the microbiome what we know and what we don't so everyone got excited in the microbiome some time ago when scientists started doing feal trans uh transplants of the entire microbiome so they'd basically take the microbiome from from like a mouse that is metabolically unwell so has obesity has diabetes and they transfer it into a m mouse that doesn't and what they see is the phenotype so the diabetes in the original Mouse then occurs in the other mouth so it was kind of causal data that the microbiome plays a really important role in influencing our metabolism but here's the thing like a microbiome number one is basically an organ we consider the microbiome to be as important as an organ and if you took the pancreas from someone with diabetes and gave it to someone who didn't have diabetes I would not be surprised that that organ transfer caused diabetes in the recipient I don't think anyone's arguing that an organ whether it's the microbiome or not is important but what people are claiming is that you can meaningfully alter the function of an organ with nutrition and that's what I find frustrating because even if you look at these later studies where people have transferred the entire microbiome for one rodent to another actually the phenotype doesn't last very long so for example some Studies have found that the microbiome from from erodent with insulin resistance causes insulin resistance in the recipient but only for a few weeks and after that the kind of phenotype disappears so even when you're TR you're trying to transfer the entire organ it doesn't actually have a massive effect for over the long term so the idea to your point that just taking one probiotic one bacteria is going to alter this kind of very stubborn entire organ to me is is very very questionable I do know and there are researchers in this field that I respect a lot Kevin wheen at Kings College London is one of them doing really good research on this and he also is not a person to over flate claims and I think there is some hope that in some inflammatory bowel conditions we might be able to use specific mixtures of these probiotics to alter in a meaningful way the microbiome to improve those symptoms um but that is very carefully defined it's done under proper clinical trial conditions it isn't this commercial by this one probiotic that we're seeing now um so in general what do we know about the microbiome for the rest of the population having lots of fiber is good that's it I mean I totally agree and in my time of prescribing uh medicines for patients I have prescribed probiotics to a few patients over the years who've had specific post bowel surgery issues or complications or specific gastroenterological conditions and those times I've prescribed the probiotics they've been medical growth so you know it's a prescription grade probiotic you know it's like a vssl contains the number of colony forming units of lactobacillus Etc and it's undergone whatever regulation it needs to undergo it's not a supplement that you can buy in a supermarket and I think probably consumers need to know that there is a diff difference between you know a medical professional saying probiotics can work for x y and Zed and that probiotic meaning to be a prescription grade medical strength probiotic versus a pill or powder you can buy online over the counter and for me on one side wanting to improve your health and looking for these hacks is one aspect and the kind of flip side is then people demonizing little things like we mentioned before the glucose but also similar to the demonization of glucose is a new thing which has you know cropped up in the last couple of years of of ultr processed foods and that's a whole can of worms and for me I really you know I guess in the grand scheme of things if everyone had access to you know enough money we'd all be eating Whole Foods great surely there's evidence saying that that that is great that's not the reality but also the reality is that some processing of foods is required to unlock the nutrition or the bioavailability or whatever so what is the science behind ultr processed foods and is it as bad as people claim it is as you know some of these long-term supposedly good epidemiological studies suggest they are you know how can someone decide whether it's truly bad or just like a fad to worry about so this is this is really interesting actually and I would tie all of this stuff up in we know 90% of what people should be doing to be healthy and we know what the unhealthy foods are things like cakes and donuts and crisps and all of those kind of things takeouts with a bunch of calories and no veggies exercise getting enough sleep blah blah blah that that hasn't changed and I'll introduce this topic by really summarizing everything that we've talked about going back to the attention economy if your goal is to get on the television sell a book sell a product you've got to give people something new you can't just say have you know fresh fruit and veg a lot exercise because people are like okay boring you've got to come up with some new science and I I think ultr processed foods is one of these I'm very critical of the famous book that came out last year because there's a real overstating of the evidence and I think it's probably very very likely that when we're seeing these relationships in observational data between Diet high and ultr processed food and negative Health outcomes it's be it's the stuff that we know already if you've ever worked in an office in the UK you'll know you know 3:00 every day often donuts come around people are having crisps at their desks they're having Coke I see kids having energy drinks on the train in the morning this is a lot of our diet and we absolutely know high sugar high fat Etc Chris who's who's written the ultra processed food will say aha but we know it's not just that because we had a trial and it was done by Kevin Hall at the NIH a wonderful researcher who I respect a lot who showed that even if you match diets for sugar and salt and fat the ultra processed diet causes weight gain but the unprocessed one didn't but if you look carefully in again in the supplementary data the unprocessed diet had seven to eight servings of fresh fruit and veg day whereas the ultra process one didn't I mean the ultr process diet basically just dodged fruit and veg for two weeks and again if you look at the smacks that were offered now why does this matter because what fruit and veg does is it dilutes the energy density of our meals and of of what we're eating and so energy density is calories per gram and the whole idea about this is if you imagine you have like meatballs and pasta just that mix it all together you're going to have more calories than if you added like three servings of veggies because the veggies have volume if they're on your plate they've got loads of volume but they basically have no calories so we've known for for DEC that if you add loads of veggies to a meal you will dilute the energy density of that meal despite the volume or the weight being the same people consume fewer calories and actually that's what I think Kevin Hall's study showed so the ultr processed diet didn't have any veggies or or fruit basically at all they had double the energy density of the ultr processed diet and research Decades of it shows that will lead us to spontaneously overc consumed calories so that's what I think the study showed and let me go back to what I said before it's not new is it make sure you're getting your fruit and veggies in like add two servings of veggies to every single meal so at the moment based on most of the science I think the ultr process story is not adding much more than we didn't know already is having low energy dense foods lots of fiber lots of fruit and veg and avoiding high calorie high sugar foods that cause us to overeat now let me just say one final thing because this is a merging science we are quite rightly I think looking more closely at all of the additives in our food that previously I think this is absolutely correct that we are focused just on whether they are toxic whether they might cause cancers and other things and we haven't looked as closely as perhaps we could have at things like altering metabolism or affecting the the health of the bowel and that research is ongoing but I've looked at some of those studies and it's it's the kind of very early science that is absolutely not definitive let me give you one example there was a study that gave uh 15 grams a day of I think it's an emulsifier I can't remember the name of it in a very small exploratory study and they found I think it was nine people in two people but not in seven they saw some changes in the bow so it's like if you've got nine people and something only occurs in two that might just be chance it might be changes that happen and if you did any drugs trial or early drugs work and you had a sample size of nine and your drug for example lowered glucose in two but it didn't in seven we'd say that drug didn't work right we wouldn't be excited so flip that around and you say okay so we have this emulsifier that looks like it did something in two people but it didn't in seven like by golly that's not conclusive at all yeah um and so I think we absolutely should be doing research in this area but I haven't haven't seen anything yet that suggests that these additives um are harmful alluding to the ultrapress uh study you suggested earlier where they compared the ultra processed diet versus the kind of Whole Foods diet and he said it was about the energy density and that the energy density of the ultrapress diet was Far lower if someone were to have an ultr processed diet then by extrapolation of this study by the results of this study and the outcomes if someone had a ultr processed diet that was rich in you know fiber rich foods for example you know if that were possible and had more of those um you know compounds which increased the energy density of that food would you then hypothesize and that diet then independent of everything else could produce similar outcomes to the whole food diet in terms of weight gain I would H I would hypothesize yes I mean just to be clear there are lots of reasons why even if you had an ultr processed food let's say bread for example by the way studies which separate Ultra processed foods into categories tend to show that things like high fiber Breads and cereals are either neutral or they're protective and unsurprisingly it's the cakes and the donuts that aren't so yes if we modified a processed food to lower its energy density and to make it harder that affects eating rate as well I hypothesize yes it would not cause overeating but I do emphasize I still would there's lots of reasons to have fresh fruit and veg you know all of the goodness that's in them the micronutrients and the phytonutrients are all really good for us so there's never a circumstance when I would ever suggest not having lots of fruit and veg but I think based on the evidence yes you can in fact have ultr processed foods in the diet and remain absolutely healthy and by the way if a study is done that shows that I'm wrong that actually if you have Ultra processed foods and you're having lots of fruit and veg actually it still causes harm I'll change my opinion um but as of right now what I find so frustrating is let's say Supermarket bread there's there's no data that I've seen that it's it's problematic and I was quite annoyed with an interview that let's just name him Chris had done and it was with the guardian and he talked about AA you know with great confidence and certainty well we know that Supermarket bread is softer it's going to make people eat more of it and like I could believe that and I remember reading that interview thinking yeah that makes sense I wonder whether anyone's actually looked at it and so I did a search I did a quick literature search I couldn't find much I found one study and it was done in France and it compared I can't remember the exact numbers but like seven to 10 industrial um homemade and an in between kind of bread it compared lots of them and it tested the energy density the softness and I think the water content and found no differences between them and it's like you know maybe the French make that even industrially maybe they make their their bread different but and I think and I'm very cynical that the reason people like Chris and others aren't talking about takeaways and Skittles and Doritos and food we know is rubbish is it's because that's not new it's not going to get people to buy your book telling people stuff they already know so you come up with this pretty controversial oh my God Supermarket bread and if you look at the average person in the UK's diet like I would I would die of shock if Supermarket bread is ever shown to be remotely related to negative Health outcomes ever like with the diet that we have with the takeouts with like I said the energy drinks with the soft drinks with the crisps Supermarket breads are probably one of the healthiest things the Brits eat and the fact that you have a person who's like we started talking of this about this at the beginning the fact that you have a Doctor Who's Making people worry about Supermarket bread I I find incredibly worrying so maybe let me add some actionable tips like when I did my PhD um I was working 7: a.m to 11:00 a.m. I ate lots of FR meals tons of them super you know Supermarket buy them at the end of the day go home microwave them in 3 minutes and what I did is I'd always add at the end of the day in the supermarket they had like carrots and and those little microwavable veggie bags on offer for like 70p so I just put those in the microwave so yes I had my ready meal and I tried to choose ones which are lower and salt that were had a good nutritional profile and I made sure I had veggies on that plate I have Supermarket bread I I do occasionally enjoy making my bread but I don't have that much time I have Supermarket bread and do not worry about it but I'll like mash an avocado on there or I'll sometimes drizzle olive oil I'll have lots of tomatoes and veggies and salad I I'm pretty plant-based for environmental reasons so I have plant-based milk Ultra processed food but I'll have oats I'll have nuts and seeds and raisins I grate an apple on my cereal so I have lots a reasonable amount of ultra processed foods but I make sure the rest of my diet is a lot of plants a lot of fiber and a lot of healthiness you know I think that's a perfect summary of everything and UL Ely I believe and I don't think it's wrong to say that probably our stresses with curating our lifestyles and our diets and our obsession with tracking things are probably more dilar to health outcomes than actually occasionally having Supermarket bread a donut a ready meal anything like that and what is missing right now in the online space certainly is some of that nuance and less polarizing opinion that's not as sensational that's not going to go viral it's not as sexy so Nicola thank you very much for providing that balanc news and just you know down toe information and actionable tips as well thank you so much for coming on and definitely need to have you on again cuz we've just scratched the surface I feel real I really enjoyed it thank you so much

I&#39;m Dr Curran an NHS surgeon and in this podcast we cut through the BS of Modern Health advice and tackle the biggest issues in science health and Medicine we know 90% of what people should be doing to be healthy and we know what the unhealthy foods are if your goal is to get on the television sell a book sell a product you can&#39;t just say have you know fresh fruit and veg a lot exercise cuz people are like okay boring you&#39;ve got to come up with some new science why are people using cgms I mean is there any role for using cgms if you don&#39;t have any issues with glucose control we don&#39;t basically know what the glucose means and it is causing so much anxiety that I see and so much confusion it&#39;s wild to me there&#39;s no evidence at all out there that this is harmful there&#39;s lots of indirect evidence it&#39;s absolutely fine and normal and I think it&#39;s people trying to sell cgms so what is the science behind ultr processed foods I think based on the evidence yes you can in fact have ultr processed foods in the diet and remain absolutely healthy I would I would die of shock if Supermarket bread is ever shown to be remotely related to negative Health outcomes ever Nica thank you so much for joining me not at all pleasure I&#39;ve I&#39;ve used to you know follow your substack and read all of these articles that you wrote about all this misinformation in pseudo science online but it seems now we really are in a new golden age of pseudo science and misinformation particularly when it comes to podcast and there seems to be a plethora of Health podcasts out there at the moment that exist purely for the sake of farming likes and engagement by you know saying very controversial things polarizing opinions and it just seems to be a complete mess out there and for the average person who&#39;s maybe not MediCal at all who just wants to improve their health it can be very difficult to separate what is the truth from what is pseudoscience and what is Flatout misinformation so why are we in this state at the moment where there&#39;s so much misinformation and number two how can someone listening to any bit of Health advice online actually know what seems legit or what seems untrustworthy I mean I think there are three things why we have this I I think firstly I mean social media has often opportunity to make people a lot of money in a fairly easy way like if you think if you&#39;re a doctor you go through all of this training if you go into clinical trials it&#39;s Decades of work before you get any attention which brings me to my second point is we have an attention economy everything is about eyeballs and clicks and so if you&#39;re able to exploit social media to get attention that is a great way of making money and I think the third thing and maybe we&#39;ll touch on this the thing that disappoints me the most is that a lot of the misinformation isn&#39;t necessarily coming from the crazy people who bought their PHD online it&#39;s actually coming from people who&#39;ve received training the right kind of training and should know better and I wonder whether it&#39;s because I mean I do research I don&#39;t know if you&#39;ve ever been involved in clinical trials but my goodness it&#39;s a hell of a lot of work it&#39;s a lot of you know drudge work being awake until 2 a.m. writing the finances out it&#39;s solving problems it&#39;s bureaucracy it&#39;s not particularly glamorous or exciting and two frankly the money is not that great and so I can see how now that there is this opportunity to earn a lot of money without having to sit awake until 2 am writing a grant that people take that opportunity and they&#39;re able to use their vocabulary and their credentials to make a lot of money really quickly to pick up on that point you made about the misinformation a lot of that coming from medical professionals Healthcare professionals with credentials and who&#39;ve been to University and done research and studied for many years to achieve a level of respect in Academia or beyond that brings me on to the point about capillary in the continuous glucose monsters right and the cgms and you know obviously you know being a doctor in the hospital I&#39;ve seen diabetics where these over the years have seen friends and family who are diabetics have you know these devices and they&#39;re very useful we know their game changes for people who have pathology but then I&#39;ve seen so many of these influences or medical content creators or Educators online who should know better who are then advocating for normal people to use these and that&#39;s when you know a few a few years back when I saw this I was optimistic and I thought hang on there there may be some value here and let me look into the research and the more I read things from reading Twitter threads from the likes of yourself and your substack and doing my own research I realized hang on there really doesn&#39;t seems to be much argument here for normal people with no diabetes no you know pre-diabetes or insulin resistance to be using these unless you&#39;re a ultramarathon runner or an athlete looking to get that extra .1% so really why are people using cgms I mean is there any role for using cgms if you don&#39;t have any issues with glucose control I on the balance of the evidence I don&#39;t think so so it&#39;s really important to note that firstly glucose almost certainly in in people without pre-diabetes or type two diabetes ever gets to a concentration that is directly causing harm so of course in diabetes there&#39;s value in these devices because glucose can get to a level that directly causes harm and so enabling people to take action to reduce that is a good thing that isn&#39;t the case in people without pre-diabetes or type two diabetes so if glucose not isn&#39;t pathological you don&#39;t need to intervene to lower glucose acutely and the second Point related to that is in people without diabetes and indeed with type two diabetes glucose is a simp symptom of everything that&#39;s going on underneath so even if you were to say oh I just want to catch pre-diabetes early you know pre pre-diabetes well actually the glucose is a symptom of the underlying damage and you need to fix that underlying damage which if you&#39;re relying on your glucose level to tell you what to do it&#39;s going to mislead you and let me give you an example like I&#39;ve seen the glucose goddess and others kind of say oh dress your carbs so this idea I mean I&#39;ve seen it even with fruit like my goodness if you have mango or blueberries dress them in Greek yogurt to lower the glucose Spike like again like I said the glucose isn&#39;t getting into a concentration that causes you harm but if you are adding some calories and all saturated fat to the to the fruit what you&#39;re doing is possibly increasing your likelihood of getting some insulin resistance the effect is probably small but two you&#39;re adding calories in unnecessarily when the absolute primary thing that most people should do is manag their weight to prevent type two diabetes so it&#39;s giving you very perverse and misleading and possibly even damaging advice by this glucocentric approach to nutrition say someone is healthc conscious and they believe these online influencers and they buy themselves a a subscription to one of these CGM glucose devices a little circle on their arm and they&#39;re looking at the readings what is a glucose for someone who has no idea about glucose physiology what is a spike and what difference does it make to a normal person without diabetes and then to a person with diabetes and why is it harmful in that case so I mean the thing is about Spike there&#39;s no definition basically my understanding and I think most people&#39;s is it means when your glucose goes up quite a lot after you eat um if you have a carbohydrate containing food it&#39;s natural your glucose goes up and it should come back down again because the pancreas responds with releasing insulin and the difference between people without diabetes and with is number one the concentration that glucose gets to so the magnitude of increase but number two the duration of that glucose Spike so you are exposed to a much higher concentration of glucose number one but you will be exposed to that higher concentration of glucose for much longer and this is what people Miss I mean the thing that really annoys me and I&#39;m sure many consultants in the hospital are also seeing this when a glucose Spike has been defined as my glucose got to a diabetic level that is a fundamental misunderstanding of what diabetes is diabetes is chronically elevated blood glucose if you have type 2 diabetes your fasting glucose May well be above seven the whole night when you eat something it might be going up to 11 12 13 14 15 it might never get below seven so you are chronically and constantly exposed to a high concentration of glucose and based on pretty much most of what we understand that is a lot of the damage because glucose at that concentration for a long long time can be toxic to the cells now people do talk about oh what about the Peaks and troughs surely that adds some extra damage and we think there might be in diabetes so if it&#39;s going up and down and up and down independent of what your overall glucose level is just the oscillating glucose itself might be damaging but this surprises people even in diabetes we are not absolutely sure whether that is the case whether oscillating glucose explains much more than overall exposure to chronically elevated glucose so I always emphasize that because what are we talking about with a glucose spike in an otherwise healthy person it&#39;s going up for high for 20 minutes not even as as high as You&#39; getting diabetes and it&#39;s coming back down again it&#39;s it&#39;s it&#39;s wild to me there&#39;s no evidence at all out there that this is harmful there&#39;s lots of indirect evidence it&#39;s absolutely fine and normal um and I think it&#39;s people trying to sell cgms and you mentioned there that I think you alluded to the point earlier that there are some people who are trying to use this as an asymptomatic screening tool and that&#39;s how they&#39;re justifying the use of these explain why why that doesn&#39;t make sense for someone who maybe has had some baseline blood tests you know a few months ago and they HBC hba1c a mark of their long-term glucose control is normal their fasting blood sugars is also normal and they&#39;ve decided to wear this device to just pick up chronically elevated spikes why is that not a good screening tool for pre pre-diabetes or even pre-diabetes to make these better health choices the short answer is is because we don&#39;t know what normal looks like we don&#39;t know what any of these spikes mean and there&#39;s also in general a lack of validation of these tools in measuring glucose there&#39;s a lot of error there&#39;s a lot of things that can go wrong and they&#39;re not standardized so of course there are limitations to any blood test but your doctor will have your medical history so they&#39;ll be able to choose the right glucose screening tool for you whether it&#39;s hemoglobin A1c which is the like you said the long measure whether it&#39;s taken a fasting glucose on the day or a glucose tolerance test they&#39;re standardized we can compare your data to hundreds of thousands of other people and put it into context with what it means we simply don&#39;t have that with the cgms so there&#39;s error between the there&#39;s variance between the devices depending on a multitude of things you might have done in the previous couple of days or the day before that&#39;s going to affect your glucose so so that we don&#39;t basically know what the glucose means it is causing so much anxiety that I see and so much confusion and I see patients in my clinic so I see people who&#39;ve been diagnosed with pre-diabetes or even type two and so when I get on you know in in the clinic appointment with people and I sort of say okay so I can see that you&#39;ve been diagnosed with pre-diabetes and we talk about it and then I always do a screening so I&#39;m like okay what&#39;s your A1C and they&#39;ve said like 31 35 like normal right so pre-diabetes starts at 42 and people are coming to me and it&#39;s it&#39;s this super low or normal um hemoglobin A1c and so I&#39;m like okay that sounds like you&#39;ve got normal blood glucose why do you think you&#39;ve got pre-diabetes oh well I wore a CGM and my glucose gets to pre-diabetes levels and it doesn&#39;t and maybe that&#39;s worth going into is is what pre-diabetes and type 2 diabetes levels are for example on a standardized test like a glucose tolerance test so this is what I see is when you have a glucose tolerance test we diagnose if diagnose is the right word pre-diabetes if your 2hour glucose is like 7.8 so 7.8 millimes per liter or above but that&#39;s two hours after you take a glucose drink and of course if your glucose is still that high two hours after a glucose drink it&#39;s an indication something&#39;s wrong because in healthy people it would have come down and it&#39;s the timing there that&#39;s really important and instead what I see is people have this misunderstanding and it&#39;s not their fault they are being told I think by folks trying to sell these CGM devices oh my glucose got to a pre-diabetic level when I had toast it&#39;s actually utterly normal and healthy for your glucose to get to 7.8 if you have toast or carbohydrate within 30 to 40 minutes of eating that food that&#39;s utterly normal and healthy the point is it comes back down again and I think that&#39;s the problem really I mean we have got people now pathologizing glucose similar to how people have historically pathologized cortisol and I think these chemicals in our body are neither good nor bad they serve a function and in extreme low States and extreme High States they can be problematic for some people and we&#39;ve got homeostasis and normal physiolog physiological mechanisms which can balance it in the average person and I actually tried to CGM for myself myself to show people why you know it&#39;s it&#39;s so Superfluous for the average person and I I ate a chicken wing you know which is 100 100 calories for one chicken wing and it&#39;s full of fat and I ate an apple a mediumsized apple which is around 80 or 90 calories full of sugar you know obviously the Apple spiked my blood sugar on my CGM device more than the chicken wing and I think it would be wrong to say that the apple is inherently worth for you than a fried chicken wing but as according to CGM if we just look at the glucose spikes the Apple spiked my glucose more than the chicken wing and if you listen to these CGM zealots and glucose zealots online they would make you believe that that is decaying your body or disrupting your body in some way purely because of that glucose Spike and and I wonder like you mentioned as well how it&#39;s causing anxiety this obsessive tracking of glucose I have seen anecdotally some patients with gou stones in clinics who have actually got a worsening of their symptoms because they&#39;re wearing cgms and and I just asked them incidentally uh you know your history online doesn&#39;t suggest any evidence of diabetes is there a reason why you&#39;re wearing these devices and they&#39;re saying they&#39;re trying to be healthier and tracking what they eat and actually their symptoms with their ghou Stones were worse because they were increasing the amount of fat in their diet to artificially blunt their glucose response like trying to manufacture a flat line of glucose so their readings look great but that&#39;s impacting their overall health and other conditions are you seeing a lot more of that in the patients that you see as well and in general yes yes and if I were to say if there&#39;s one thing that I am most concerned about and in fact that I see the most it is a rise in LDL cholesterol in people who are trying to follow this glucos Centric approach because like you say they are focusing on oh healthy eating means lowering my glucose and so naturally they tend to follow a higher fat diet a lot of high fat foods have more saturated fat in them and some people only need a small amount of extra saturated fat in the diet to push their LDL cholesterol up and I think the really important thing to note even in type two diabetes which is a condition diagnosed via high blood glucose we don&#39;t just pay attention to glucose because in diabetes what sadly kills people is heart attacks and strokes so it&#39;s high blood pressure and LDL cholesterol it&#39;s lipids that we need to pay attention to and I always think how perverse that is that we have this glucocentric approach in people who don&#39;t need to be concerned about their glucose and it&#39;s leading them to take steps that could actually be worsening their other risk factors um because across the population I think around half of people depending on how you define it have a cholesterol level that&#39;s high enough to be a contributing factor to cardiovascular disease and other things and I think it&#39;s probably around a third even higher who have hypertension so those are the things my goodness we should be focusing on but we&#39;re not because someone hasn&#39;t developed this tiny very convenient sexy little device that is going to be giving people this by a feedback and I think that&#39;s that&#39;s very very worrying and so yeah that&#39;s what I see in my clinic it&#39;s it these things I think could be doing harm do you think that there are things that people ought to be tracking even if not on a daily basis maybe on a weekly basis and this is assuming you don&#39;t have any chronic health conditions for the average person looking to better their health are there any variables or metrics worth keeping an eye on that&#39;s a great question and I think actually it really speaks to your point about galston that people are worsening other aspects of their health like health is lots of thing things and focusing on just glucose is is very misleading even in diabetes like I said and just to add that a lot of these CGM companies will say get insight into your metabolism now glucose in people someone without diabetes tells you actually very little if negligent amounts about your metabolism so that&#39;s really important in terms of what though is valuable what I want to know about as as a reasonably healthy person who wants to stay healthy um my blood pressure cholesterol so LDL cholesterol particularly um resting heart rate because it means I I&#39;ve got a strong heart and hopefully that&#39;s going to help me to live a long time um muscle mass so being strong and functional over a long period of time and maybe insulin like if you wanted something that&#39;s going to tell you about your metabolism and how metabolically healthy you are insulin is far better than glucose in that regard yeah I mean for me I mean even though there&#39;s no guidelines to suggest that this is the case I believe that probably over the age of 30 I mean this is again purely an arbitrary number it&#39;s probably worth most people if they&#39;ve not in their lifetime had it getting a a baseline set of blood tests just to check some of those metrics that you mentioned like your cholesterol etc for men potentially something like testosterone uh just to see at what range it&#39;s in is there factors in your life that you could change to improve that such as your sleep Etc and on your point of people obsessing over glucose and thinking that is the reading that matters a lot of these CGM companies claim that their benefits can be extended towards your sleep and your focus and your energy and they&#39;re actually forgetting that your focus and energy and concentration Etc that&#39;s all because of high glucose usually you get those benefits of improved cognition because your glucose is probably normal SL High because it needs to be high your body is making it high so you can function better when my glucose is low I know I feel lethargic and I feel a bit grumpy and my reflexes and energy are not quite right so I think it&#39;s almost false advertising for these companies to suggest that lowering your glucose bike or being aware of that has anything to do with all of these wide reaching facets of everyday biology yeah like I see where they&#39;re talking about it very often it&#39;s the Peaks and troughs so it&#39;s like this roller coaster of glucose that I was talking about and like I said even in in diabetes we are not entirely sure how important that is or whether it matters so very likely it doesn&#39;t in people without diabetes but the the thing that worries me even more is the evidence that&#39;s being used to make these claims so for example there&#39;s a company that have cross-sectional data and they&#39;ve used this cross-sectional data to find a relationship between Peaks and troughs so that roller coaster and things like hunger and energy but cross-sectional data is the weakest type of data we have this is the kind of data where you get those spurious associations of if you buy an iPhone on Tuesday you&#39;re more likely to have Crohn&#39;s disease it&#39;s sort of meaningless and I I going back to the first point you made about this misinformation what bothers me is that it&#39;s coming from scientists who have this product they want to sell they&#39;ve got all of this data and people are paying them paying this company to give them their Health Data the company are then analyzing this data doing trash science frankly to publish these spirous associations to say aha look there&#39;s a relationship between these roller coasters and energy and all of those things so buy our product whereas in fact the stronger evidence the randomized experimental evidence has not shown relevant relationships between Peaks and TR of glucose and things like appetite hunger energy and all of those things so I think you know some of that data dredging um you know as you can call it just looking at random observations and correlations is being used to almost to prove a causation which it&#39;s not and I think ultimately there will be a lot of people watching this who you know are sort of really fixated and love their cgms even if they&#39;re not diabetic and they might be resistant to hearing some of these myths being broken here but also for people listening who maybe are diabetic or have some issue with glucose regulation what are some actual actionable things that someone can do to actually regulate their glucose levels whether it&#39;s during a meal or during a day nutritionally or any hacks that someone can do so I would make a distinction here between someone with and without diabetes because I think there are some hacks that actually are really useful for people with type 2 diabetes so for example meal ordering there is very good evidence that just simply changing the order of how you eat lowest blood glucose so if you&#39;re having a meal having particularly the protein before so that might be the chicken the tofu or whatever you&#39;re choosing to have as your protein even having maybe some salad or vegetables and then consuming the carbohydrate that is really effective at lowering glucose it&#39;s a great thing to do because you haven&#39;t to change what what you eat it&#39;s the order with which you consume it but why don&#39;t I recommend that for people without pre-diabetes or type two diabetes it&#39;s simply because you don&#39;t need to worry about your glucose and I worry that we are turning meals into scientific experiments and food is meant to be enjoyed the socialization aspect and I like like we talked about with other risk factors I would much prefer if people are going to pay attention and you know give their brain energy to something do it to things like blood pressure where having fruits and stuff like that is going to help lower your blood pressure and do it with having healthy fat so pay attention to that I worry about encouraging people to do things that are simply not necessary so that&#39;s one hack that I think is really good great for people with type two diabetes I also um in my practice a lot I kind of use a high protein diet that seems to be very effective for managing glucose and it can lower glucose a lot um without needing to lose weight which is very useful but again why don&#39;t I recommend that for people without diabetes because it&#39;s not necessary and you should simply have a healthy diet that you enjoy the the high protein diet and its role in regulating blood glucose do you think that&#39;s because the higher protein foods are more voluminous and more satiating so thereby you might consume less calories or less likely to overc consume calories or is there mechanism by which so mechanistically what they do and actually some of the food order Studies have shown this is when protein gets broken down into amino acids in the blood and what we know is amino acids are great at getting the pancreas to produce insulin and this is really necessary and important in type 2 diabetes because as you develop type 2 diabetes particularly if you&#39;ve had it for a couple of years or longer the beta cells of the pancreas are less sensitive to to glucose in your blood and what that means is so in a healthy person if you have like some toast for breakfast your glucose will go up you have a sensor on your pancreas that recognizes oh gosh glucose is going up let&#39;s produce some insulin that&#39;s happens in healthy people that sensor doesn&#39;t work as well in people without type 2 diabetes and it works terribly in people who&#39;ve had type two diabetes for a long time what happens is you eat those two slices of bread your blood glucose goes up your pancreas doesn&#39;t recognize it because the sensor doesn&#39;t work but the pancreas and the sensor remain sensitive to amino acids even if you&#39;ve had type two diabetes for we think quite a long time so if you have a lot of protein with your meal or you have protein first those amino acids tell the pancreas produce some insulin and you can really help lower particularly the after meal glucose so that&#39;s what we think the primary mechanism is well that&#39;s really interesting actually I think that&#39;s useful hacking I guess for diabetics as well if they combine that with resistance training and the high protein more muscle increase muscle protein synthesis potentially which can then also sensitize cells well the muscle cells can uptake glucose a bit more and it also helped to you know contribute to that regulation of the glucose so I guess it&#39;s like a a win-win scenario in that case yeah absolutely your muscles are a massive reservoir reservoir for glucose so the bigger they are and the more they work the more glucose suck out of the bloodstream so absolutely and I would just add I&#39;m not a a carnivore advocate in the sense that it&#39;s a a high meat High saturated fat diet you can have high protein and I encourage lots of plants in there even if they&#39;re low carb plants having nut seeds lots of fiber in there so even though you&#39;re getting the high protein I always focus on all of the other cardiovascular risk factors as well so you want to keep your saturated fat intake low lots of of veggies and fruits so so that you&#39;re keeping your blood pressure low as well what are your thoughts on this kind of trend of I say it&#39;s a trend but it&#39;s just it keeps having its Peaks and troughs and it&#39;s currently having its moment again I guess where people are advocating for the use of apple cider vinegar to blunt glucose spikes as well and looking into the literature there seems to be some minimal data to suggest that there may be something there but clearly you know this is a small win if it exists at all yeah so I think it I think the effect is real um it&#39;s I mean it&#39;s not massive but I just think of all the other things that you could do to to lower your glucose it&#39;s one unpleasant two I mean I&#39;m not I don&#39;t know I&#39;m not a gastro expert but I can&#39;t imagine having something that acidic going down your esophagus frequently is a good thing and the the other point as well and it comes back to does lowering glucose acutely so does taking steps to blunt this this glucose spike in the short term have benefits over the long term and again I go back to the fact that your if your glucose is getting too high it&#39;s because you have underlying damage so you have insulin resistance and your beta cells are probably failing and to fix those things you can lose weight that&#39;s that&#39;s effective in anyone even people who are relatively lean if you have large waist circumference or fat around the middle losing weight is going to fix your beta cells it&#39;s going to fix your liver fat it&#39;s going to fix your insulin resistance it&#39;s going to lower your blood pressure and all of the other things exercise is a better choice to lower glucose acutely and it&#39;s going to improve the underlying damage having more fruits and veggies is going to make you more insulin sensitive so you put all of the different things that you could do that are hopefully Pleasant enjoyable fun to lower your glucose and you compare it to Apple side of vinegar I I mean I&#39;ve never in my ever in my clinical career ever ever recommended anyone have apple cider vinegar to to blunt a glucose bike and I never will I think this CGM trend is emblematic of The Wider problem of people wanting and the people wanting personalized Health Care is not a problem in itself but I guess it&#39;s the owners of the companies to then outline the limitations of these things and I think the next thing I worry about is something which revolves around the gut health space in the microbiome we&#39;ve seen an uptake in the number of people promising atome microbiome testing like stool sample testing now as a surgeon the NHS the stool testing that I&#39;m used to you know seeing patients have is a fecal occult blood test at home for the you know bowel cancer screening program you get a bit of uh you know a kit sent at home you you poo onto this stick essentially and that gets analyzed for blood that&#39;s a very easy loow hanging fruit to test potentially for bowel cancer or at least a suspicion index for bowel cancer and then you&#39;ve got lab grade assays for microbiome testing which are quite expensive used for you know feco microbio to transplants poo transplants Etc and those cost thousands of pounds in a lab but then you&#39;ve got consumer grade poo testing and I must admit I haven&#39;t looked in detail at the evidence behind this but I cannot imagine how someone can take a a lab grade test which costs a lot of money and then make that available for you know1 pound or dozens of pounds at home and then tell you we can an analyze your entire microbiome based on this and not only that we can then tell you what specifically you can eat based on this 00 home test surely there is no you know solid science behind that so I can&#39;t comment on how valid the kind of shotgun metabolomic type approach is for analyzing the microbiome people I trust who do that kind of work tell me no it can&#39;t it cannot do what people are claiming it can do but I can speak to whether these kinds of tests are able to personalize your diet and the answer is no that there&#39;s two academic groups who also have a commercial product who do this and they simply haven&#39;t published any data whatsoever showing that their um offer is able to personalize diets so when I think about this when I read about this like five years ago and they said oh we&#39;re going to analyze the microbiome to see what diets people should have and I remember thinking oh okay so like maybe if people have more of the kind of bacteria that can metabolize carbohydrates the algorithm would recommend a higher carb diet maybe other people they&#39;re better able to metabolize protein you know like I I was expecting to see meaningful dietary recommendations that were different and then one of the first groups and it was a big paper published in cell in 2015 this idea that oh we&#39;ve personalized diets and hidden deep in the supplementary data was the dietary breakdown of what their algorithm recommended and it was a low carb diet and it that made sense to me because if you look at what they&#39;re doing and lots of these companies are now similar they kind of say oh we&#39;re going to take your microbiome data and we&#39;ll take your glucose data and we&#39;ll put it all together in machine learning and it sounds very Cutting Edge and we&#39;ll give you these these recommendations and I think all their algorithm did is look at what people&#39;s glucose responses to food was acutely and guess what carbohydrate Foods push the glucose up and high fat and high protein foods don&#39;t so it recommended a high fat high protein diet to everyone that&#39;s not personalization um and more recently there&#39;s there&#39;s a company in the UK that published some data and it looks like their algorithm recommended a pretty healthy diet I mean it&#39;s it&#39;s plant-based it&#39;s reducing Ultra processed food like great but it&#39;s not the promise of this personalized um nutrition and it&#39;s not a surprise to me and I&#39;m a real cynic that none of these companies have ever tried to test the reproducibility of their product so I don&#39;t know if you remember like 10 years ago where food intolerance tests were all the rage you know you test your skin or test your hair with things and it would give you a long readout of foods you can and cannot tolerate and I think it was witch magazine or someone else did a like a secret shopper so they went and had this food tolerance test twice and one time the test said you absolutely cannot have tomatoes and the other time it didn&#39;t and I I would bet quite a bit of money that these tests are equally unreproducible that someone Mak your microbiome on a Monday and says these are the foods you can and can&#39;t have and do it on Tuesday and I think it would tell you something different yeah I mean I can&#39;t I can&#39;t buy the personalized nutrition aspect when you know you recommend essentially a healthy diet nothing wrong with that as you suggested more plants more fiber Etc and a range of different things and then naturally if the average person increases their fiber intake and we know in the western world most people probably have a fiber deficient diet if they increase their fiber content because of this money they&#39;ve spent thus they&#39;re you know heeding to the recommendations at least for a few weeks or a few months and they even increase their fiber intake by 10 grams a day they&#39;re going to poo better they&#39;re going to probably lower their cholesterol they&#39;re going to have all of these extra benefits of Simply increasing their fiber and eating more plant-rich foods and the antioxidants Etc and they&#39;re probably going to account those health benefit improvements and those metric improvements to XY Z company which offers this personalization rather than just realizing I&#39;ve just eaten more fiber and I&#39;m pooing there um I mean I I think so and it&#39;s very difficult when you&#39;re a consumer because all the things that you&#39;re talking about like confounding factors and things so you know if you have a trial and the group that gets the personalized nutrition gets a bunch more coaching and the group that has the generic advice doesn&#39;t obviously the group that got the personalized advice is going to get better outcomes because they&#39;ve got more coaching they&#39;re going to stick to a healthy diet better and it&#39;s really sexing up like you said it&#39;s just nothing wrong with having a a healthy diet have more plants um have less Ultra processed foods fabulous but it&#39;s this packaging up of this science in a way that you kind of know the public are probably not going to notice you just say oh we did a randomized control trial it&#39;s the gold standard and most of the public are going to go wow they&#39;ve actually tested their personalized nutrition intervention in a gold standard program whereas actually if you look at the data it&#39;s it&#39;s coaching like you said people are paying either either they&#39;re paying more money they&#39;re getting more coaching um and they&#39;re just sticking to healthy dietary guidelines better and something that&#39;s personalized nutrition adjacent and also in the gut health space is probiotics 20 30 years ago the whole chat about the microbiome and probiotics was probably Fringe hippie science and people are taking it seriously now as they rightly should but there&#39;s also open the door for charlatans and people trying to make a quick Buck off selling probiotics and I remember as a kid I used to religiously drink yakult every single day I love the taste of it and for a while people just assumed it was a good thing to do and didn&#39;t even question the science of probiotics and these natural bacteria found in these little you know tasty drinks but now there there should be some skepticism and cynicism rightly so because none of the data suggests that for the average person who doesn&#39;t have any specific bowel conditions IBS or diarhea Associated disorders would benefit from a off-the-shelf off the chilled section probiotic drink or powder or pill so what does the evidence say about probiotics I mean I I can&#39;t understand or how a one- siiz fits all probiotic can be beneficial for everyone and why people still continue to take it I mean so I should say this this is not my area of expertise so I should add that as a major um disclaimer there I mean I guess if I offer my broader views on the microbiome what we know and what we don&#39;t so everyone got excited in the microbiome some time ago when scientists started doing feal trans uh transplants of the entire microbiome so they&#39;d basically take the microbiome from from like a mouse that is metabolically unwell so has obesity has diabetes and they transfer it into a m mouse that doesn&#39;t and what they see is the phenotype so the diabetes in the original Mouse then occurs in the other mouth so it was kind of causal data that the microbiome plays a really important role in influencing our metabolism but here&#39;s the thing like a microbiome number one is basically an organ we consider the microbiome to be as important as an organ and if you took the pancreas from someone with diabetes and gave it to someone who didn&#39;t have diabetes I would not be surprised that that organ transfer caused diabetes in the recipient I don&#39;t think anyone&#39;s arguing that an organ whether it&#39;s the microbiome or not is important but what people are claiming is that you can meaningfully alter the function of an organ with nutrition and that&#39;s what I find frustrating because even if you look at these later studies where people have transferred the entire microbiome for one rodent to another actually the phenotype doesn&#39;t last very long so for example some Studies have found that the microbiome from from erodent with insulin resistance causes insulin resistance in the recipient but only for a few weeks and after that the kind of phenotype disappears so even when you&#39;re TR you&#39;re trying to transfer the entire organ it doesn&#39;t actually have a massive effect for over the long term so the idea to your point that just taking one probiotic one bacteria is going to alter this kind of very stubborn entire organ to me is is very very questionable I do know and there are researchers in this field that I respect a lot Kevin wheen at Kings College London is one of them doing really good research on this and he also is not a person to over flate claims and I think there is some hope that in some inflammatory bowel conditions we might be able to use specific mixtures of these probiotics to alter in a meaningful way the microbiome to improve those symptoms um but that is very carefully defined it&#39;s done under proper clinical trial conditions it isn&#39;t this commercial by this one probiotic that we&#39;re seeing now um so in general what do we know about the microbiome for the rest of the population having lots of fiber is good that&#39;s it I mean I totally agree and in my time of prescribing uh medicines for patients I have prescribed probiotics to a few patients over the years who&#39;ve had specific post bowel surgery issues or complications or specific gastroenterological conditions and those times I&#39;ve prescribed the probiotics they&#39;ve been medical growth so you know it&#39;s a prescription grade probiotic you know it&#39;s like a vssl contains the number of colony forming units of lactobacillus Etc and it&#39;s undergone whatever regulation it needs to undergo it&#39;s not a supplement that you can buy in a supermarket and I think probably consumers need to know that there is a diff difference between you know a medical professional saying probiotics can work for x y and Zed and that probiotic meaning to be a prescription grade medical strength probiotic versus a pill or powder you can buy online over the counter and for me on one side wanting to improve your health and looking for these hacks is one aspect and the kind of flip side is then people demonizing little things like we mentioned before the glucose but also similar to the demonization of glucose is a new thing which has you know cropped up in the last couple of years of of ultr processed foods and that&#39;s a whole can of worms and for me I really you know I guess in the grand scheme of things if everyone had access to you know enough money we&#39;d all be eating Whole Foods great surely there&#39;s evidence saying that that that is great that&#39;s not the reality but also the reality is that some processing of foods is required to unlock the nutrition or the bioavailability or whatever so what is the science behind ultr processed foods and is it as bad as people claim it is as you know some of these long-term supposedly good epidemiological studies suggest they are you know how can someone decide whether it&#39;s truly bad or just like a fad to worry about so this is this is really interesting actually and I would tie all of this stuff up in we know 90% of what people should be doing to be healthy and we know what the unhealthy foods are things like cakes and donuts and crisps and all of those kind of things takeouts with a bunch of calories and no veggies exercise getting enough sleep blah blah blah that that hasn&#39;t changed and I&#39;ll introduce this topic by really summarizing everything that we&#39;ve talked about going back to the attention economy if your goal is to get on the television sell a book sell a product you&#39;ve got to give people something new you can&#39;t just say have you know fresh fruit and veg a lot exercise because people are like okay boring you&#39;ve got to come up with some new science and I I think ultr processed foods is one of these I&#39;m very critical of the famous book that came out last year because there&#39;s a real overstating of the evidence and I think it&#39;s probably very very likely that when we&#39;re seeing these relationships in observational data between Diet high and ultr processed food and negative Health outcomes it&#39;s be it&#39;s the stuff that we know already if you&#39;ve ever worked in an office in the UK you&#39;ll know you know 3:00 every day often donuts come around people are having crisps at their desks they&#39;re having Coke I see kids having energy drinks on the train in the morning this is a lot of our diet and we absolutely know high sugar high fat Etc Chris who&#39;s who&#39;s written the ultra processed food will say aha but we know it&#39;s not just that because we had a trial and it was done by Kevin Hall at the NIH a wonderful researcher who I respect a lot who showed that even if you match diets for sugar and salt and fat the ultra processed diet causes weight gain but the unprocessed one didn&#39;t but if you look carefully in again in the supplementary data the unprocessed diet had seven to eight servings of fresh fruit and veg day whereas the ultra process one didn&#39;t I mean the ultr process diet basically just dodged fruit and veg for two weeks and again if you look at the smacks that were offered now why does this matter because what fruit and veg does is it dilutes the energy density of our meals and of of what we&#39;re eating and so energy density is calories per gram and the whole idea about this is if you imagine you have like meatballs and pasta just that mix it all together you&#39;re going to have more calories than if you added like three servings of veggies because the veggies have volume if they&#39;re on your plate they&#39;ve got loads of volume but they basically have no calories so we&#39;ve known for for DEC that if you add loads of veggies to a meal you will dilute the energy density of that meal despite the volume or the weight being the same people consume fewer calories and actually that&#39;s what I think Kevin Hall&#39;s study showed so the ultr processed diet didn&#39;t have any veggies or or fruit basically at all they had double the energy density of the ultr processed diet and research Decades of it shows that will lead us to spontaneously overc consumed calories so that&#39;s what I think the study showed and let me go back to what I said before it&#39;s not new is it make sure you&#39;re getting your fruit and veggies in like add two servings of veggies to every single meal so at the moment based on most of the science I think the ultr process story is not adding much more than we didn&#39;t know already is having low energy dense foods lots of fiber lots of fruit and veg and avoiding high calorie high sugar foods that cause us to overeat now let me just say one final thing because this is a merging science we are quite rightly I think looking more closely at all of the additives in our food that previously I think this is absolutely correct that we are focused just on whether they are toxic whether they might cause cancers and other things and we haven&#39;t looked as closely as perhaps we could have at things like altering metabolism or affecting the the health of the bowel and that research is ongoing but I&#39;ve looked at some of those studies and it&#39;s it&#39;s the kind of very early science that is absolutely not definitive let me give you one example there was a study that gave uh 15 grams a day of I think it&#39;s an emulsifier I can&#39;t remember the name of it in a very small exploratory study and they found I think it was nine people in two people but not in seven they saw some changes in the bow so it&#39;s like if you&#39;ve got nine people and something only occurs in two that might just be chance it might be changes that happen and if you did any drugs trial or early drugs work and you had a sample size of nine and your drug for example lowered glucose in two but it didn&#39;t in seven we&#39;d say that drug didn&#39;t work right we wouldn&#39;t be excited so flip that around and you say okay so we have this emulsifier that looks like it did something in two people but it didn&#39;t in seven like by golly that&#39;s not conclusive at all yeah um and so I think we absolutely should be doing research in this area but I haven&#39;t haven&#39;t seen anything yet that suggests that these additives um are harmful alluding to the ultrapress uh study you suggested earlier where they compared the ultra processed diet versus the kind of Whole Foods diet and he said it was about the energy density and that the energy density of the ultrapress diet was Far lower if someone were to have an ultr processed diet then by extrapolation of this study by the results of this study and the outcomes if someone had a ultr processed diet that was rich in you know fiber rich foods for example you know if that were possible and had more of those um you know compounds which increased the energy density of that food would you then hypothesize and that diet then independent of everything else could produce similar outcomes to the whole food diet in terms of weight gain I would H I would hypothesize yes I mean just to be clear there are lots of reasons why even if you had an ultr processed food let&#39;s say bread for example by the way studies which separate Ultra processed foods into categories tend to show that things like high fiber Breads and cereals are either neutral or they&#39;re protective and unsurprisingly it&#39;s the cakes and the donuts that aren&#39;t so yes if we modified a processed food to lower its energy density and to make it harder that affects eating rate as well I hypothesize yes it would not cause overeating but I do emphasize I still would there&#39;s lots of reasons to have fresh fruit and veg you know all of the goodness that&#39;s in them the micronutrients and the phytonutrients are all really good for us so there&#39;s never a circumstance when I would ever suggest not having lots of fruit and veg but I think based on the evidence yes you can in fact have ultr processed foods in the diet and remain absolutely healthy and by the way if a study is done that shows that I&#39;m wrong that actually if you have Ultra processed foods and you&#39;re having lots of fruit and veg actually it still causes harm I&#39;ll change my opinion um but as of right now what I find so frustrating is let&#39;s say Supermarket bread there&#39;s there&#39;s no data that I&#39;ve seen that it&#39;s it&#39;s problematic and I was quite annoyed with an interview that let&#39;s just name him Chris had done and it was with the guardian and he talked about AA you know with great confidence and certainty well we know that Supermarket bread is softer it&#39;s going to make people eat more of it and like I could believe that and I remember reading that interview thinking yeah that makes sense I wonder whether anyone&#39;s actually looked at it and so I did a search I did a quick literature search I couldn&#39;t find much I found one study and it was done in France and it compared I can&#39;t remember the exact numbers but like seven to 10 industrial um homemade and an in between kind of bread it compared lots of them and it tested the energy density the softness and I think the water content and found no differences between them and it&#39;s like you know maybe the French make that even industrially maybe they make their their bread different but and I think and I&#39;m very cynical that the reason people like Chris and others aren&#39;t talking about takeaways and Skittles and Doritos and food we know is rubbish is it&#39;s because that&#39;s not new it&#39;s not going to get people to buy your book telling people stuff they already know so you come up with this pretty controversial oh my God Supermarket bread and if you look at the average person in the UK&#39;s diet like I would I would die of shock if Supermarket bread is ever shown to be remotely related to negative Health outcomes ever like with the diet that we have with the takeouts with like I said the energy drinks with the soft drinks with the crisps Supermarket breads are probably one of the healthiest things the Brits eat and the fact that you have a person who&#39;s like we started talking of this about this at the beginning the fact that you have a Doctor Who&#39;s Making people worry about Supermarket bread I I find incredibly worrying so maybe let me add some actionable tips like when I did my PhD um I was working 7: a.m to 11:00 a.m. I ate lots of FR meals tons of them super you know Supermarket buy them at the end of the day go home microwave them in 3 minutes and what I did is I&#39;d always add at the end of the day in the supermarket they had like carrots and and those little microwavable veggie bags on offer for like 70p so I just put those in the microwave so yes I had my ready meal and I tried to choose ones which are lower and salt that were had a good nutritional profile and I made sure I had veggies on that plate I have Supermarket bread I I do occasionally enjoy making my bread but I don&#39;t have that much time I have Supermarket bread and do not worry about it but I&#39;ll like mash an avocado on there or I&#39;ll sometimes drizzle olive oil I&#39;ll have lots of tomatoes and veggies and salad I I&#39;m pretty plant-based for environmental reasons so I have plant-based milk Ultra processed food but I&#39;ll have oats I&#39;ll have nuts and seeds and raisins I grate an apple on my cereal so I have lots a reasonable amount of ultra processed foods but I make sure the rest of my diet is a lot of plants a lot of fiber and a lot of healthiness you know I think that&#39;s a perfect summary of everything and UL Ely I believe and I don&#39;t think it&#39;s wrong to say that probably our stresses with curating our lifestyles and our diets and our obsession with tracking things are probably more dilar to health outcomes than actually occasionally having Supermarket bread a donut a ready meal anything like that and what is missing right now in the online space certainly is some of that nuance and less polarizing opinion that&#39;s not as sensational that&#39;s not going to go viral it&#39;s not as sexy so Nicola thank you very much for providing that balanc news and just you know down toe information and actionable tips as well thank you so much for coming on and definitely need to have you on again cuz we&#39;ve just scratched the surface I feel real I really enjoyed it thank you so much

Transcript for:Dr. Curran's Insights on Modern Health

Transcript for:
Dr. Curran's Insights on Modern Health