Why This Cardiologist Recommends Fasting with Dr Pradip Jamnadas (re-release) #513

TRIGGER WARNING: This podcast discusses fasting and its advice may not be suitable for anyone with an eating disorder. If you have an existing health condition or are taking medication, always consult your healthcare practitioner before going for prolonged periods without eating. You probably wouldn’t expect a cardiologist to tell you that not eating is the key to better heart health. But today’s guest is a passionate believer in finding new solutions to old diseases – and in finding those solutions within ourselves. Dr Pradip Jamnadas is a Florida-based consultant cardiologist and a clinical assistant professor with more than 30 years’ experience and a keen interest in preventative health. He has performed thousands of interventional procedures during his career and his educational videos on fasting and heart health have been viewed by hundreds of thousands on his YouTube channel. From weight loss to reversing diabetes, lowering blood pressure and cholesterol to increasing longevity, Dr Jamnadas outlines the evidence-based, dramatic changes that fasting can bring. He talks us through the restorative processes that take place in the body when we take longer breaks from food and details the discoveries he made about fasting and its effect on insulin, metabolic health, obesity and heart health – along with the astounding difference it’s made to his patients’ lives. But it's not just physical benefits. Dr Jamnadas explains the ripple effect that changing your beliefs and habits around food can have on your mental well-being and the rest of your life. Dr Jamnadas also shares the very gradual and specific protocol he takes patients through, to build up their fasting in a way that’s sustainable. We discuss whether fasting is more beneficial for men than women, we touch on food addiction and talk about eating disorders. This is a fascinating episode and I think you will really enjoy it. Support the podcast and enjoy Ad-Free episodes. This January, try FREE for 30 days on Apple Podcasts https://apple.co/feelbetterlivemore. For other podcast platforms go to https://fblm.supercast.com. Thanks to our sponsors: https://drinkag1.com/livemore Show notes https://drchatterjee.com/513 DISCLAIMER: The content in the podcast and on this webpage is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your doctor or qualified healthcare provider. Never disregard professional medical advice or delay in seeking it because of something you have heard on the podcast or on my website. Learn more about your ad choices. Visit podcastchoices.com/adchoices

Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.

• 0:00Speaker 00

  I've been a cardiologist for 30 years and I've tried everything. But when I tried fasting, I started seeing changes. People began to lose weight. People's blood pressures came down. Diabetes got reversed. The progression of coronary artery disease went down.

• 0:17Rangan Chatterjee?

  Hey guys, how are you doing? Hope you're having a good week so far. My name is Dr Rangan Chatterjee and this is my podcast, Feel Better Live More. This podcast is getting a lot of new listeners at the moment because of the global release of my brand new book, Make Change That Lasts. And so for the next few Sundays, like I did when my last book came out, I plan to re-release some classic evergreen conversations from my back catalogue to give new listeners a real flavour of what my podcast is all about. And today's re-release is a quite wonderful conversation all about fasting with Dr Pradip

• 1:01Rangan Chatterjee?

  Jamnadas. Over the course of his long clinical career, Dr Jamnadas discovered that the therapeutic use of fasting could be a really helpful tool for a variety of different conditions. Weight loss, reversing type 2 diabetes, lowering blood pressure, improving cholesterol profiles, as well as increasing longevity. In today's conversation, Dr Jamnadas shares the incredible physiological and psychological benefits of fasting. We discuss who benefits the most from fasting? Is it better for men or women? And is it more helpful at some stages in our life compared to others?

• 1:44Rangan Chatterjee?

  But this is not just a conversation about fasting. We also explore food addiction, eating disorders, the small things we can do each day that will have a big impact on our health, and also the positive ripple effect that can ensue when we change our beliefs and habits around foods.

• 2:05Rangan Chatterjee?

  Now, before we get into the conversation, I really want to frame the context in which we are having it. Dr Jamnadas is a cardiologist. He has put thousands of stents into people's hearts. He sees people who are really sick and who are often regretful of the choices they have made in life. Dr Jamnadas and I both understand that eating disorders are on the rise. Yes, fasting can be a powerful therapeutic tool, but it's not for everyone. If you are suffering or recovering from an eating disorder, the advice in this episode may not be suitable for you. So please do bear that in mind as you listen. Regardless

• 2:47Rangan Chatterjee?

  of where you currently are with your health and life, I think you will get a lot out of today's conversation. Dr Jamnadas is knowledgeable, he's passionate, and this is a conversation full of inspiration, practical advice and wisdom.

• 3:08Rangan Chatterjee?

  I've been pretty excited about talking to you for a number of months now, ever since I saw some of your YouTube videos. So first of all, thank you for making time to come on to the show.

• 3:17Speaker 00

  It's a pleasure for me. I'm honoured, actually. You know, it's always a pleasure to talk to people like you, especially you that I've looked at and listened to. A lot of your videos are amazing.

• 3:29Rangan Chatterjee?

  Oh, amazing.

• 3:31Speaker 00

  You're so broad. I mean, you look at things from all aspects and that's what's fascinating.

• 3:36Rangan Chatterjee?

  Oh, thank you. Well, I think there's a lot that we're gonna share a common view on, and I want to unpick a lot of that. To start off, though, you were a cardiologist and you're very proactive about promoting the benefits of fasting with your patients and I guess across society as a whole. So right at the start of this conversation, I wonder if you could outline what are the key benefits of fasting that you have seen in your patients?

• 4:08Speaker 00

  Traumatic, you know, I've been a cardiologist for thirty years and I've tried everything. But when I tried fasting, I started seeing changes. People began to lose weight. People's blood pressures came down. Diabetes got reversed. The progression of coronary artery disease went down. You see, I had the benefit of seeing patients from day one. So I saw that they were having a second angioplasty, another heart attack in two years, five years. I saw the numbers going down on those whom I was able to get them to lose weight through a fasting program. And I tried lots of diet programs. They didn't seem to work, but fasting did. So decreased blood pressure, decreased diabetes, rehospitalization.

• 4:53Speaker 00

  LV function seemed to stay good, which means that heart muscle function continued to do well. Patients mentally also seemed to be doing better. So fasting gave me not just this benefit, but a lot more also. My patients didn't end up in the hospital with fractures or falls and had stronger muscles and mentally they were better. So I started seeing that just generally patients were doing better. ER doctors telling me, how come your patients don't end up in the ER with acute heart attacks? All these benefits I saw with fasting.

• 5:28Rangan Chatterjee?

  With all these, you know, quite different benefits that you've just outlined for us. Why is it, do you think that very few medical doctors are promoting fasting with their patients? Of course, as you've demonstrated, it has huge benefits. It's very effective. It's also kind of free of charge. So why is there such a resistance among, you know, like our profession to recommend this as a treatment?

• 5:57Speaker 00

  It's a tough sell. And it takes time. You see, you're only as good as getting into your patient's brain. Can you get in there and make them make those changes? And that's a tough one, because all you're doing is you're giving them their advice. There's no tools for me to give them. There's no tablets to give to them. They've got to make that effort. And all I got to do is get into their brain, change the way they think. And if they get convinced that, yes, Doc is telling me something that resonates inside me and and I'm gonna, I'm gonna make that change, um, then they'll do it. So the trouble is that most of us doctors are too busy. We're actually taking care of disease processes rather than prevention.

• 6:41Speaker 00

  Here, we're really talking about a lifestyle change. And that's the hard part about fasting and talking to someone about fasting. Physicians find it very difficult to talk to them about that because you can just tell them that, okay, these are the benefits. That's not good enough. It takes much more than that. It's a deeper dive into the patient's lifestyle. How do you wake up in the morning? How do you feel in the morning? What are the main issues in your life? So it's not just about fasting. It's about your relationships. Who are you? What's your life all about? All that affects your diet. Because, see, fasting is also about, it's much more. It's about your whole life. It's about who do you think you are?

• 7:26Speaker 00

  And can you empower yourself to do it? Or are you just a slave to your day-to-day routines and advertising? So to get somebody to fast, you really need to change their, their whole outlook on who they are. You are not your habits. You are not even your body. You are something that can change everything. There's a separate part of you besides your body, even your mind. There's a separateness. There's an awareness inside you. And if I can get into that awareness.

• 8:03Speaker 00

  Then I can empower you. And if I can empower you, then I can make you fast. So doing this whole thing, i- i- it's not easy for most physicians. And you know, e- even, even, even people are dedicated to teaching people about diet. It's a hard sell. And I think that our approach has to change. Our approach, I first look at patients and I have to empower them to say, you know, you are more than what you think you are. You can do it.

• 8:31Rangan Chatterjee?

  Your videos on YouTube have been going viral for a number of years now. And, you know, I've read a lot of the comments and I've watched a lot of those videos. And I think what, one of the many things people deeply resonate with you and your message about is this real passion to help people and this real passion to empower people. And I want to sort of dive in there a little bit because you are, you know, a very well-respected cardiologist. You literally go into people's hearts, you put in stents, you do all this kind of stuff. In some ways, you know, as life-saving as putting a stent in someone's heart potentially can be, you know, it's slightly disempowering, isn't it?

• 9:15Rangan Chatterjee?

  It's kind of like, well, I've got to rely on the skill and ability of my doctor to be good at what he does, to be sharp on the day, to have slept properly the night before, right? Those, all these things are out of my control as a patient. Whereas pretty much everything you're talking about and we're going to go through in detail today, it's about putting the patient back in control of their health. And I guess I would argue their wider happiness as well.

• 9:45Speaker 00

  Absolutely, absolutely. And, and, and that's the thing, that the patients have to take responsibility. Because the medical profession, the way it's set up right now, we, we, we just, we're not in a position to do that. We have to, you know, we don't have enough resources, we don't have enough time. So what we can do is we can educate patients and we can throw light on the issues that have brought them to where they are now and show them how they can get out of it, show them, empower them. And. Educate them so that they make their decisions and when they make their decisions, they will do it. And then it's it's it's self empowering, it feeds back on themselves and say, look, I was able to do this and I didn't think I could do this.

• 10:24Speaker 00

  And so that brings us to that issue that there are so many layers of onions that we can peel off. And fasting is the one that really seems to me to open up aspects of their lifestyle, which they would not have otherwise looked at. Because fasting does bring in lots of issues into their life. It it it opens up the introspection into their life. It's what's going on, what's driving these things in my life? And that's what I like about fasting, it's it's it's so different. I mean, imagine if I just give them a diet and say, okay, you're just gonna eat this. Um, okay, they're gonna eat that, that's it. But in fasting, it's self-control, it's it's it's deeper thinking about the habits

• 11:09Speaker 00

  and all the other things that we're we're gonna talk about.

• 11:12Rangan Chatterjee?

  Yeah, in in many ways fasting is,

• 11:19Rangan Chatterjee?

  you know, really swimming against the tide of societal norms. Because we live in a society of abundance. Yet fasting is self-imposed scarcity. And, you know, we're going to talk about fasting from food and the benefits for various different disease processes, but also for promoting health and wellbeing. But you could take it a little step further, couldn't you? If we're gonna sort of link mind and body and heart all together. Well, it's not just about fasting from food, is it? It's it's also, we can take social media fasts, we can take alcohol fasts, we can take caffeine fasts.

• 12:01Rangan Chatterjee?

  Even that term fasting, it goes far beyond just food, really, doesn't it?

• 12:06Speaker 00

  Absolutely, absolutely. You have so much insight into this. You've just hit onto something very important. When we talk about our habits in fasting and our addiction really to eating and this pattern, you also talked about digital addiction. You almost just, you didn't quite say it in that way, but there is digital addiction. There's alcohol addiction. There's gambling addiction. There's other forms of addictions and sugar addiction. And all these things seem to go to that part of the brain that gives us that reward. So we're living in a society where it's all about the instant rewards. And when you prime yourself in one area, you can slip

• 12:48Speaker 00

  into other areas as well. And that brings up this whole addiction thing that perhaps this pattern of eating that we've developed and this addictive pattern of eating every few hours all the time, it's really an addiction. It is an addiction and it it seems to give us that instant reward. And it doesn't really matter what you're eating, but it's the fact that you're eating all the time and we need to get out of this. So we need to really look at our whole life to say that, look, the dopamine centers are primed already from a young age. And yes, we are addicted. We're an addicted society. You know, the book that I just finished reading a few months ago, Dopamine Nation, I think it's called.

• 13:30Rangan Chatterjee?

  Yeah.

• 13:30Speaker 00

  Yeah. Fascinating insights that, you know, you prime yourself in one area and then you'll slip into another addiction very easy. And I think that food is one of them. I am convinced that food is one of them. So yeah, no, you're absolutely right. It is a whole lifestyle. And I tell my patients that if you really want to come off your current eating habits, we need to look at your whole life as well. Are you addicted to alcohol? Are you addicted to caffeine? Are you addicted to sugar? Are you addicted to even digital media? Because it's just the way we're priming ourselves. And when they start looking to that, they do see insights. Oh, my God, you're right. You know, I am probably addicted

• 14:14Speaker 00

  to this pattern and I can get out of it.

• 14:16Rangan Chatterjee?

  I've read that book, Dopamine Nation. I actually spoke to Anna Lempke, who wrote that just a few weeks ago on the show. A great conversation. I agree. It's a, it's an awesome book.

• 14:29Rangan Chatterjee?

  Many of us have heard of fasting. We've heard that various religions have used fasting for years. Many of us, depending on what culture we have grown up in, may know that our parents or our grandparents would fast from time to time. Yet despite knowing that, certainly in our current society, many of us aren't taking that next leap. Many of us think, you know, and I know you, I've heard you say before that you were a bit sceptical of fasting when you were at medical school. Many of us probably have thought in the past that, oh yeah, you know, what did my grandparents know, you know, I'm not going to fast. And what I'd love to do, because I think you do it so well, is really go through what

• 15:10Rangan Chatterjee?

  happens in the body biochemically, physiologically, when we start fasting. Because I think for many people, they're going to need that knowledge and that science to convince them that, actually, you know what, maybe I should give this a go.

• 15:26Speaker 00

  Yeah, yeah, yeah, no, absolutely, absolutely. You know, what fasting does, it allows the body to do what it was made to do. You see, we eat, eat, eat. Insulin comes in, puts everything into storage, so you build up some fat. And then you're supposed to live. So when you live, you now start utilizing your calories and you start burning the sugar. When that goes out after maybe about four hours or five hours, then the glycogen stores in your liver and then your muscles start breaking down, start giving you the calories that you really need to burn, so you can run, do your day-to-day activities and all that. And when you run out of that by, let's say, about 18 hours or 20 hours, and then the body says, hmm, I need to start burning fat now. That's what you're supposed to do. That's why you put on fat in the first place.

• 16:09Speaker 00

  That's why we have fat, it's a storage. And then you start burning that fat. And therefore you start burning that fat, so the fat comes out, comes into your liver, gets converted to some ketones perhaps, and now you're making ketones, and the ketones have been utilized for energy, and then you go for your next meal again. So the body was made to do this. It was not made to just pile on, pile on, pile on all the time. Because that, that results in increased fat stores, which you'll never break down. So your body was supposed to do this. From the, from the, from the design, you're supposed to do this. So the important thing is that when you eat...

• 16:50Speaker 00

  And you're taking calories, your insulin level obviously goes up. Why? Because insulin has to get that sugar out of the bloodstream. Blood sugar must always come down because otherwise you get damage from that high glucose level in your bloodstream. That's why we treat diabetes, right? Because the blood sugar, or the glucose rather, attaches itself to proteins, glycation end products. And therefore, these proteins become, they become dysfunctional. So insulin says, I'm gonna take the glucose out, put it down into the blood, into the storage. First place it puts it into is the liver. When the liver stores are full, then it spills over into the pancreas. More calories coming, there's more glucose, then it goes into the muscles. And it stores everything and from there into the skin.

• 17:34Speaker 00

  And that's the way it was supposed to be. But now, when we continue to do that, we just keep piling it on, piling it on. We never get a chance to burn it down and we're supposed to burn it down. So the biochemistry of the body was made for feeding fasting cycles. And this is the way the bioengineering of our body was, but we became dysfunctional. Because as food became more available, we just kept piling it on and on and on and on. And that's the problem that we have today. It's exactly what you said, excessive calories too frequently. So our insulin levels stay high all the time. So that's the biggest problem I found as a cardiologist.

• 18:16Speaker 00

  You're eating all the time, you're stimulating your insulin all the time. Insulin stays high, stays high, never gets a chance to come down. And because your insulin doesn't come back down again, you're always in a storage mode. This high insulin is the problem. We've hormonally changed because we're eating too frequently. We're not designed to eat that frequently. Insulin's supposed to go up, then come back down again, up and back down. We stay up all the time. So your body develops, in a simple terms, insulin resistance. Now, the next time you eat, you need even more insulin. Because just like wearing a jacket, you first feel it, then you don't feel it.

• 18:56Speaker 00

  The body, when it has high levels of insulin all the time, it becomes insensitive to it. And that's what's happening. We are a hormonally modified human being now. We're becoming insulin resistant. And this insulin resistance results in higher and higher insulin levels. And that's the problem I found. And I just wanna digress a little bit and I'll tell you how I came to this. In my practice, what is happening is patients were coming in with heart attacks and hardening of the arteries and angina. And I said, okay, there must be a cause. And I looked for it. And the cholesterol most of the time was okay. Blood pressure was okay. They were not diabetic. And then I see all this hardening of the arteries. And I'm wondering why. So about twelve, fifteen years ago, I, I started doing sugar tests on them.

• 19:41Speaker 00

  And I found that they actually had mild diabetes, what we call glucose intolerance or impaired glucose, fasting glucose. So the sugars were just slightly high, but not enough to make them a diabetic. So I said, okay, fine. So I should put these patients on something to sensitize them and make them better. And I put them on metformin. And I got a lot of resistance from a lot of physicians in the community, plus patients. But the outcomes were better. They, they actually did better. Then I started doing insulin testing in my office. And I started doing this when I read some information from, from a physician who wrote a book on, on, on insulin and he called, Dr. Kraft. So it's called the Kraft test.

• 20:21Speaker 00

  So now what we do is we give them sugar water, patients, and we measure the, the sugar levels going up and back down again. And said, okay, it went up a little bit, not too bad. But I looked at the insulin response and it was massive in these patients. I took a hundred patients. And I saw that they were making so much insulin. And I says, this is ridiculous. Why are you making so much insulin? Well, they had insulin resistance. And then I linked the fact that it's the high insulin level that's actually causing the hardening of the arteries because the sugar levels are okay. Of course, what happens is over time, it's taking a gallon of insulin to bring your sugar levels under control. Eventually, even that's not enough. So then the sugar level goes up.

• 21:06Speaker 00

  And then they go to the doctor and say, oh, your sugar levels are high or your hemoglobin A1C level is high. Now you're a diabetic. Well, guess what? It's too late. You already have all the hardening of the artery. You've done so much damage to your artery. You probably did it for fifteen to twenty years. And that's the discovery and that's what really motivated me to make these changes in my patients to say that. Look, you know, I got to get that insulin level down. And it is that high insulin level that really motivated me to really do the fasting program because I said, okay, how am I going to get insulin levels down? How how do I do that? I don't have a drug. So that's what, look, the whole thing comes down to insulin for me it was. Now, as things happen, I discovered more and more fun things in this fantastic journey.

• 21:51Speaker 00

  But the bottom line is it was the high insulin level that really got me into this. Because I found that when I brought the insulin levels down, my coronary artery disease, atherosclerosis, just went down. Patients did so much better. And that high insulin level, the only thing I know that really helps to bring that insulin level down, besides metformin and a few other drugs, really is fasting.

• 22:16Rangan Chatterjee?

  Yeah.

• 22:16Speaker 00

  Because when you don't eat, guess what? You don't make insulin. That's it. Your insulin levels plummet. And then the next time you eat, you make insulin, but a much less amount because you're not sensitive. So this fasting, I got into it through this way. Not because I've, I I just wanted to make them reduce weight, not because I just want to reduce blood pressure. It was really the insulin that got me into fasting. Then, of course, I discovered as time went on that, my God, the blood pressures were coming down. And I realized that insulin is a vasoconstrictor. It reduces nitric oxide in your blood vessels. So therefore, your blood vessels can't dilate. Now that brings me to hypertension. That I said, oh, my God.

• 23:00Speaker 00

  I was taught and you were taught that ninety-five percent of hypertension is essential.

• 23:07Speaker 00

  And this very word essential, there's nothing essential about hypertension. You don't need it. So I discovered.

• 23:15Rangan Chatterjee?

  Should we just, should we explain to non-medical listeners, what, what does that term essential mean? When we say essential hypertension, what do we mean by that?

• 23:23Speaker 00

  Which means we don't know the cause of it. It's idiopathic. Idiopathic is another word we use. Which means we don't really know clearly what the cause is. It's just something that just happens. So this essential hypertension is not really essential. You don't really need it. And I found through my own experiences here that the fasting brought the blood pressures down. And I said, okay, so what's the correlation? It's insulin. I started reading more about insulin. And sure enough, when you give patients an insulin shot, the blood pressure goes up. You take them off insulin, blood pressures come down. Insulin causes nitric oxide depletion in the blood vessels. Nitric oxide, by the way, is a vasodilator. Nitric oxide is a natural endogenous product that makes your blood vessels dilate.

• 24:08Speaker 00

  And then when nitric oxide goes down, the vasodilate. This is a dynamic state that you're supposed to have. You walk into a cold room, your vasodilate. That means your blood vessels go down. When you go into a hot room, your vasodilate, that's a normal response. This nitric oxide is most essential in our body. It is so important for blood vessels that in fact there was a Nobel Prize awarded for this nitric oxide, as you know. So for the audience to realize that insulin, when it comes down, your nitric oxide production goes up. And therefore your vasodilate appropriately, your blood vessels are not imprisoned anymore. And blood pressure started coming down. I said, this is amazing. Because for the first time in my life, I felt that the patients were doing something

• 24:53Speaker 00

  that was actually bringing their blood pressures down. I mean, we always tell patients who have high blood pressure, okay, avoid excess of salt and go do some exercises and those are fine because they also can improve nitric oxide production. But this was a very powerful one. When I brought that insulin levels down on these patients through fasting, blood pressure just plummeted and I had to actually take patients off blood pressure medications. So that was a huge thing that I found with insulin. So fasting seemed to me the, the best way to, to, to really make the patients' blood pressures come down. And I found that the weights came down. And the question is, why did the weight come down?

• 25:38Rangan Chatterjee?

  Today's episode is sponsored by the daily health drink AG1. The clocks are about to change, the mornings are darker, everyone around you seems to be coming down with something and suddenly that wellbeing you felt in the summer seems a long time ago. I certainly know that feeling and that's why at this time of year, I remind myself to lean into the fundamentals and one of those fundamentals is AG1. AG1 is a daily health drink that has been in my own life for over eight years. And one of the many things I like about it is the fact that many of the nutrients it contains, for example, vitamin C, vitamin A, zinc and selenium, supports a healthy immune system. Some of the other things I really like about AG1 is that they are committed to continuous

• 26:21Rangan Chatterjee?

  improvement and updating their formula as a scientific research involves. And each batch is independently tested for quality and safety markers, including heavy metals, allergens and banned substances. This is how they can guarantee what's in your scoop and what's not. Right now, AG1 is offering a free AG1 flavour sampler and AGZ sampler to try all the flavours, plus free vitamin D3 and K2 and AG1 welcome kit with your first AG1 subscription order. That's $87 in free gifts for first time subscribers.

• 27:00Rangan Chatterjee?

  All you have to do is head to drinkag1.com/livemore to claim this offer before it ends. Today's episode is sponsored by the daily health drink AG1. The clocks are about to change, the mornings are darker, everyone around you seems to be coming down with something and suddenly that wellbeing you felt in the summer seems a long time ago. I certainly know that feeling and that's why at this time of year, I remind myself to lean into the fundamentals and one of those fundamentals is AG1. AG1 is a daily health drink that has been in my own life for over eight years. And one of the many things I like about it is the fact that many of the nutrients it contains, for example, vitamin C, vitamin A, zinc and selenium, supports a healthy immune system.

• 27:45Rangan Chatterjee?

  Healthy immune system. Some of the other things I really like about AG1 is that they are committed to continuous improvement and updating their formula as a scientific research involves. And each batch is independently tested for quality and safety markers, including heavy metals, allergens and banned substances. This is how they can guarantee what's in your scoop and what's not. Right now, AG1 is offering a free AG1 flavour sampler and AGZ sampler to try all the flavours, plus free vitamin D3 and K2 and AG1 welcome kit with your first AG1 subscription order. That's $87 in free gifts for first time subscribers.

• 28:30Rangan Chatterjee?

  All you have to do is head to drinkag1.com/livemore to claim this offer before it ends.

• 28:44Speaker 00

  Insulin, bottom line for all your listeners, insulin just is a storage molecule. It puts everything in storage. So when the insulin levels come down, the storage padlocks are taken off. So your fat can now be mobilised. Now there's, of course, I can go into all the enzymes that are involved and the hormone dependent lipase, et cetera, et cetera, et cetera. But the bottom line is when insulin levels come down, now your fat pads are available for metabolism. And I found that the fats just started coming off the patients. And when I would look at these patients who would do the fasting programme, I'd look at them and they look great. It's not like their faces are all, you know, the excess of skin hanging off or they have

• 29:29Speaker 00

  skin hanging off their arms. No, fasting patients seemed to lose weight in a more beautiful way. They were actually losing fat, but they were also losing the right amount of skin as well. You see, prior to this, prior to this, I used to tell patients, okay, you're going to cut your calories to only 850 calories a day and you're going to have four meals a day, each one is going to be this much. And the patients would come back, sure, they lost some weight, they would lose a lot actually sometimes, but they would look terrible. They would look absolutely terrible, their faces, their skin and and and plus they were miserable. Because they just never, they didn't feel good.

• 30:15Speaker 00

  Eating small amounts of food frequently. This advice that we gave patients previously, that hey, cut your calories down by eating four small meals a day or nibble throughout the day. Totally wrong in clinical experience. They lost temporary weight, they all were put it back on again. Did it for years, I did it for fifteen years and I was sick and tired of it. They would come back miserable, saying, Doc, my my life's miserable, I only eat this much and I just feel terrible, I'm hungry all the time. And I look at them, they're sure they even look miserable and their skin was just so. So when patients were fasting, they would come back and they were laughing, they were they were so happy.

• 30:58Speaker 00

  The mood was better. I said, no, why is this guy's mood so good? He hasn't eaten for two days now. And he says, Doc, my mood is better than it ever was before. I'm sleeping better as well. And and he empowered himself. I said, no, this is psychological, he's just, you know. He was able to do it, so he's feeling good about himself. He says, no, Doc, I I I do feel good that I was able to do it. And and I I'm self empowered, but also they felt better. And then, of course, as I do the research, I see that there are many substances that are produced during fasting. And one of them is B D M F, which is a big word for brain derived neurotropic factor. What that really basically means is, look, when you are fasting.

• 31:42Speaker 00

  Does nature want you to just crawl into your into your cave and fall asleep? And and and and just just just just die? No, nature wants you to go out there, find your kill. Or your your your prey, or your your find your berries or something. So it actually makes your brain more alert.

• 32:03Speaker 00

  Enju- rejuvenates your brain. And you actually, now there's data to show that you can actually grow new cells as well in prolonged fasting. So what happens that you actually become more wide eyed and bushy tailed? And that's what I saw with the patients too. That they were, they were so happy when they walked into my office, you're walking to a cardiologist's office laughing and joking, this is fantastic. So, and then, so that's something. And then I found that the, the, the energy levels, they just not only felt better mentally and, and, and, and the mood was better. But they said that they moved around better. So I said, what does that mean? This is, well, look, my aches and pains went away. I said, come on. I said, yes, I only lost fifteen pounds so far, but my joint pains are all gone.

• 32:48Speaker 00

  Now, wait a second, why is that? Why did the joint pains go away? You don't take off that much weight to take it off your knee. Well, this inflammation. And I found that inflammation went down in these patients. So I said, okay, so how do I measure inflammation? So I looked at the CRP levels on these patients. And I found that the CRP is a blood test. And your audience would know that this is a test that we do to look for inflammation, microinflammation in your blood vessels. And I found that they were coming down. Now, you know how hard it was for me to bring these inflammatory markers down? I mean, you know, we give patients statins and that does bring down CRP. But I found that these patients who were fasting, the CRP's levels came down.

• 33:32Speaker 00

  And perhaps a lot of the inflammation in the joints was getting better because the inflammation went down. So I said, okay, that's fine. What else are you feeling? They said, well, you know what? My, my stomach feels good too. I said, wait a second, come on, guys. I mean, you're fasting and how can this be happening to you? This is, yeah, less bloating. Uh. My power movements are better. Um. I'm not getting so gassy and I don't get that fatigue after eating, you know, I just, oh, I just feel so down. Of course, they're not eating, but when they do eat after the meal, they feel so much better. So they are eating after when they break the fast, but they're feeling better. Their guts are better, their joints are better, their minds are better.

• 34:16Speaker 00

  I just said, oh, God, this is crazy. This is crazy. So that's what really I got so excited about fasting, as you could tell, I just, it is amazing journey.

• 34:26Rangan Chatterjee?

  Yeah, it's, you know, what's incredible is hearing you talk about this with this incredible passion.

• 34:34Rangan Chatterjee?

  You know, you have seen really, really sick patients. You've been inside their body. You're, you're obviously, you know, there was, there was clearly a frustration at some point that, you know, why am I keep doing this with all these patients? They keep coming in. What else can I do? But what you're talking about with fasting,

• 34:52Rangan Chatterjee?

  it's not giving more things to someone, or you've got to add this into your life. You've got to take more medications, take more supplements, go, uh, go to the gym more, right? Because most of the things we advise, we're asking them to do more, add more things in. Actually, this is very, very simple at its core. We're asking them to do less. We're saying, actually, don't cook. Um, we'll get, we'll get into the specifics, but I'm just saying sort of thirty thousand foot view is it's kind of like, well, I'm gonna save you some money. You can eat less. I'm gonna save you some time. You don't have to cook. Uh, this is gonna help improve your sleep, your cognitive function. It's kind of, it's

• 35:33Rangan Chatterjee?

  very interesting. It's something so simple that pretty much every religion has as part of its kind of culture and tradition, yet it's so alien to us in the way that we currently live or as doctors, the way we currently practice, isn't it?

• 35:49Speaker 00

  Absolutely, absolutely. And, you know, on this journey, they find out something about themselves.

• 35:54Rangan Chatterjee?

  Yeah.

• 35:55Speaker 00

  I'm talking about what they find out. They find out that they are not the hunger. They are not the craving, that they are something. I mean, I'm just gonna say in first terms, I am something beyond my hunger. I'm beyond my body, I'm beyond my habits. I've suddenly realized that I am in charge, that I don't have to have breakfast. If I'm not hungry, I don't have to have breakfast. And now Doc tells me, that's good for me. Lunch comes around, are you hungry? Or have you been a victim of just, it's one o'clock, so I have to eat? So when the patient suddenly realized that, gosh, I don't have to eat because I'm not hungry. Of course, if you're not hungry.

• 36:39Speaker 00

  And now they're empowering themselves. They realize that there's another part of themselves, a real inner amnesis, my, my awareness, the, the real me, which is beyond my body, beyond my feelings, beyond my sensations, and I have control over it. Now, I've found that that seems to empower patients more because you start them out first doing this, this, this, this dietary stuff. Okay, learn how to just skip meals. Then all of a sudden, it roller coasters and they themselves become so empowered. They say, whoa, whoa, whoa, whoa, what have you done? He says, well, you know, Doc, you told me to fast, I haven't eaten for forty eight hours. I said, yeah, but I didn't tell you, tell you forty eight hours.

• 37:20Speaker 00

  So what I'm saying is that it empowers them even more because they realize, yes, I have control. I've regained my control over my eating habits. I don't have to eat because it's one o'clock in the afternoon. I have to go downstairs to the cafeteria to eat. I don't have to do that if I'm not hungry. And when I am hungry, my adrenaline levels have gone up.

• 37:43Speaker 00

  They'll stay up for about an hour, Doc told me, and then it'll come right back down and my hunger will be gone. So now I'm empowering myself that, yep, I can do it. I'm gonna wait it out for one hour. Drink a glass of water, Doc told me to drink a glass of water. And yeah, sure enough, my hunger went away and moved on. Doc told me to keep my mind busy, go and do your chores at one o'clock, go do your shopping at one o'clock, or pay your bills at one o'clock and your time will pass. And before you know it, you'll be back to work at two o'clock and you'll have no problems till the evening. So I think that.

• 38:17Speaker 00

  Self empowering the patients this way, they're taking control and they're looking back and they're getting positive feedback. Oh yeah, I have regained control.

• 38:23Rangan Chatterjee?

  Yeah.

• 38:24Speaker 00

  So, you know, because compliance is such a big problem. So when I did that, the compliance with medications also improved. Because the patients just, they, they, they took control, they took control.

• 38:37Rangan Chatterjee?

  Yeah.

• 38:39Rangan Chatterjee?

  Yeah, I mean, there's so many things to kind of follow up on there. You mentioned that actually when people fast, they often get more energy and more mental clarity. And this is very alien to, as you say, how most of us have been brought up. And I think kids are still being brought up that you have to eat regularly. And I give an example from my own life, which is my son is 11 years old currently. And every Saturday morning, we try and do something called Park Run, which is a five kilometer run in the local town. Now, just to be clear, I am not giving anyone medical advice with their children at the moment. So this doesn't get misinterpreted. But I know my son, I know his health well, I know what he's capable of.

• 39:24Rangan Chatterjee?

  And we run at nine o'clock and my son loves food, right, he loves food. But actually he's realised that actually he runs better and feels better when he runs at nine if he doesn't eat. So he said, Daddy, you don't want to eat, so eat. I said, no, no, if you don't want to eat, that's fine. Right. Which is not what I would have been told at that age. I can tell you it would have been, no, you're going to need to eat so you've got energy for your run. So on a Saturday morning, he gets up, let's say at seven. He'll probably have, you know, I'll probably keep reminding him, stroke nudging him to have two glasses of water. But then we'll go and do a run together at nine, let's say nine till half nine. Then we nip to the supermarket, we come back. And what I've started doing with him is I say to him, gentlemen, how do you feel now?

• 40:09Rangan Chatterjee?

  You know, you missed breakfast. And he'll say often. Daddy actually feels really good, like I could think really clearly. So first of all, kids get this stuff, right? And I'm delighted that my son is actually showcasing some of the stuff that you are talking about at the age of 11. I tell you, I certainly was not. I was very much eat from the minute you get up, go downstairs, I have your bowl of cereal and still be eating last thing at night. But I remember just going to my room with big bowls of Muesli and milk and just, I was eating all the time. So that was one thing I wanted to say. But the second thing I wanted to talk about was what you said about, I am not the hunger.

• 40:50Rangan Chatterjee?

  I thought that was so powerful, Dr Jamnadas, because I think many people these days have forgotten what real hunger is. And then if they ever experience hunger, it's like, I need to eat now because I'm hungry. It's like, well, you could just sit with your hunger and see what happens. So just a couple of points there. And yeah, I'd love you to share your sort of view on that.

• 41:11Speaker 00

  Absolutely. Now, the experience with this son is so empowering. So he's, he and all of us have realised, there's a, you know, that we are a hybrid engine. So you have your metabolism that's based on glucose and everyone needs to understand it's sugar and glucose. That, that is the ultimate currency that we use to produce ATP. But there's another currency in the body and that currency is ketones. So when everything's put into storage and you've depleted the glycogen in your liver because you've been exercising now, then you need your fat stores. That's another source of energy. So when the fats kick in and your ketones start going up, you will feel different when the ketones are in your body.

• 41:54Speaker 00

  So that feeling of euphoria, that feeling that the patients feel empowered and your son feels so good after running on an empty stomach, of course, partly because of endorphins that are produced through exercise, which is very good. But the other product is this ketones. We all make ketones. We are supposed to make ketones. The trouble is when you eat so frequently, you turn ketones off. We must all experience some degree of ketogenesis in our life. In our day to day, maybe at least two to three times a week, you should become significantly ketogenic. That does not really mean that you need to fast for three days or four days. No. Look, when we cut down on the amount of carbohydrates, simple sugars, and we we will go into ketogenesis

• 42:39Speaker 00

  sooner and sooner in a fast. So that's adaptation. You're adapting your metabolism. If you're eating a lot of carbs and sugars all the time, then stop eating, you will start producing ketones maybe at twenty four, thirty six hours. But if you're already on a diet that cuts out processed foods, sugars, simple starches, all the refined products, now your body will start making ketones at a much earlier stage. So maybe by about fifteen, sixteen hours or so, some people start making substantial amounts of ketones. Now, those ketones, when they are being used in your metabolism, you will experience what your son experienced. I feel great, my exercise time's better, my thinking's better.

• 43:23Speaker 00

  So it's a different chemistry you're using in your body. And I think all of us, all of us, need to go into some degree of ketone production because it has multiple other benefits to be in ketone production. And in ketone production, there's a whole new biochemistry that's going on in the body, which we need because one is anabolic, what putting on, on, on all the time. When you're in the ketosis, now the body's cleaning up and becoming efficient. So it's another metabolism that we need to engage and we just don't engage enough of it. And now, on the fasting program, is when I'm seeing that the reparative processes all kick in.

• 44:03Speaker 00

  Now, I'm gonna say this again, the reparative process in your body is kicking in at a higher level when you are doing your fasting. How do I say that? Oh, my blood pressure comes down, joints seem to get better, all symptoms seem to get better, patients look better. But now there's data showing that these patients live longer, less cancer as well.

• 44:27Speaker 00

  And we know about the chemistry that is induced, which one of them is called autophagy, where the cells actually recycle all the inner parts to become more efficient. And mitochondria recycle as well, which go mitophagy. So these autophagy and mitophagy, which is recycling your biochemistry of your cells, does not occur in a fed state. It occurs much more when you're in a fasting state. So we're supposed to have that. We're supposed to do it. That's what our life cycle was supposed to be. Yeah.

• 45:06Rangan Chatterjee?

  Yeah, it's, it's, it's interesting. As you speak, you remind me very much of a conversation I had with Dr. William Lee, very, very recently on the podcast, who's done a lot of research into comparing food as medicine compared to drugs. And Dr. Lee talks about these defence systems that we have inside our body. He's got these five, he talks about these five defence systems and he talks about using food as medicine to support these defence systems. And, you know, there are things like, you know, inflammation, the immune system, the gut microbiome, stem cells, DNA. And it's interesting, he talks about what particular foods have been shown to support

• 45:50Rangan Chatterjee?

  those various defence processes. But also what you're talking about is the withdrawal of food at prescribed set intervals also activates these natural defence processes that the body have got. And I find that really, really fascinating that actually what we're trying to do is support the body's natural defences. We're trying to support that body's own natural resilience that's there if we and modern life kind of gets out of the way. We're getting in the way and actually stopping this stuff from working. But what you're talking about is let's get out of the way and we're going to naturally kick all of these kind of different systems into gear.

• 46:35Speaker 00

  Yeah, yeah, yeah, so right. Now, Dr. Lee, amazing. So he talks about the foods that you want to, to, to, to consume to, to, to bring about these beneficial changes, right? And the mechanisms are immunity, of course, and stem cells, as you mentioned, and, and, and your gut microbiome, which we know now plays a huge role in your day to day health. Now fasting.

• 46:57Speaker 00

  Impacts on all of them.

• 46:58Rangan Chatterjee?

  Yeah, exactly.

• 46:59Speaker 00

  After you finish your fast and then when you have your meal, you get you get stem cell mobilization. So after a fast, you're getting you're getting more stem cells mobilized from your bone marrow. Now, what are stem cells? Stem cells will go into the circulation, go to the parts of the body. And they already have messages on them, tagging them, where to go, what to do. The body has immense internal signals. So these stem cells go exactly and hone in exactly where they need to go and create the new cells and repair the body. Because maybe those cells that were senescent died. Maybe certain organs, dysfunctional cells died. And these stem cells move in.

• 47:42Speaker 00

  And we know that, we know this is stem cell mobilization, it occurs with fasting. You talk about growth hormone, growth hormone. You want to increase your growth hormone? Growth hormone, as you know, goes down after the age of thirty, plummets, really goes down. Growth hormone is responsible for muscle building, health. And growth hormone production skyrockets when you're fasting. Because your body makes much more growth hormone, you you you more than taking shots. So if you exercise in a fasting state, you'll actually put on more muscle mass. Which is what your son is going to come back and tell you that, Dad, I'm I'm putting on more muscle in my fasting state when I exercise it then than if I exercise. It's because of growth hormone. So there's another immunity.

• 48:27Speaker 00

  Your immunity gets better when you're fasting. During your fast, your body is developing mechanisms to to strengthen itself. And and immunity does go up. And we know that that certain foods could go do the same thing. But but there you go. Now imagine the power if we joined all those together. So eat the right foods, eat the foods to improve your immunity as well, and do the fasting as well. This is just, I think that the future. It's so exciting in this area where where people like you and Dr. Lee and come together and we're gonna we're gonna change things and say, look, we need to change what we're eating.

• 49:08Speaker 00

  We need to change the sourcing of our foods and we need to broaden our outlook. Look up at the microbiome. I didn't even talk about the microbiome just now. So fasting does affect the microbiome.

• 49:17Rangan Chatterjee?

  Yeah.

• 49:18Speaker 00

  It it does. And and when you know that that's a whole new area that's so dynamic and the the the life, the the half-life of of bacteria and the gut changes. So we know that when we're fasting, certain bacteria are gone. And we know that the types of foods that we eat affect our microbiome. But fasting itself also affects the microbiome.

• 49:39Rangan Chatterjee?

  Yeah.

• 49:39Speaker 00

  I love fasting because it it does have positive effects on the microbiome and we know that that's huge. I never believed about the microbiome stuff until about five years ago, but the data now coming out is so compelling for me. As a cardiologist, in fact, I just saw a patient yesterday. And I advised him that he needs to be eating probiotic foods and fermented foods. And and he's like, but Doc, I'm here for my my coronary calcium score, which was so high. You know, so it's just fascinating stuff.

• 50:13Rangan Chatterjee?

  Yeah, it it really is. And it's it's again, it's that one thing. Fasting that's hitting so many different things, isn't it? It's reducing your insulin. It's encouraging autophagy. You know, we've not mentioned where the apoptosis yet. It's encouraging apoptosis, stem cell production, growth hormone. So many different things are being activated. And actually, if we could get a drug to do any one of those, we'd be sort of shouting about it. But but this one thing does all of them, which is which is incredibly fascinating. Look, I I really want to understand because I I want to talk more about the science a bit later on in this conversation, but in terms of getting really practical for people. Like if we, if we compare fasting to, let's say, movements, right?

• 50:56Rangan Chatterjee?

  So people, if they want to move more, they know they could start off with a 15 minute walk around the block. You know, they want to do a bit more, they make it 30, 40 minutes around the block. Then they might start jogging. Some people might want to do a 5K walk or even a run, a 10K. Some people want to do a marathon, right? So there's different grades of movement. And so what are the different grades of fasting? You know, where can people start? You know, super, super simple. What are the benefits of that level? And then how can people progress up depending on their state of health, depending on their goals? You know, I, I think that would be quite a useful way at looking at fasting and making it really practical for people.

• 51:44Rangan Chatterjee?

  Today's episode is sponsored by the daily health drink AG1. The clocks are about to change, the mornings are darker, everyone around you seems to be coming down with something and suddenly that wellbeing you felt in the summer seems a long time ago. I certainly know that feeling and that's why at this time of year, I remind myself to lean into the fundamentals. And one of those fundamentals is AG1. AG1 is a daily health drink that has been in my own life for over eight years. And one of the many things I like about it is the fact that many of the nutrients it contains, for example, vitamin C, vitamin A, zinc and selenium, supports a healthy immune system. Some of the other things I really like about AG1 is that they are committed to continuous

• 52:27Rangan Chatterjee?

  improvement and updating their formula as a scientific research involves. And each batch is independently tested for quality and safety markers, including heavy metals, allergens and banned substances. This is how they can guarantee what's in your scoop and what's not. Right now, AG1 is offering a free AG1 flavour sampler and AGZ sampler to try all the flavours, plus free vitamin D3 and K2 and AG1 welcome kit with your first AG1 subscription order. That's $87 in free gifts for first time subscribers. All you have to do is head to drinkag1.com/livemore to claim this offer before it ends.

• 53:14Rangan Chatterjee?

  Today's episode is sponsored by the daily health drink AG1. The clocks are about to change, the mornings are darker. Everyone around you seems to be coming down with something. And suddenly that wellbeing you felt in the summer seems a long time ago. I certainly know that feeling. And that's why at this time of year, I remind myself to lean into the fundamentals. And one of those fundamentals is AG1. AG1 is a daily health drink that has been in my own life for over eight years. And one of the many things I like about it is the fact that many of the nutrients it contains, for example, vitamin C, vitamin A, zinc and selenium, supports a healthy immune system. Some of the other things I really like about AG1 is that they are committed to continuous improvement

• 53:59Rangan Chatterjee?

  and updating their formula as a scientific research involves. And each batch is independently tested for quality and safety markers, including heavy metals, allergens and banned substances. This is how they can guarantee what's in your scoop and what's not. Right now, AG1 is offering a free AG1 flavour sampler and AGZ sampler to try all the flavours, plus free vitamin D3 and K2 and AG1 welcome kit with your first AG1 subscription order. That's $87 in free gifts for first time subscribers. All you have to do is head to drinkag1.com/livemore to claim this offer before it ends.

• 54:50Speaker 00

  My general advice in my office and all my nurse practitioners do the same thing with our patients is look, the first thing you need to do is cut out all the sugars. Because if you go into a fasting with your regular diet pattern, you're going to have a very nasty experience. You're going to feel very hungry, you're going to go through withdrawal from sugar, you're going to feel terribly hungry, sweaty, you may even actually have worse symptoms. So the first thing we go to is look, we explain to the patients that your body is not supposed to consume so much sugar. You know, we consume about, about more than 10, 20 teaspoons of sugar a day in one form or the other. So the first thing I tell my patients is look, you need to get rid of all artificial foods.

• 55:33Speaker 00

  Sugar is manufactured, sugar is artificial, sugar is a poison for the body.

• 55:40Speaker 00

  You need to cut out all sugar, all processed foods, processed foods. Anything that is made in a factory, anything that has a barcode on it is suspect. Anything that's been pulverized, anything that has been made into a powder, get rid of everything. You need to eat foods in their natural whole form. And that's the first thing you do. So forget fasting right now. The first thing you're gonna do is just change your diet. I want you to eat whole foods. So I have a chart in my office. It's an anti-inflammatory diet. And it contains all the whole foods. I said, when you look at the food in your plate, you need to be able to recognize it. Yes, this is what this is. This is what this is. And they said, what about meat and chicken and fish? I said, no problem. As long as it is grass finished meat, organic chicken, organic eggs.

• 56:25Speaker 00

  And you can have some uh some turkey, but you must have vegetables in their normal, natural state. And first thing you need to do is do that. So get rid of all the bread, all the bagels, pastries. All the things that are coming in a box, spaghetti included, pasta included. I said, look, right now, just get rid of all those things. I want you to eat a natural diet. So eat as much as you want, but of the right food. And I want you to do that for approximately two to three weeks. No fasting right now. No, no fasting right now. So that way, they get used to that idea.

• 57:04Rangan Chatterjee?

  Yeah.

• 57:05Speaker 00

  That I'm going to first just change my diet. And then after two to three weeks. Then I bring them back inside and I say, okay, so now that you've been doing this, how do you feel? They said, okay, really, I feel much better. Now I said, now you're gonna learn to skip meals. So step number two is skip meals. Wake up in the morning, I'm not hungry for breakfast. Skip it. Come around to lunch, have your lunch, have your dinner. Next day, uh have breakfast, but skip your lunch. Um the next day, skip your dinner. So learn to just skip meals. And look, you felt fine. Nothing bad happened. You were perhaps a little hungry. You got over it by drinking a glass of water, drink lots of water during the daytime. So I do that for another two weeks or so.

• 57:48Speaker 00

  See, I'm doing it gradually, just like your athlete. You can't go to your five K right now. You first need to build into it. So for a couple of weeks, I make them just skip meals randomly. Then I sit down with them and say, now. This week, five days a week, I want you to have only two meals. And these two meals are gonna be within six hours of each other. So that you're gonna have eighteen hours that you're not gonna eat at all and only drink water, no calories in those eighteen hours whatsoever. You can have water, black tea, black coffee, but no calories whatsoever. And they say, oh, gosh, that's great. And they do that for about two weeks. So for two weeks, Monday to Friday, two meals within a six-hour window period. So they're eighteen hours, they are fasting. They do that for

• 58:32Speaker 00

  two weeks. Weekends, I let them have fun because they're with their families. So I say you can have breakfast, you can have lunch, dinner, but no snacks in between. So most you're gonna have on weekends is three meals on the weekends. Then they do that for another two weeks. Then I say, okay, now is when you're really gonna start your fasting. Monday, Wednesday, and Friday, I want you to skip that second meal also. Now you're only gonna eat one meal on Monday, Wednesday, and Friday. That's it. Rest of the days during the week, you're gonna have your two meals. Weekends, you can still have your three meals. So I gradually get them into that. And most of the time, patients are able to do it this way. When I go there, when I try to make them go to once-a-day

• 59:13Speaker 00

  eating or time-restricted feeding within a six-hour window from the get-go, my failure rate is much higher. So I make them do it gradually. And then they self-empower themselves. And then eventually I come to a three-day water fast, which we can talk about. I have the biochemistry of that.

• 59:30Rangan Chatterjee?

  Yeah, yeah. I mean, I love that. And I, you know, I love chatting to fellow clinicians. I love chatting to researchers as well, I must be honest. But clinicians like yourself, you know, you've got the real-life experience, not just what does the laboratory study say? What happens in the lab? No, you're dealing with real patients who are probably quite scared. And, you know, that sort of protocol you just took us through, just to make it really clear for people, you know, what types of patients are you recommending this in? You're a cardiologist, of course, you know, you practice in America. I don't know the exact differences on who gets referred to a cardiologist in America compared to here in the UK. So my guess would be that people are

• 1:00:15Rangan Chatterjee?

  You know, sick on some level, you know, they've they've either got angina already. Maybe they've already got ischemic heart disease, maybe they have already had a heart attack, you know, you're obviously seeing those kinds of patients, but then we could take it one step further, which is that we know in America, there was a recent study, wasn't there? Well, not that recent, a few years ago now, that showing that maybe over 80% of Americans are not in good metabolic health, which is really quite incredible. So I'm imagining pretty much all of your patients who come to see a cardiologist are already metabolically unhealthy, are already having a degree of insulin resistance and therefore problems with their health and wellbeing. So, you know, maybe help us through

• 1:00:59Rangan Chatterjee?

  that a little bit, because what I want to be really clear on, someone who feels that they're in good health, they're of, you know, a decent weight, they don't have any health problems, is that the approach that they should be doing as well? That we're specifically talking about patients who are already a little bit sick?

• 1:01:17Speaker 00

  You're so right. No. What I'm talking about here applies to just about everybody. In fact, it's more than 80%. I think it applies to more than 90% of it. Now, of course, the cohort that I see in my office are patients who already have coronary artery disease, or they already have had a heart attack. So those patients are kind of easy for me to convince that, hey, listen, you've already had a heart attack now. You want another one? Well, you already have had two stents, and then you're going to get the third one. So you need to do this, and I'm going to put you on this program. Okay, that's fine. But then there's another cohort of patients who come to me, and I do a coronary calcium score, and it's high. But they're asymptomatic, and they've passed their stress test. So

• 1:02:00Speaker 00

  let me just tell everybody who doesn't know about coronary calcium score, because this is so important. And I'll tell you why it really is important. So. It's a C T scan, low level radiation of the heart and it looks at the amount of calcium buildup in your coronary arteries. So it tells you you already have atherosclerosis. So it's no guessing that, oh yeah, you know, your cholesterol, your blood pressure, your weight, and therefore your risk of having a heart attack in the next 10 years is such and such and such, plug you into a formula. No, this is, do you have the disease? Yes or no? Do the scan. Yes, you have disease. Do the stress test? Pass my stress test? Why? Why did I pass my stress test when I have calcium in my arteries?

• 1:02:41Speaker 00

  Well, you pass the stress test because your blockage in your artery caused by the calcium is less than 70% because it takes a blockage more than 70% to reduce the blood flow in it and then you may have symptoms or you may pass, I mean, fail your stress test.

• 1:02:59Rangan Chatterjee?

  Can we just back, can we just back it up a second for people? Like what is ischemic heart disease? What is atherosclerosis? What is a stress test? Because I think there'll be some people listening who probably may not be familiar with those terms and I think it would be quite useful to sort of set that foundation if you don't mind.

• 1:03:16Speaker 00

  Yeah, yeah, they're very important. So atherosclerosis is the buildup of plaque in the walls of the arteries and they occur everywhere, in your neck, in your brain, in your legs, but most importantly in your heart. So when the artery, the walls of the arteries develop calcium in them, it's atherosclerosis. You cannot get atherosclerosis without calcium. Actually, you can, but very little. Most of the time, there's a lot of calcium with it. So the calcium is a surrogate for the plaque buildup in the walls of the arteries. And that calcium buildup, the atherosclerosis, can cause two problems. It can narrow your artery down on the inside, so the pipe becomes narrowed and therefore that causes ischemic heart disease.

• 1:04:00Speaker 00

  Ischemic heart disease, lack of circulation, lack of blood flow going down that artery. Therefore, the muscle is deprived of blood and the patient may experience pressure, tightness, heaviness in the chest, particularly around exertion. That's called angina. So angina, chest pain, is because of Lack of circulation due to the plaque, which is picked up by the calcium and a positive stress test. Now, a positive stress test, stress test is where you exercise you or we use chemicals to simulate an exercise. And it can tell us the consequences, the consequences of the blockage. Is my blockage more than seventy percent or less than seventy percent?

• 1:04:41Speaker 00

  If it is more than seventy, it may reduce the blood flow in the muscle and will pick that up on the stress test. The stress test can be a nuclear stress test or an EKG stress test. But now, if your blockage is more than seventy, you are more likely to experience chest pain and the effects of the lack of circulation in the heart muscle. And depending on the location of that blockage and how much muscle is getting the effects of the lack of circulation. Your cardiologist may opt to either put your medicines or if you're having very bad symptoms, maybe even put a stent inside which we can talk about. But what I really want to stress here is that you can have a blockage, atherosclerotic, calcium laden blockage

• 1:05:25Speaker 00

  that is less than seventy percent. You pass your stress test, you have no chest pain. And those are the patients that I'm seeing in my office now. Because they're coming in, they're getting the coronary calcium score, which they would not have otherwise. Because you go to your primary care physician's office and they say, oh yeah, your stress test is good, your cholesterol is fine, your blood pressure is okay. Yeah, keep going. And the guy gets a heart attack within a year or two years. And so what happened to me? Well, because you already had the plaque, you just didn't know it. So the coronary CT scan that we do, low level, looking for the calcium, picks up the calcium in the walls of the arteries and quantitates it on a score that goes from like zero to four thousand.

• 1:06:07Speaker 00

  Over one hundred is significant, between a hundred and four hundred is is very significant. But over four hundred is critical. That means you really have a lot of calcium in the walls of the arteries. So these are the patients who are coming in, they do the scan, and I see that they have all this calcium in the walls of it. Now, I turn around to them and say, did you know that you already have atherosclerosis? You already got it. And we have studies that show that that coronary calcium is going to predict whether you're going to have a heart attack or a coronary event or a stroke or even total mortality more accurately than all the other blood tests put together. So now I say, now, do I have your attention?

• 1:06:51Speaker 00

  You already have, you see, you've got to motivate the patient. And this is my carrot. Look, you have atherosclerosis. Now I want you to do my program. Now I'm going to look for some parameters on your blood test. I'm going to see what's causing this calcium buildup. And the patient said, but I'm fine. I said, yeah, but you didn't just build this up. Something is making your coronary calcium build up. So let's find out what it is. So I do a CRAFT test, I do a full physical examination, I'll do tests, advanced lipid panel. These are tests that I do in the office to see. And then I might even inquire into their gastrointestinal health. I will do a whole evaluation to see why this patient's building up this atherosclerosis. And part of the treatment program is going to be my fasting program,

• 1:07:37Speaker 00

  which I think is the number one program for this. So those patients are very happily motivated because I show them the coronary calcium score. I said, look, look at the picture. This is it. Check it out. You got this calcium. Another group of patients, they come in, the 80% that you're referring to have metabolic syndrome. So for the, for the sake of the audience, I'm just going to tell you on what metabolic syndrome is. Thank you. This is a derangement of your metabolism. And basically it means that you're, you're overweight, your body mass index is greater than 25. And you have an increased abdominal girth. All the weight is around the belly. And there's actually a ratio that you can do between the waist and the belly. Belly is increased.

• 1:08:22Speaker 00

  And then the HDL, the cholesterol is low. The triglycerides are high. And they have borderline high blood pressure. Now, when you look at all these numbers, what's the common thing that comes to mind from everything I've already said? It's insulin. It's all about insulin lowers your HDL, increases your triglycerides, increases your abdominal girth because all the fat is down there. Remember what insulin does? Insulin puts all your calories, excess calories and frequent calories and because of the high insulin levels, puts it where? Into the liver, pancreas and visceral gut. And that fat is totally different

• 1:09:02Speaker 00

  from the fat that you put on all over your body when you overeat. When I overeat, just eating a lot of fats and you know, okay, that's different. But the fats that are produced under the influence of insulin by the liver, de novo lipogenesis, the new fats that are created, the glucose has to be converted into a storage product. The storage product is that fat. That fat in the liver gets deposited in the liver, pancreas, visceral gut is very inflammatory. Composition is totally different. You do a biopsy of it, you'll find inflammatory cells in it that are producing tons and tons of interleukin-6 and tumor necrosis, bad stuff. So metabolic syndrome, although you have these basic features, when you do additional

• 1:09:46Speaker 00

  biochemistry on them, you will find that they have increased CRP level, which is a blood test for inflammation. And if you can do even further testing, you will find that they have very high interleukin-6s or tumor necrosis factors and they have small, dense LDL particles indicative of inflammation. So these patients come into the office for prevention or they're sent to me because they have a low HDL. And, and these are the patients that also do the fasting program. So some patients are motivated to go into my fasting program and lose the weight that way. Because see, the weight, by the way, I can't tell everybody, the weight is a side effect of the metabolism that's gone wrong.

• 1:10:27Rangan Chatterjee?

  Yeah.

• 1:10:28Speaker 00

  You fix the metabolism, the weight comes down as a side effect.

• 1:10:32Rangan Chatterjee?

  Yeah.

• 1:10:32Speaker 00

  It's not really a weight loss program. It's a metabolic program in which one of the side effects is that your weight comes back down to the way it's supposed to be? Comes back to where it was supposed to be. So, um, so these patients come in and, and they get referred to me. So I almost invariably do a coronary calcium score on them. But even if they're Calcium score is not very high. The metabolic derangements are going to make coronary calcium in the future. And I motivate these patients to start making the lifestyle changes by showing them that their metabolism's off. Now, these metabolic tests are not being offered by every doctor's office and and nobody. Cause it takes a lot of effort and the insurance companies sometimes don't wanna pay for it, like the advanced lipid panel. Um, sometimes they pay for it, sometimes they don't.

• 1:11:16Speaker 00

  So what I did in my office, I developed a program where it's a cash paying. If the insurance doesn't pay for it, okay, this is how much it's gonna cost you. But get the test done, it's a good investment and I have to show them that it's uh that it's gonna change their life. So.

• 1:11:30Rangan Chatterjee?

  Yeah.

• 1:11:31Speaker 00

  But you're absolutely right that this metabolic derangement is is not eighty percent, it it's probably more than that.

• 1:11:37Rangan Chatterjee?

  Uh.

• 1:11:37Speaker 00

  Uh, and it's very, because I'm seeing it in children, I mean, I just the other day I saw a mother bring in her sixteen year old. And I'm like, you know, and I said, you, I'm not a pediatric cardiologist, but there you go. Um, she had all the derangements already at the age of sixteen.

• 1:11:53Rangan Chatterjee?

  Yeah, thi- this is, this is so, i- it's so fascinating and I think. You know, I I think I've read a study where they're saying nowadays atherosclerosis starts in some children, even under the age of ten, I believe you can see in some kids, which is.

• 1:12:10Rangan Chatterjee?

  You know, you know, clearly no one wants to be hearing that, no parent wants that for their child, we don't really want that across society. Um, what what I find really interesting is that the different groups of patients who come in to see you, you know, the. Proper the ones who've already got established heart disease and obviously, hopefully, a lot of them will be motivated to go, okay, doc, tell me what to do and I'll do it. But you've also got some who are probably coming in for prevention, you know, what's the state of my heart, what's the state of my bloods? You know, is there anything I need to do? And the approach I can see is is very similar.

• 1:12:49Rangan Chatterjee?

  But you also, you know, you're sort of encouraging them to go all out and cut out all of the highly processed foods. You know, you're saying all breads, all pastas, which for many people is very difficult. Now, some people in the UK at least would call that quite extreme. Okay. Now, I also have used that approach successfully with my patients. So I can, I've absolutely seen the value off that. But I think it's worth talking about that. Does everyone need to go to that extreme? And I know a lot of breads these days are highly processed. They've got about 10, 15 different ingredients in. They have a high glycemic index, a spike in blood sugar. Whereas I know some of the

• 1:13:30Rangan Chatterjee?

  kind of German breads, like the rye breads sometimes, and some of the, like in the UK at least, the square shaped German breads often can have a much lower sugar response. So I guess what I'm trying to get at is, all patients presumably say, look, I'm going to try it, but they can't do the whole thing the way you would ideally want them to. You know, are there some common obstacles? Are there some sort of common compromises you have to make with people when they can't go the whole way?

• 1:14:00Speaker 00

  No, you're absolutely right. I mean, if you grew up on toast and white bread, and it's going to be very hard to do. So it just depends on their status. Now, they're coming purely for prevention. They're not overweight, but they do have some family history. It might be difficult for me to convince them that, hey, listen, you need to cut out all the bread. But clearly, if they're overweight, you know, it's basically convincing the patient that, look, you're overweight. You have metabolic disease. I can see some parameters here on the blood tests, or you already have coronary calcium in your arteries. And then explain to the consequences of that. That is not just that you're going to get a heart attack, okay? You're also at risk of getting dementia. When you got older, you're gonna get peripheral astrodysseus, you're gonna get renal

• 1:14:45Speaker 00

  failure, such a big link between kidney disease and heart disease. I said, so take a peek, what do you want, what do you want? And cancers, obesity is also related to cancer. So, sitting down and between myself and my staff, explaining to the patients that, listen, this is not just about about your heart, this is also about your whole life. This is a really a holistic approach. This is gonna affect everything. This is gonna affect the way you're gonna retire and what your retirement gonna be like and are you gonna be aware of your own retirement and be able to think, because Alzheimer's is going off the roof too. I mean, we have a huge increase in the amount of dementia that's going on and I'm one of those who believes that much of that is also vascular, it's all vascular. I think

• 1:15:26Speaker 00

  everything, you're as old as your arteries, you know. So what's your arterial age? Let's look at that. And so I think that making these dietary changes and cutting out the bread, yes, you are absolutely right, it's a difficult one to sell, but at least even if they cut down or move to pumpernickel bread or even sourdough bread is better because at least it has some benefit on the microbiome, but at least make some compromises and start, start, at least do something. And I think that that's the key thing is motivating the patient to think more long term also and not just think coronary artery disease. Everything that I tell the patients to do for their heart, I tell them straight up front. This

• 1:16:08Speaker 00

  is gonna keep your eyesight, this is gonna keep you from getting dementia, your renal disease, this is gonna help you from hopefully also decrease your risk of cancer, joint disease, back problems, I mean, name it. It really has so many ramifications. So, yeah. So, again, it comes down to what we said right in the beginning of this talk, we have to motivate the patient. I need to get into your brain, make a change in you so that you know that this is the right thing to do and then it resonates with you. Yes, this is right. And then see the practical results of it. And it's a slow process, gradual process, but, you know, we've done this. We've gotten patients off blood pressure medication, got them off insulin. You know, the biggest achievements I've had in the last few years now is getting

• 1:16:52Speaker 00

  patients off insulin. And it makes me feel so good when I do that. And all through this program, they come in and they're already taking twenty five units of insulin twice a day, and now they're on nothing. And their A1Cs are so good.

• 1:17:06Rangan Chatterjee?

  Yeah, you love it and I bet the patients love it as well, don't they?

• 1:17:10Speaker 00

  Oh gosh, coming off insulin, coming off blood pressure medications.

• 1:17:14Rangan Chatterjee?

  Yeah.

• 1:17:14Speaker 00

  Coming off cholesterol medications. Do you know how many patients walk into my office and there are tons of statins? And I do a coronary study on them and the score is zero. Score is zero. They have no coronary calcium and they're taking all these statins and they're hobbling around with all these muscle aches and pains. And I'll just stop the statin. So that's another thing, you know, empowering patients to know that, you know, there's no one treatment for all that. Yes, your cholesterol level is a little high. And therefore you have to be on a statin. I try to individualize the treatment for the patients based on what's doing to your body. You know, you have a decent advanced lipid panel. And we can make some dietary changes here so that you don't get any more coronary calcium, but you don't have to be on a statin.

• 1:18:00Speaker 00

  Empowering the patients to do that as well. Yeah.

• 1:18:03Rangan Chatterjee?

  What, what, you know, thinking about your approach, because I've been using similar approaches with my patients for a number of years now. And I think we see a different subset because I'm a general practitioner and you're a cardiologist. Of course, there's a huge crossover, given how common type two diabetes is, how common metabolic syndrome is. And, but it's interesting. So

• 1:18:30Rangan Chatterjee?

  you go, before you approach any form of fasting, you have a three week period where you, you know, in inverted commas, try and clean up the diet. You try and reduce the processed foods that they're going to consume, increase the whole natural foods, which is just going to put them in a much better state for when you then bring in your eighteen hour fast. So, which is really interesting. I, I take quite a softly, softly approach, I guess. I always start with a twelve hour fast, which some people wouldn't even call a fast. But I think pretty much every human being should be able to go for twelve hours and every twenty four hours without eating food. And if you can't currently, that's okay.

• 1:19:13Rangan Chatterjee?

  But it would indicate that you are, you know, you have some sort of dysfunction, some metabolic dysfunction somewhere. Otherwise you would be. Able to because some people, you know, say, I really struggle with that. And I say, okay, it doesn't mean that that's not a good thing for you. It just means at the moment you're biochemistry and physiology is not able to support that. So let's, let's, let's work on that and get you to a point where you can. And then, yeah, for the right patient, I also increase it up gradually. So I find that super interesting as, as kind of just to notice a difference because there's no right or wrong, is there? There's just, we're all trying to empower our patients and we're all kind of biased, I guess, by our own experiences as to what we have found. Working with patients. So I found that really interesting.

• 1:19:57Rangan Chatterjee?

  Also, are most of your patients men? And the reason I ask that is because, of course, heart disease, we hear a lot about killing men. Of course, it affects women as well.

• 1:20:11Rangan Chatterjee?

  But also there is this question mark that many people have over fasting as, okay, it kind of works for men. But maybe it's not so good for women. I have my own view on that, but I, I wonder if you could share some of your thoughts on that.

• 1:20:24Speaker 00

  Yeah. So the first part was twelve hours versus eighteen hours. You know, there's two things that I'm concerned about when patients start fasting. One is the withdrawal. And I think that withdrawal is, it comes in two shapes. There's mental withdrawal, that it's, I'm, I'm a Pavlovian reflex, I have to eat at eight o'clock in the morning. I've done that for so many years. The other one is a true biochemical addiction at the level of the brain. So that really concerns me that that's why I do this period to come in. Because that gets them rid of the addiction because I think addiction is a real issue. That they're addicted Pavlovian wise, but they're also biochemically in the brain.

• 1:21:10Speaker 00

  And some of them really do go through withdrawal symptoms. And they say, you know, I felt terrible. I started sweating and I had this intense cravings and, and, and I said, God, this sounds like heroin withdrawal. And I think it's real. So that's why I do this, just skipping meals and gradually getting into it. But once, how long does that take? That's the question. How long does that take? And in my experience, I've been doing this, it takes three weeks. At the end of three weeks, I can pretty confidently say that the patients have gone through their withdrawals. And they're gonna be now okay to take on the eighteen hours. And that's why I do it that way. And the withdrawals are very real because the foods have addictive properties. Sugar is definitely addictive, we know that.

• 1:21:55Speaker 00

  We know dairy products have caseyomorphine, which actually are addictive. So you crave those things that you that that that doctor told you to to to skip the meals on and all that. But I think that after three weeks, they're done. And I tell patients, it's not gonna be easy. The first three weeks, you're gonna get a lot of cravings. You need social support, you need to structure your life. You need to do your shopping during the times that you're gonna be eating that meal. Otherwise, you keep your mind busy and you and you've got to get your seven hours of sleep. And so, yeah, so the withdrawal issue is very important. That's why I do this gradual stuff. And then the answer to the second part, the women, definitely, women are not exempt from C A D and heart disease.

• 1:22:37Speaker 00

  And and and something that applies to you and me is Asian women too. Did you know, did you know that the incidence of coronary artery disease in Indian women is actually higher than Indian men? But it's just that they they don't get diagnosed. And and they don't seem to complain that much, so they don't come to to to the doctor's office. But actually, I've seen worse coronary artery disease in Indian women in my office than in Indian men. And in Indians in general, they have far more coronary artery disease than Caucasians. So it's a huge problem. So I think that women are are certainly a a a a a population that is not exempt from coronary artery disease.

• 1:23:22Speaker 00

  Now, the fasting programs in women, there are some data to suggest that they may not benefit as much as as men. But overall, I think that what I've seen is that they also seem to benefit just as much. So I I I don't make much distinction between men and women. When they come in here, I work them up the same way. I'm very aggressive with the women as well, especially especially women from South Asia. The the when they walk in, they've got my antennas up. In fact, any South Asian that walks into my office, my antennas are up because they're what I call toffees. You know, they're thin on the outside, they're fat on the inside and they're metabolically

• 1:24:01Speaker 00

  very deranged. And there are specific things that I tell them about fasting and dietary recommendations for their diet. And the reasons have to do with vitamin K2 as well, which I'm finding absolutely fascinating these days. So.

• 1:24:18Rangan Chatterjee?

  Now, I very much appreciate that perspective. So thank you, first of all, for sharing that you're seeing lots of coronary artery disease, potentially the worst in South Asian women, the South Asian men. I don't think that is commonly known. I did not know that. And actually, I'm now thinking of people and women in my family. I'm thinking, right, okay, maybe instead of thinking about the men, we need to start thinking about the women as well in terms of, you know, prevention, in terms of getting early screening done, blood tests, maybe, you know, coronary calcium score, you know, whatever might be available to people. My experience of fasting, in inverted commas, because fasting can mean so many different things to so many different people is, yeah, I have seen some women with

• 1:25:01Rangan Chatterjee?

  hormonal problems. I'm not talking about necessarily insulin hormonal problems. I'm talking more about kind of around the menopause, let's say, or estrogen, progesterone, sort of imbalance issues. I've found with some women, it can be a bit challenging for fasting, and some women don't do so well. But I've also found many women who thrive on it. So I think a lot of the time, people, I've noticed this on social media, a lot of people try to, oh, it doesn't work for women. It's like, well, what do you mean, 100% of women all the time? It's like, you know, and this is why I love talking to real life clinicians. It's like, well, we see that not everything works for everyone all of the time, and we have to tweak our view depending on what we see. And, you know, when we make these

• 1:25:44Rangan Chatterjee?

  kind of gross generalizations that, oh, fasting doesn't work for women, it's like, well, we put, like, let's say there's that subsection of women who thrive on fasting, well, they get put off. They think, oh, it's not for me. And it's kind of like, well, there's no one size fits all in anything. And you see enough patients, you kind of realize that, that there's very few, although fasting might be one of them, I guess, you might argue. But do you know what I mean? I kind of feel these days we get too polarized on these things. And we just miss the kind of nuance that's actually there.

• 1:26:17Speaker 00

  You're absolutely right. And this is the new medicine. We're going to become more individual. Okay, why is this lady not able to enter into my fasting program? She really needs to. BMI is forty two and she has all this stuff going on. There may be other reasons. She may have so much stress in her life, you know? She may have financial problems that she can't buy the right kinds of foods that I want her to buy. She may be in a very dysfunctional relationships and that may be causing so many problems for her. She may not be sleeping at night, a simple thing. She may have undiagnosed obstructive sleep apnea, which is why during the daytime she has so much fatigue, tiredness, and she's never going to develop enough willpower to enter into my program until I get her a good night's sleep. So maybe put a CPAP on her for the time being and then see that, oh yeah,

• 1:27:02Speaker 00

  now she can abide by the principles of the fasting. So, you know, it just means looking deeper into the, why weren't you able to do this? There are obvious factors why you cannot. Where's your willpower? Why don't you have the willpower? Let's look into this. And we don't always find the answers to everything, but I think that looking at them overall. So the sleep apnea is a huge issue, by the way. I mean, massive problem that I find. So oftentimes, temporally, I do put them on a CPAP mask and say that you're going to have more energy, mental energy and clarity and less neuro dysfunctional during the daytime. And therefore you will be able to abide by the diet.

• 1:27:43Speaker 00

  But the goal is really to lose the weight so that we can get you off the CPAP eventually. Yeah.

• 1:27:49Rangan Chatterjee?

  So back to the kind of therapeutic use of fasting. So you do this kind of three week program where they unprocess their diet. Then you put them on this kind of eighteen hour fast. So they're having two meals a day over six hours. And then for eighteen hours are not consuming anything. We must talk about any contraindications like insulin or blood sugar medications at some point, just to make sure that, you know, people who are listening, who want to try stuff, that we've covered that. But also, I want to go a bit further because I know you have used 24-hour fasting with patients. I know you have used three-day fasts and you have also shared in previous conversations, some very powerful statistics.

• 1:28:33Rangan Chatterjee?

  One in particular, I remember on a seven-day fast, you shared a statistic, a bit of research from Boston in terms of what that does to your lifetime cancer risk. So maybe you could talk about some of these longer fasts and then practically how do people start going about that?

• 1:28:49Speaker 00

  Yes, yes, so absolutely. So at all times, they are supposed to take their blood pressures twice a day, make sure that the blood pressure not going down to, because that do not stop the blood pressure medications right off the bat. So the blood pressure medication reduction will be done depending on your blood pressure readings. As far as blood sugar is concerned, if they are on oral agents, I'll continue those oral agents while they're doing the 18-hour fast periods. Even the 24-hour fast, I'll keep them on it and I will ask them to monitor their blood sugars. Now, continuous glucose monitoring, the little devices, I only advise those on patients who are on insulin when I'm fasting them, because I want to make sure that their insulins don't drop off.

• 1:29:33Speaker 00

  But when a patient is taking insulin and he does the 24-hour fasts, I drop the insulin levels by half first, I mean insulin dosage by half, and I monitor their blood sugars. And then, when they go beyond 24-hour fasts, I stop insulin completely, completely, completely. I stop it completely because I don't want them to become hypoglycemic. So oral agents, I will continue.

• 1:29:59Speaker 00

  Insulin, I will discontinue if I'm doing more than 24 hours, but I monitor their blood sugars very closely. And then that brings me to a little longer fast. Before I go to longer fasts, I make them do a 36-hour fast. So I'll make them do that once a week. Once a week means that evening rolls around, skip that meal also and then have yourself a breakfast. Treat yourself for the breakfast the next day. And that brings it to thirty six hours. So I make them do at least one thirty six hour fast for maybe, you know, two consecutive weeks. And then I'll take them to higher levels.

• 1:30:36Rangan Chatterjee?

  Can I just clarify, can I just clarify that? So the thirty six hour fast, the way you have found it most beneficial for most of your patients is what? You skip one evening meal to the next evening meal? What, when, when does that fasting time? I know you can do it any way you want, but what have you found to work? Can we just clarify that?

• 1:30:54Speaker 00

  Yeah, so the patients already are used to having only one meal a day. So then I'll say skip that one meal and then have the next meal when you're supposed to have them. That'll bring it to thirty six hours. So for most patients these days, they're having their evening meals because it's more social, they're having it with the families.

• 1:31:10Rangan Chatterjee?

  Okay.

• 1:31:10Speaker 00

  So they'll skip breakfast, they'll skip lunch, evening comes around, they're supposed to eat. And I tell them skip it and go and have breakfast the next day. That brings them to thirty six hours.

• 1:31:20Rangan Chatterjee?

  I guess if they're already used to having one meal a day, then actually skipping that evening meal is kind of, I don't know.

• 1:31:29Speaker 00

  Yeah.

• 1:31:29Rangan Chatterjee?

  Just go to, go to bed early as well, you know, sort of, you know, it's, yeah, I like that. So what stage do you take them from this two meal a day, which is this, you know, this six hour eating window? You know, you, you do that initially for the eighteen hour fast, then you take them to twenty four hours, do you? With just one meal a day, is that how you do it?

• 1:31:47Speaker 00

  That's exactly how I do it. And then they're doing one meal a day, five days a week. Weekends, they're gonna have two meals. They do that for two weeks. And then I say, okay, you've been doing this for two weeks now, you've been having only one meal a day. Next few weeks, one day a week, you're gonna go to thirty six. And the way you're gonna do it is you're gonna skip that one meal also and then have a breakfast the next day. So that'll bring you to the, and I'll see how you feel. And most of them come back saying, I just missed the meal in the evening, I watched a movie and went to bed. So why am I going from 24 to 36? Because I want to get them ready for longer fasts, especially if they're tremendously overweight and they're metabolically deranged.

• 1:32:32Speaker 00

  What's the biochemical advantage between 24 and 36? At by 36 hours, almost all of them will be in some degree of ketogenesis. So it's hard to know who's going to start spilling ketones at 18 hours, 24 hours, 30 or 32 hours. It's hard to know that. So when I prime them, then I'm finding that there's longer and longer periods of ketogenesis. That means they go into ketone production at 16 hours. So long as they made their dietary changes, gradually got into this, the ketogenesis phase starts a little bit sooner at about 16 hours. And the most motivated patients say that, oh, I want to know.

• 1:33:16Speaker 00

  I said, okay, if you want to know, then go to the pharmacy and pick up some keto sticks and just test your urine and tell me when you started spilling the ketones. So after 24 hour fast, almost all of them are spilling ketones. And when they're spilling ketones, I know what's going on with their physiology at that point. I know that they're getting the benefits of some degree of autophagy, growth hormone, BDNF production and mitophagy. I know that's happening because they're spilling ketones. So spilling ketones. So that's another motivating thing. In the patient who's showing me the interest and the ones I really want them to do, yes, give them the tool, take this home, check your ketones.

• 1:34:01Speaker 00

  That's what I find so fascinating. So by 36 hours, they're making the ketones. So they'll do that for a couple of weeks where they now went to 36 hour fasts once a week for two weeks. Now, at that point, depending on how motivated they feel and how well they are doing, now I'll go to more prolonged fasts. And my favorite fast is the three day water fast. And most of the, I'm telling you, greater than ninety five percent of them, when they've graduated to this point, where they've gradually gone and done all this, they're able to do the three day water fast with no difficulty whatsoever. And if they get cramps, then I tell them, okay, take a glass of water and put a pinch of salt in it and just, just down it and you'll feel better.

• 1:34:45Speaker 00

  But most of them don't because they've adapted themselves. If you go into a three day water fast too quickly, you're going to get more cramps. But more importantly, you're going to go through what is known as keto flu and you just feel terrible and aching and you just feel really bad. So I do it gradually, but I must make them go to a three day water fast. I use it in that case. I also use it in patients who are able to lose weight, but then they reach a plateau. So now they're weighing two hundred and thirty pounds and I want them to have more weight loss. So they've been doing this now for a month and they said, look, doc, I just can't shed any more weight now. I've done everything you're saying and I'll put them on a three day water fast. And lo and behold, they'll start losing weight again. So I use that in patients who've reached a plateau, going to the three day water fast.

• 1:35:30Rangan Chatterjee?

  Yeah. Thank you for sharing that. I think something I did want to bring up today, because I know a lot of people, and again, we're all influenced by the online world or the patients that we've seen or the online world that we inhabit. And, you know, I spoke to David Sinclair, this Harvard professor, who talks about aging in a very, very profound and novel way. And, you know, when I put out that episode with David, a lot of people were saying, look, asking people to skip meals is very triggering for people with eating disorders. And I know eating disorders are on the rise massively all over the world,

• 1:36:14Rangan Chatterjee?

  certainly here in the UK and in America.

• 1:36:18Rangan Chatterjee?

  So I think we need to be careful about that. I think it's worth me just flagging that here that potentially this advice is not for people with eating disorders. That's a sort of separate issue. Well, I'd welcome your perspective on that. But also, you know, is it possible that we take these things to extremes? I guess there would be some people, we mentioned Anna Lempke's book before Dopamine Nation and that we're all, we're living in a world of addicts now and that, you know, she mentions that the smartphone is the modern day hypodermic needle, which I thought was a very provocative way, but, but I actually completely agree with her of talking about it. There's health, there's physical biochemical

• 1:37:00Rangan Chatterjee?

  health, but there's also this kind of emotional health and our mental wellbeing. Do you think, as much as you love fasting, do you think some people, they can sort of overdo it and get so addicted to kind of that feeling of fasting and actually go to an extreme which potentially could become problematic?

• 1:37:22Speaker 00

  I think you're right. It can happen. Fortunately, I haven't seen it here with somebody. I tell them, stop now, stop, stop. This is enough. Now you should be eating two meals a day. And, you know, I think that the pattern you need to settle down in is for you, I think that two meals a day in a six or eight hour window period may be a nice thing for you to do chronically to maintain what you gain, the benefits that you've already gained. Then I haven't seen any patients who ignore that and continue to do the three day water fasts on a, on a weekly basis or whatever, or two weekly basis. I haven't seen that. But, but you are absolutely right that there are some patients who clearly have an eating disorder and they clearly have a type of addiction and they're going up at

• 1:38:06Speaker 00

  night and they creep downstairs and they're eating away five bars of chocolates and all this kinds of stuff. And those patients clearly do need help and I will not deal with those on my own. I will supervise it, but I'll send them to a psychologist that actually specializes in addictions because they have to really spend time with that patient about addiction behavior. And it's not just behavior about the food. There may be other Issues that are actually triggering, um, could see you you slide from one addiction to the other, to the

• 1:38:33Rangan Chatterjee?

  Yeah.

• 1:38:33Speaker 00

  The other. So so you can't take off this alone on its own until you also take you take you up the sugar and maybe the the cell phone and and other digital gadgets that gives you the instant gratifications and and there may be even be other issues. He may be a gambler for, you know, or have other type of uh deviant behavior addictions. So, no, you're absolutely right. So recognizing those with the biggest problems and addiction is a huge problem and it's becoming more more known now that uh the addiction is to not only sugar, but it's also addicted uh to to to process food content, processed foods and the content of processed foods um are very addictive.

• 1:39:15Speaker 00

  And I think that that's why you want to change the the type of food that you see. You're getting rid of all the addictive substances in the food, the addictive sugar in the food and then addictive behaviors in other aspects of your life as well.

• 1:39:27Rangan Chatterjee?

  Yeah.

• 1:39:28Speaker 00

  So so it's it's really looking at the whole thing. Uh it's it's it's a huge problem. It's a huge problem. And yes, we we are an addicted nation.

• 1:39:35Rangan Chatterjee?

  Um yeah.

• 1:39:35Speaker 00

  We we we and that's why it's making it so easier for us to become addicted to food later on in life because it starts at a very young age. You're already getting addicted to gadgets um and instant gratification.

• 1:39:48Rangan Chatterjee?

  I want to move on to the mental benefits shortly of fasting because I think there's a real uh important piece there that we touched on a couple of times in the conversation already. Before I do, I sort of feel that

• 1:40:02Rangan Chatterjee?

  that there's so much um divisiveness and um, you know, frankly, fighting about different diets that I think sometimes gets so unhelpful for the general public. Um they see doctors who they admire saying this diet has got this evidence. This is really good. And they see another doctor who they admire. Say this diet is really good. It has all this evidence. And I think, and I know this from talking to patients and talking to the public, that many people find this incredibly confusing. I I really like fasting for the right person in the right state of health. I kind of see it as the great unifier in many ways because

• 1:40:45Rangan Chatterjee?

  As long as you are metabolically able to do that fast, you know, whether you choose to eat meat and fish, or whether you choose to be vegan, if you are whole food primarily and not having much processed food at all in your diet, then you're still going to get benefits from fasting, right? Whether you're low carb or whether you're vegan. And, you know, it's interesting, that video that you did on fasting, fasting for survival on YouTube, which is, you know, had millions of views. I was reading through the comments just before this conversation, Dr. Jamnadas. And the top comment was really, I think, encompasses everything that you stand for.

• 1:41:30Rangan Chatterjee?

  He, I think, said he was mostly plant-based and he started off following your advice with a whole food, mostly plant-based diet. I think he started off with 18-hour fasts. He moved up to 24-hour ones. I can't quite remember, then he moved to maybe one three-day one every six months. And he's documented his health journey over two years. And it is utterly remarkable that you put out a video on YouTube and you have completely empowered that guy to transform his life. So first of all, just, I want to acknowledge you for that. That's just one of millions of people who've seen that video and changed their lives. So that's just incredible work that you're doing. But what do you think about this concept that fasting could be the great unifier?

• 1:42:12Rangan Chatterjee?

  No matter what tribe you belong to, you can still evolve with fasting and yields and reap many of those benefits.

• 1:42:22Speaker 00

  You're absolutely right. The various dietary programs that have come out have confused the public. It's confused physicians as well. I mean, my patients come and say that I'm following this diet, that diet, and nothing happened, and this one's too hard for me, and this one's too restrictive for me, and it doesn't fit with my lifestyle. I understand that, I understand that. Fasting forgives you. Fasting, in a sense, forgives you for certain foods that you may then consume. And actually, think about it this way also. You eat that slice of bread. After a fast, your insulin response is totally different in the fasting state than in a fed state. You're gonna make less insulin for the same slice of bread in a fasting state.

• 1:43:06Speaker 00

  So it's and the the the the the type of food that they consume. So when I first started out, I was years and years and years ago, I was I was say, oh, you gotta be a vegetarian. You got you gotta drop all meats and being in the United States, ah ah how many patients are gonna become vegetarian, right? So and then as the data came out and I started studying more and more, I changed. I decided that hey, there's something wrong with this. You know, people should be able to eat ancestral foods and what they grew up with. Uh uh uh but the problem was processed foods. Then we take the foods and we process them, we change them and all the additives that we put into.

• 1:43:50Speaker 00

  And the way we grow our food or way we we we we get our meats has changed. So I said, no, no, no, no, this is not right. When I studied non-vegetarian diets um around the world. How come there is low incidence of heart disease? There are populations that eat only meat and only drink milk and and blood. Or or the population that only eat starches and a lot of it, and they also live long. What's the commonality? What was the commonality in all of them? The commonality was no processed foods, no additives, right? No, no sugar. So they they they all had simple diets. So then I came up with my own plan and I said, listen, you you what do you like to eat?

• 1:44:34Speaker 00

  What do you like to eat? So you wanna eat red meat? Okay, then eat grass finished meat. Because that will have more nutrients in it, their fats will be the right kind of fats. You will not have all those omega sixes in there, you you you'll have more natural fats in there. And if you want your eggs, chicken, so I let them do that. And I said, but you gotta also introduce plants in your diet because you need the plants, not for you. Yeah, and you're gonna get some, some water soluble vitamins, et cetera, et cetera, into your system and eat plants and all, but it's really for your gut bacteria. So again, I had to read a lot about the microbiome to understand that the fibre is hugely important, very important. And, and so I tell, eat your vegetables as well. So this is my diet plan.

• 1:45:17Speaker 00

  It's not so restricted, just stay away from anything that your great, great grandfather wouldn't eat. And no processed foods, anything in a packet, box, barcode, stay away from anything made into a flour. And that's been a hard one, the flour one.

• 1:45:30Rangan Chatterjee?

  Yeah, it's everywhere. It's everywhere, isn't it?

• 1:45:34Speaker 00

  It's a huge, huge, huge problem.

• 1:45:36Rangan Chatterjee?

  Yeah.

• 1:45:36Speaker 00

  But I think you would without it.

• 1:45:38Rangan Chatterjee?

  I, I, I love this, um, you know, I'm so enjoying speaking to you. There's a real kind of, there, there's just a beautiful energy. There's also this kind of real life practicalness that you know what it's like when these patients come in and you've got in your head the ideal thing, but you've got to work with people and their taste and their preferences and their culture and what they want. And I really do strongly feel that too many people these days on social media commentate, they look at the science and go, oh, this is what everyone needs to do. It's like, it's just not how it works in real life in my experience. You know, people are different, they've got different desires, they've got different cultures, different preferences. So I really like that. You've mentioned all the kind of physical benefits, the biochemical benefits,

• 1:46:23Rangan Chatterjee?

  when we have a period of not taking in food, a period of fasting. But there's also something really powerful, isn't there? Like you have touched on several times. About what it does for you when you know, oh, I can go 12 hours without food. I can go 18 hours. Wow, actually, I can go 24 hours and I don't actually need to put something in my mouth. I think we shouldn't.

• 1:46:53Rangan Chatterjee?

  Undervalue just what that does for someone. You know, I think it's freedom. It's freedom from a dependency on foods. Addictive foods, processed foods, sugar. It means that you can go about. You're out on the train station or the airport and there's no good food to have. Cool, just don't eat. Take the flight, don't eat. There's a real freedom which many people feel that they are, they're in chains. I guess to the food industry and to their, their hunger and their stomach. So, you know, can you speak a little bit about that and why you feel that's so important?

• 1:47:27Speaker 00

  Yeah, I, I love the fact that you use that word freedom. Because, you know, I said, okay, it empowers the patient, but it is a real freedom. It's a freedom that, that they know that what their behavior resulted in no adverse effect. And that they were able to overcome this, which they never thought they could overcome. So these little hurdles that they're overcoming in their diet actually has huge repercussions in other aspects of their life. And really, honestly, it, it percolates into their, into their workplace, into their family life, in their social interactions with their friends.

• 1:48:07Speaker 00

  And I've seen that these people, they just, they just become more, more self-confident. And, and I think it's because we introduce terms to them like, that's who you are. The real you. So it opens up a new aspect of their existence. That there is a part of me that's separate and apart from my body and from my mind and my cravings and my stomach and my feelings and, and all these things. And that's the real me. And of course, you know, this gets into some of that part that I have a huge interest in, which is, who are you?

• 1:48:47Rangan Chatterjee?

  Yeah.

• 1:48:48Speaker 00

  What, you know, who are you really? Where is the you?

• 1:48:55Speaker 00

  And why can't you, that you, change your behavior? Of course you can, because you need to change your identification. So this is an identification change that I see the patients doing. They realize that they are in charge, that them inside them, not the body, not the mind. There's actually an awareness, an am-ness, an I am. And that is huge, huge. And I've found that people who have done this program over the last few years, they actually get work promotions, they actually become better supervisors, they become just better family members and caregivers. It's miraculous, how one thing, because it's showing them that, yes, you are in charge.

• 1:49:39Speaker 00

  Look, you can do it, you can do it. And they just self-empower themselves, it feels so good. Self-confidence just goes off the roof. And I think that, that, that, you know, I'm learning more about this. But I think it does boil down to, because that also brings me to stress management. Because one of the things we do tell our patients is that, if you start getting stressed out during all this, these periods where you're getting into the fasting period, you need to go out and do some meditation, we tell them. And we show them how to meditate. And I have a very simple meditation technique where I just basically ask the patients to, okay, just close your eyes and just concentrate on your breathing only.

• 1:50:21Speaker 00

  And when a thought comes, let the thought go, don't follow up on it, because then another thought will come in a few minutes. Don't follow up on it, wait, just come back to your breathing, concentrate on your breathing as the breath goes in and out. And you will find that there'll be gaps in between your thoughts that get longer and longer and longer. And my patients have all said, yes, you're absolutely right, there's blankness. I said, well, that blankness, when you don't have a thought or when you're not thinking of something, that's you, that's the real you. And when you come out of this for fifteen, twenty minutes, you will realize that there is that you in you and you can make up your mind about anything. You can, you can do anything, it'll empower you.

• 1:51:05Speaker 00

  And you'll feel less stressed out, you'll feel less compelled, you're less automatic. You will be, you will become, as you said, that word that you used, you'll have freedom, you'll have freedom. And I find that fascinating. So you see this whole thing, I said this in the beginning, that fasting seems to open up that onion into all different parts of your life. You know, it's just amazing stuff.

• 1:51:29Rangan Chatterjee?

  I mean, I love it. I just love it. And if and when we have our second conversation, I could see us going deep into who we are, spirituality. And I really do feel that's a missing piece in medicine. Like, it's not just about telling someone what they should do for their health. I mean, people don't really do what other people say in the long term, in my experience. They might do initially to get them going, but at some point, it has to change from being the doctor's plan to being my plan. At some point, it needs to be, like, they go on your three-week unprocessed, your diet sort of regime, they start fasting. At some point, maybe after a month, two months, three months, you want that self-empowerment

• 1:52:14Rangan Chatterjee?

  piece where it's like, yeah, okay, the doc's guided me, but I know what I'm doing now. I want to eat this way. I want to fast like this because I feel good when I do it. So I'm now doing it, not because he told me to, but because I want to. And I think that, you know, I, like you, I teach doctors, I always talk to them about this. This is a really important piece of the puzzle. Another thought I had is fasting is, initially at least, a difficult thing for many people to do. And we kind of know that when humans do difficult things, whether it's fasting for 24 hours when you find it hard, or whether it's completing a half marathon when, you know, six months ago, you couldn't walk around

• 1:52:58Rangan Chatterjee?

  the block, what it does for us in terms of who we are and our self-esteem and our confidence, it's very, very powerful, isn't it? So I really love that you are bringing that up also in the context of fasting.

• 1:53:13Speaker 00

  We have to. You know that there's a huge, in health, there's a huge component of your mental being and your understanding of who you are and your role in your life and the people around you. You. So I one of my interests and maybe we can talk about this in other occasions is is, you know, what are your relationships like, especially with your mother? Because that's going to tell you how long you're going to really live. It's amazing. Or, you know, when my patients are in the hospital, how many people come visit them after open heart surgery? Determines how quickly they're going to recover from open heart surgery. Same surgery. What's going on here? So we can, you know, there's huge repercussions on how patients' health is,

• 1:53:54Speaker 00

  depending on their social and then how do they view themselves in society and their role and and and the hierarchy in society. And that seems to also dictate outcomes in health irrespective of how much healthcare provide facilities are available to them. So there's all these other social determinants of health that are extremely important. And I think that we don't talk about that enough. And I think that that's something that we need to talk about because in cardiology, besides my fasting, my other aspect is, is, is I do want to get into all that with my patients to see that, you know, health is defined by you. You basically metabolize

• 1:54:37Speaker 00

  your psychosocial being, you metabolize it into your body. So be careful about your thoughts about who you are and how you're interacting with the world and everything that's going around you, because in an instantaneous moment, you're actually metabolizing it into physiology in your body. So it's fascinating stuff and I have lots of data on that, lots of it.

• 1:55:00Rangan Chatterjee?

  Well, well, we are definitely going to have a second conversation because I think we've not even scratched the surface of that. Just to finish off this conversation, Dr. Jan Madass, firstly, thank you for your time. I know you're a super busy cardiologist. This podcast is called Feel Better, Live More. When we feel better, we get more out of our lives. And I wonder if we're at the end of this conversation, you could share with your decade of experience as a cardiologist, with all the patients you've seen, can you share with my listeners, with my viewers, some of your very top tips that they can think about applying into their lives immediately after this conversation finishes?

• 1:55:44Speaker 00

  Number one, eat only natural foods in its natural state.

• 1:55:52Speaker 00

  Number two, eat infrequently, only when you are hungry. Number three, sleep at least seven hours a day.

• 1:56:05Speaker 00

  Number four, find pleasure in your life and activities so that you don't metabolize bad physiology from bad habits. Find happiness, find pleasure in your life. And if you do these four things, you'll find your health will turn around completely.

• 1:56:29Rangan Chatterjee?

  Well, thank you so much for your time. Where can people learn more about you if they want to sort of follow you on social media or on your website? You know, where, where, where should people go?

• 1:56:38Speaker 00

  Yeah. Well, on the YouTube, I have a channel for cardiovascular interventions with my name, Pre Gymnatus. And I also have a Galen Foundation. Now, Galen Foundation is a foundation that I set up about 12 years ago for educational purposes. And I do give talks all over town. And of course, because of COVID, we did not do that. I go all over Florida to do it. It's called Galen Foundation. It's also on YouTube. And my website is orlandocvi.com. And even if they just Google my name, it'll show up. And on my website, I have a lot of educational materials that people can use, videos. But a lot of that has to do with real cardiology, like how to put a stent in, or what's a pacemaker, and what's an ICD, and all that kind of stuff. But that's also still very important. So, but I think

• 1:57:23Speaker 00

  that the most important new things that are on the websites that they can see is the diet and the coronary calcium, which I think is a huge advancement in motivating patients to make the changes, that they need to change catching disease before it actually becomes a problem.

• 1:57:38Rangan Chatterjee?

  Dr. Jamnus, you're incredible man. You're doing incredible work. Thank you for joining me on the show. I'll see you very soon.

• 1:57:48Rangan Chatterjee?

  Really hope you enjoyed that conversation. Do think about one thing that you can take away and apply into your own life. And also have a think about one thing from this conversation that you can teach to somebody else. Remember, when you teach someone, it not only helps them, it also helps you learn and retain the information. Now, before you go, just wanted to let you know about Friday 5. It's my free weekly email containing five simple ideas to improve your health and happiness. In that email, I share exclusive insights that I do not share anywhere else, including health advice, how to manage your time better, interesting articles or videos that I've been consuming,

• 1:58:32Rangan Chatterjee?

  and quotes that have caused me to stop and reflect. And I have to say, in a world of endless emails, it really is delightful that many of you tell me it is one of the only weekly emails that you actively look forward to receiving. So if that sounds like something you would like to receive each and every Friday, you can sign up for free at drchatgy.com/friday5. Now, if you are new to my podcast, you may be interested to know that I have written five books that have been bestsellers all over the world, covering all kinds of different topics: happiness, food, stress, sleep, behaviour change and movement, weight loss, and so much more. So please do take a moment to check them out.

• 1:59:13Rangan Chatterjee?

  They are all available as paperbacks, ebooks, and as audiobooks, which I am narrating. If you enjoyed today's episode, it is always appreciated if you can take a moment to share the podcast with your friends and family, or leave a review on Apple Podcasts. Thank you so much for listening. Have a wonderful week. And before you go, I just wanted to let you know about an exclusive January offer. If you want to listen to every episode without having to hear any of the adverts, you can do so with an Apple subscription. We're extending the free trial from seven days to 30 days. So if you want to take advantage of this offer and support the podcast,

• 1:59:56Rangan Chatterjee?

  and enjoy every single episode advert-free for an entire year, just go to the Apple Podcast app and subscribe. And always remember, you are the architect of your own health. Making lifestyle change is always worth it, because when you feel better, you live more.