DR FEDERICA AMATI: How Weight Loss Drugs Can Rewire Your Brain

Dr Federica Amati is the Head Nutritionist at ZOE and author of The Appetite Reset, https://amzn.eu/d/0iodLEof. https://amzn.eu/d/0iodLEof She first came on the show back in 2024 and she completely blew my mind. Now she's back…And this time, she's tackling weight loss drugs. What started as a prescription treatment for diabetes has become a global cultural phenomenon, with millions now taking GLP-1s to lose weight. Dr Federica reveals that people can eat up to 40% less food while taking these drugs, causing significant changes to their bodies. She also explains how they can rewire our brains, as well as the short and long term effects of taking them. In this episode, she shares: How weight loss drugs really affect our bodies and minds The connection between GLP-1s and addiction How ‘skinny jabs’ are changing our supermarket shelvesWhy young women may face unique long-term risks from GLP-1s This is a fascinating conversation about medication that’s changing the way we think about our health, our bodies, and our relationship with food. Dr Federica Amati is Great Company. You can buy Dr Federica’s latest book, The Appetite Reset HERE https://amzn.eu/d/0iodLEof! If you enjoyed the show, you can also follow us: Instagram - @greatcompanypodcast TikTok - @greatcompanypodcast Jamie - @jamielaing And if you've got thoughts, questions and comments, you can email us at: [email protected] THE CREDITS Producer: Magda Cassidy Assistant Producer: Issy Weeks-Hankins Video: Josh Bennett Senior Social Media Manager: Laura Coughlan Audio: Rafi Amsili Geovannetti Shot on Sony Cinema Line cameras FX6, FX2 with Sony G-Master lenses 16-35GM, 24-70GM Hosted on Acast. See acast.com/privacy https://acast.com/privacy for more information.

• 0:00Speaker 00

  Everyone, it feels like, is talking about what we call the skinny jabs.

• 0:03Speaker 01

  The most vulnerable population for this is girls in their late teens, early twenties. Reflux, vomiting, nausea, constipation. They've seen a huge increase in people taking these medication who developed an eating disorder. If you undernourish yourself, your muscles and your bones will suffer. The risk that they are undermining their long-term health is huge.

• 0:24Speaker 00

  Is it a miracle drug or is it a danger? Wow.

• 0:29Speaker 01

  Hi, I'm Dr. Federica Amati and I'm in great company again.

• 0:32Speaker 02

  A leading nutrition scientist, Dr. Federica Amati.

• 0:36Speaker 01

  GLP-1 receptor drugs, they are a medical breakthrough. The idea that we can now harness peptides and completely change metabolic health is wild. This drug has been taken as a lifestyle drug because we're obsessed with weight. I'm not pro-drug or anti-drug, I'm pro-patient. Retatutrid, Reta, known on Instagram. It is not yet approved by the FDA, untested, untracked, unregulated. But people are accessing it on the black market. They're really for rats in labs, I'm not joking.

• 1:06Speaker 00

  I have like a million more questions.

• 1:09Speaker 01

  Weight loss is almost not the most interesting part of this drug. It also turns down your desire for alcohol and gambling.

• 1:16Speaker 00

  No.

• 1:16Speaker 01

  Yeah, it's a brain drug. I'm very angry about this. There are adverts that target postnatal women. Recovery requires a lot of nutrients, especially if you're breastfeeding.

• 1:27Speaker 00

  What are the long-term effects of taking these drugs?

• 1:29Speaker 01

  Everybody should know this.

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• 2:33Speaker 00

  She's back for a second episode. It's Dr. Federica Amati. Federica is one of my favorite people to have ever been on the show. She's one of the first people we had on the show, one of the first experts. Today, we're talking about so many different things, but most importantly, GLP-1s and the side effects and the things that they do to their mind. What I learnt today is simply incredible. Now, before we start, if we can do one thing, click that subscribe button. It's completely free and keeps allowing us to make the show better for you guys every single week. If you can do that one thing, thank you so much. Okay, enjoy this amazing episode of Great Company with Dr. Federica Amati.

• 3:10Speaker 00

  Federica, hi.

• 3:11Speaker 01

  Hi, Jamie.

• 3:12Speaker 00

  Do you know, we have, I think we've only ever done one other person twice on the show. So you are.

• 3:19Speaker 01

  Oh my god, I'm honored.

• 3:19Speaker 00

  You are the second person to come back. And if I'm totally honest, the first time you came on

• 3:24Speaker 01

  Yeah.

• 3:24Speaker 00

  was so mind-blowing and so wonderful. And you were one of the early guests on the show. And it kind of, for some reason, it put this sort of footprint out there. And so people went, oh, I really like this podcast, I really like this show. So I owe you a lot.

• 3:39Speaker 01

  Oh my gosh, thank you.

• 3:40Speaker 00

  For allowing people to really enjoy what this show is about.

• 3:43Speaker 01

  Well, I loved our first podcast. I was actually, I don't think I told you this, but I was in quite a bad mood that day.

• 3:49Speaker 00

  Were you?

• 3:49Speaker 01

  Yeah, I was, I think I'd done quite a few podcasts for my last book and I was just like, oh gosh, I've got to do one more podcast. And your old studio was in Bauxall, which is quite far.

• 3:58Speaker 00

  Yes.

• 3:59Speaker 01

  And I just remember being like, come on, pack up, you know, just, you can, and, and I had the best time. To this day, I tell everyone that whenever they're like, oh, you know, I've been invited to this podcast, great company, let's do it. It's one of my favorite podcasts to record.

• 4:14Speaker 00

  That is so great.

• 4:15Speaker 01

  Honestly, I, I loved it. I had so much fun that day. I came out bouncing.

• 4:19Speaker 00

  Did you really?

• 4:19Speaker 01

  Yeah, but when I arrived, I was like, come on, deep breath, you can do this.

• 4:23Speaker 00

  That's you in a bad mood?

• 4:25Speaker 01

  Yeah, that's me on a bad day.

• 4:27Speaker 00

  That was wonderful.

• 4:30Speaker 01

  So thank you, because I really enjoyed it. And I'm so glad it helped because, yeah, I think I remember it was just launching, so.

• 4:36Speaker 00

  It was just launching and it was just incredible and it did amazing things. And so much has changed since then, I'm now a dad.

• 4:41Speaker 01

  Yeah, I know, I know.

• 4:42Speaker 00

  That's a lot.

• 4:43Speaker 01

  It's a big step.

• 4:44Speaker 00

  It's a huge step because you have how many kids?

• 4:48Speaker 01

  Two.

• 4:48Speaker 00

  You've got two babies. And yeah, it changes your mind completely.

• 4:53Speaker 01

  Yes, well, it actually does as well for mothers, it actually rewires your brain, but with each child. But also it changes your entire perspective on life, doesn't it? We were just talking about this earlier. It pivots all the priorities. Well, it did for me. And I think it's, it's interesting because when you talk to someone who becomes a parent, you start to see, there's so much more common ground now where you're like, oh my gosh, this and this. And as much as you can talk about the changes beforehand, but until you live it, it's just, you can't, your head, just, your brain just can't do it, that you can't actually imagine what it's going to feel like.

• 5:30Speaker 00

  That was my biggest shock is that it's exactly that, where you try and discuss it. Someone tries to say, by the way, get, get sleep now because you don't know what it's going to be like.

• 5:39Speaker 01

  Terrible advice.

• 5:40Speaker 00

  Just terrible advice.

• 5:40Speaker 01

  You can't bank sleep.

• 5:41Speaker 00

  No. And you also, you can't comprehend what it's going to be like and how it's going to change your life.

• 5:46Speaker 01

  Yeah, and, and I think a big thing, and certainly my husband said this to me a few times, is that when you speak to other parents, you feel like it's not just you.

• 5:55Speaker 00

  Yeah.

• 5:55Speaker 01

  It's not just you that's struggling with X, Y, Z or, you know, as your kids get older, it's not just you that's noticed that your four-year-old has become really defiant. It actually, you start to see that there's lots of patterns and there's lots of common ground. And that makes you feel like, okay, actually, it's not just me as a parent. So there's, there's, that's a really important part.

• 6:15Speaker 00

  But it's hard.

• 6:16Speaker 01

  Oh, yeah, yeah, it's like a, you know, technically the most intense job in the world. It's 24/7, you don't get a break. And you, it's a big responsibility, depending on how, how you parent. Because I know there's different attitudes to parenting and different viewpoints. But certainly, I think where I stand and my idea of parenting is that you're raising the, the next generation. And so I want my kids to be good citizens. I want them to be a good contribution to humankind. And I want them to have a really good life. I, you know, part, part of our job as parents is to help set them up to be able to navigate life and not only have fun and have a great time and lovely holidays, but also be prepared to, to challenge,

• 7:00Speaker 01

  to take on challenges, know how to respond and hopefully be quite resilient. I think that, that is, that's the hardest bit, isn't it? Because you can't protect your kids from everything. So what you try to do is give them the tools to know what to do when they are having difficulties. Because life's going to hit you around the head at some point anyway. I do think that when, when I hear people say, you know, he needs to toughen up a bit, and it is usually about boys, he needs to toughen up a bit, I'm like, life will do that.

• 7:28Speaker 00

  Life is tough.

• 7:29Speaker 01

  Life will toughen people up.

• 7:30Speaker 00

  A hundred percent.

• 7:31Speaker 01

  Like, make them feel safe, that's the main thing.

• 7:32Speaker 00

  Is that the main thing to do?

• 7:34Speaker 01

  Oh, I say, I'm not a like child psychology expert, but certainly what I think as a parent and what I've read is that it's like, like helping children feel like they have a safe place within the family. And it might be your parents, it might be your adoptive parents, it might be your aunties, grandmas. It's different for each family, for each child. But having a very firm, fixed, safe person is so important for psychological safety. There is a study of what's called adverse childhood events, so ACEs. And when you look at predictors of health, ACEs are one of the biggest predictors for health outcomes. And there's a scale, basically.

• 8:15Speaker 01

  So the more ACEs, the more adverse childhood experiences or events you have in your life, the higher the likelihood of certain outcomes are. For example, suicide, for example, high blood pressure. So actually, it's, it's fascinating when you start to look at this.

• 8:30Speaker 00

  Wow.

• 8:30Speaker 01

  Just how much impact childhood events have. And this is things like your parents divorcing when you're young. It's things like surviving war. So there's some pretty serious ones, abuse, neglect. But when you start, you know, add them up, if your parent was an addict, for example, while you were a child. So some of the children do have a lot of these exposures. And I think as a society, our job is to try and protect the most vulnerable children who are at risk of having several ACEs. And then as a parent is understanding that childhood exposures are really important. And how do we create the best possible environment to help our kids flourish and have a good life

• 9:11Speaker 01

  and enjoy their sort of, enjoy their life as much as possible despite the challenges.

• 9:17Speaker 00

  It makes you, it makes me feel, it makes you feel sorry for people. Firstly, it makes us realise that, that, which we all slightly know is that childhood kind of is the roots for everything within our lives, right? That's what makes our flower blossom to what it, what it is. And it makes us feel so sorry, or makes me feel sorry for people. You know, you think of the amount of people who are probably incarcerated, right? Who have been put in prison, who may have made mistakes, done things. And yes, there is, there, I'm generalizing here, right? But you kind of go, God, what, what happened in their lives?

• 9:45Speaker 01

  Well, you've touched on something here because I think what's really, what I'm really passionate about at the moment in sort of wellness and health culture.

• 9:52Speaker 00

  Yeah.

• 9:53Speaker 01

  Is that we talk about wellness and health and life outcomes as though it's an even playing field.

• 9:59Speaker 00

  It's not.

• 9:59Speaker 01

  But it's just not.

• 10:00Speaker 00

  Totally not.

• 10:01Speaker 01

  So what I, and, and actually, interestingly, GLP-1s have shown us this. But there's still this tension in wellness culture where I saw recently, I saw an influencer, just yesterday, actually, someone sent me a video saying, of an influencer saying, why would you take a medicine that's made synthetically to lose weight when you could just have the natural alternative? And this, this influencer is extremely slim. She's extremely wealthy and no shade on what she's doing. But that kind of story where it's like, actually, if you just tried harder and if you just like, you know, bought this supplement and it would be fine. When we have to understand, it's not sexy, but where you have to understand that socio-demographic factors underpin the rest of your, the rest of everything else.

• 10:44Speaker 01

  So if you are someone, we're lucky, we were educated, we were born into families that could afford to take us on holiday and do things. We both have homes, like, we have to appreciate that we're lucky and own that. So when people say, oh, you know, but. Do you think that these medications are bad? Or do you think that we should all just exercise and eat less? It's like, no, we live in an obesogenic environment right now, where sixty percent of adults are either overweight or obese. What does that tell you? It tells you that the environment is stacked against health, right? It's actually currently, we're swimming upstream. We're all these little fish swimming upstream. So if you're one of the lucky ones, like us, that aren't suffering with a chronic condition and are not overweight,

• 11:30Speaker 01

  that's quite a lot down to luck, right? Partly genetic and epigenetic luck, because perhaps our parents and our grandparents didn't suffer with obesity, and down to the fact that we have access to make it easier for us not to be overweight. So we have to accept that it's not the same for everyone. And it's the same with, I mean, aces especially. Children have no control over the exposures that they are generally exposed to. So we do have to take these things into consideration and hope, and help to build a way of looking after people and looking out for people that actually says, okay, here's your deck of cards. What, what can we do? There's lots of evidence around what works, what doesn't work.

• 12:13Speaker 01

  What can we do to help you play that deck as well as possible? You can't really change the deck of cards. It's really hard to do. But what can, how can we help you, give you the tools to change how you play it? So that perhaps you don't end up spending the rest of your life in prison, or perhaps you learn ways to make the most of the skills you do have, and then flourish that way. So there's, it's just, but you have to be compassionate and you have to think about where you sit in, in that scale and be comfortable with the fact that perhaps you are a lucky one, actually.

• 12:49Speaker 00

  You have your new book, The Appetite Reset, How to Eat, Drink and Thrive Before Drawing in After GLP-1s. So everyone, it feels like, is talking about this sort of what we call the skinny jabs.

• 13:02Speaker 01

  Yeah.

• 13:02Speaker 00

  Ozempic jabs, Manjaro is another one. Is it a miracle drug? Or is it a danger?

• 13:10Speaker 01

  They are a medical breakthrough. So like, the idea that we can now harness peptides and completely change metabolic health is wild. It's something we've been waiting for, for decades. Because the diabetes pandemic, so diabetes, type 2 diabetes and obesity have been rising steadily for decades. And in terms of public health, it's, you know, it's been watching a car crash. Like, how do we slow this down? What do we do?

• 13:35Speaker 00

  That's because of different, that's because of the foods we're creating, right?

• 13:37Speaker 01

  It's, it's, as I said, it's a whole, it's an entire obesogenic environment. So it is the food. It is how we live, how we work. We're very sedentary. There's much less manual labour. It's also how much time we spend outside. It's a lot of factors. Food is definitely a massive one, don't get me wrong. But I think we have to realise that there's, there's other pieces to the puzzle. There's undercurrent disrupting chemicals in the environment. There's lots of other things that all converge towards obesogenic environment, right? So having a medicine that can actually help, because the problem is, is that when we talk about obesity, we talk about excess adiposity. So it's not how much you weigh.

• 14:19Speaker 01

  It's actually how much of your weight is fat tissue compared to lean mass.

• 14:25Speaker 00

  Okay.

• 14:25Speaker 01

  If you have, and so you can be quite lean looking. You can be quite, quite sort of small stature. But you can still have this real mismatch between lean mass and fat mass. And when we have increased adiposity, increased fat mass, that's when you start to see the metabolic health consequences of obesity. And type 2 diabetes actually goes hand in hand. So type 2 diabetes risk increases with obesity. And type 2 diabetes is like, has lots of consequences downstream. So living with either type 2 diabetes or obesity impacts your lifespan and it impacts the diseases that you're likely to develop. This is why we want to tackle it, right? We don't, we want to help people reverse that risk or at least reduce that risk. And here's a medicine that can do it.

• 15:09Speaker 01

  However, it's a powerful metabolic medicine. And it was actually initially licensed just for type 2 diabetes. And for many years, it was only prescribed for type 2 diabetes. But then people noticed that it helped people lose weight. It's like, oh, my diabetic patients are also losing weight without really trying.

• 15:29Speaker 01

  And so here then we have, so for, for a medicine that was prescribed for, you know, GLP-1 receptor agonists were prescribed for fifteen years or so, without making any much noise at all. But as soon as the prescription moved to obesity and weight loss, it just took off. And a combination of celebrity endorsement, press, and not so much in the UK, although you started seeing it here. Just on my way here to the studio today, I saw a massive bus advert that had, because you know, you're not allowed to, you're not allowed to advertise pharmaceutical products in the UK. So you've been to the US. You know, you switch a TV on in your hotel room and it's like these really long adverts all about drugs. Now, in the UK and EU, actually, they're not legal.

• 16:13Speaker 01

  But I've noticed for the first time, on a bus on the way here, there was a big bus poster and it was a tiny pill held between two fingers. Didn't say the name of the drug. It didn't say like weight loss. And then it just said, I won't say who it was, but it would say who the company was that can provide it.

• 16:28Speaker 00

  What? Is that legal?

• 16:30Speaker 01

  Very borderline, right? So the, I don't know if you saw the Eli Lilly adverts that were on the tube. There's been a lot of complaints to the ASA about these adverts because it's, it feels like it is advertising drugs. Point being is when you have a combination of celebrity endorsements from the likes of Oprah Winfrey, Serena Williams, right? To advertising in the US, then social media phenomenon. And then suddenly, the, the demand for this drug far outweighed the actual clinical prescription for it. So people who absolutely don't need this drug, they don't have type 2 diabetes, they are not living with obesity, are trying to access the drug. And what happened here in the UK is that the NHS is really strict with which medicines it buys for the population,

• 17:16Speaker 01

  in part for cost saving, so like it has to be cost effective, and in part because it has to be safe. You can't start giving out a medicine on the NHS and then find out that it's damaging people's health. So getting a prescription for GLP-1 receptor agonist on the NHS is actually quite hard work. There's quite a serious clinical pathway. You have to be assessed. It has to be the right, the right population. The cutoffs for BMI are really quite high. So there's, it's not easy to get a GLP-1 receptor agonist prescription on the NHS. So what's happened instead is people are just buying it privately. So ninety-five percent of UK adults that are currently using these drugs are buying them privately. They're not going through the NHS. What does that mean?

• 18:00Speaker 01

  It means that most of the time, and listen, different providers are better or worse at doing this, of this assessment and screening. But mostly, the problem is, is that patients aren't assessed properly. You know, these medicines impact your brain. They're brain drugs. That's where most of the work happens. They impact your gut. They impact your pancreas. So having some sort of screening ahead of time is really useful to make sure that you're the correct patient to receive this drug. So screening is very poor with a lot of these providers because you fill in an online form and you can lie. So there's lots of stories of people who are very slim, doctoring images to upload it to show that they're overweight or just downloading an image of Google, frankly.

• 18:45Speaker 01

  So assessment, then prescription is, is made and then follow up and screening. So there's no continuation of like, how's your side effects? What's going on with your weight? Like what is happening with your mood, your energy, your constipation? Like, so the most common side effects are non-life threatening. They're gastrointestinal.

• 19:05Speaker 00

  Okay, so that is.

• 19:06Speaker 01

  That's reflux, vomiting, nausea, constipation, right? All of them can be quite well managed with dietary intervention.

• 19:14Speaker 00

  Sure.

• 19:15Speaker 01

  But if you don't tell people that and you don't help them understand what to do, then a lot of them are turning to buying medicines. So over the counter antacids, for example, have shot through the roof.

• 19:27Speaker 00

  Because people are taking the drug and then going, well, I'm constipated or my stomach hurts or whatever it is. And so then they need to take that.

• 19:32Speaker 01

  And then they're taking the antacid on top, right? So this journey, I've worked with a lot of people who went through that journey, had a terrible time. And these are patients who actually need the prescription. So they ended up going private, but they did have obesity, or they did have type two diabetes. And, and actually, type two diabetes, I have to say, access is easier. It's mostly obesity. So they come to me and they've done, they've just spent hundreds and hundreds and hundreds of pounds for six months on these drugs. Nothing, it didn't work, or the side effects were terrible. And so they then came off the drugs. And then desperate, last minute, last resort, they come to me. And they're like, I've tried everything. I even tried the drugs, they didn't work for me. Please help me. And the psychological

• 20:17Speaker 01

  damage I've seen in these patients, where they feel like they failed because the miracle drug didn't work for them. And then I explained to them that actually, non responders is about 20%, one in five people. And it's not because you failed.

• 20:31Speaker 00

  It doesn't work.

• 20:31Speaker 01

  Well, just for weight, just in one in five people, you don't see a clinically significant weight loss. So more than 5% of your body weight in about 20% of people. But here's the thing, these drugs are not just weight loss drugs. So like, these drugs are designed to help your metabolic health. Primarily, it was type two diabetes, so glucose, glucose control. It, it tells your pancreas to release insulin when you eat carbohydrates. So it pumps more insulin into your blood. But also, it's, it seems to have an anti-inflammatory effect. So people who have rheumatoid arthritis are reporting that their rheumatoid arthritis is better.

• 21:03Speaker 00

  Wow.

• 21:04Speaker 01

  Now, this does go hand in hand with weight loss.

• 21:06Speaker 00

  Wow.

• 21:06Speaker 01

  But, but just because the medicines haven't resulted in clinically significant weight loss, doesn't mean they haven't had a benefit on your overall metabolic health. This is obviously given that you're actually a patient that needs them. So I think the way we framed these, like the skinny jab, it's like, actually, it's not just about weight loss. Weight loss is almost not the most interesting part of this drug. And we have to be mindful that the way that the drug is evolving right now, like the access to it, the, the sort of desire to try it out, patient populations that shouldn't access this are accessing it. It also makes it harder for people who actually do need it to navigate how to be successful on it and what to look out

• 21:47Speaker 01

  for. So there's so much. So the reason I wrote this book is because there's so much confusion about how to take them. There's literally no conversation about how to prepare for them. So the way I think about this, I did a BBC panorama documentary for this like two and a half years ago, is these drugs are delivering the same level of weight loss, and so change in body composition as bariatric surgery. That's huge, right? But can you go to your local wherever and just access bariatric surgery? No. So there's like enormous amounts of screening and preparation. Now, of course, bariatric surgery is major abdominal surgery, but the physiological outcome on the other side after the surgery, in terms of weight loss, body composition has changed,

• 22:32Speaker 01

  like even the, some of the gastric symptoms, quite similar, but you have none of the follow up, you have none of the nutritional screening. So with bariatric surgery afterwards, you're closely monitored for micronutrient deficiencies because you're at higher risk. Why? Because you eat less food.

• 22:46Speaker 00

  And then what, what's the side effect to that?

• 22:48Speaker 01

  Well, if you have micronutrient deficiencies, then you run into risk of losing, being ill for other reasons. So for example, if you suddenly have a huge B12 deficiency, then you'll be exhausted, you'll start to feel like your, your hair might start falling out. There's other issues. If your iron levels are really low, and you're a woman especially, so and you're still menstruating, you could run the risk of anemia. So micronutrients are an important part of the picture, but because of the way we've set these drugs up, right, we don't follow people up. So if you think about bariatric surgery as the closest medical comparison, and, and the difference in care that you get.

• 23:24Speaker 00

  Can you explain what peptides are?

• 23:25Speaker 01

  So peptides are teeny little proteins. And we have hundreds of them in our body. So they're teeny little proteins that act as messengers between tissues.

• 23:34Speaker 00

  Okay.

• 23:34Speaker 01

  So GLP-1 is a peptide. So peptides are often hormones. So kind of, they're just signaling molecules that happen between tissues. You have myokines from your muscles, you have, you know, adipokines from your fat cells. There's lots of different peptides. So what's happened is because GLP-1, which is a very specific peptide, which has got over 20 years of clinical use and like has, was discovered in the seventies. So it's pretty, pretty, we've known it for a while. That's obviously now become a super popular pharmaceutical product, and it's used widely. And we have a lot of data on safety, efficacy, population data, who's, who it's good for, et cetera.

• 24:13Speaker 00

  And that is used for?

• 24:15Speaker 01

  GLP-1 is now the prescriptions, so like the licensing is used for type two diabetes control. And that's what semaglutide is licensed for. So Wegovy, for example. And then you have tisepotide, which is a dual agonist, so two peptides in one drug, and that's used for obesity. So you use that to treat obesity. And then there's future ones, retatutrid, Reta, known on Instagram, everyone's going mad. It's a triple agonist. So there's three peptides. And it is not yet approved by the FDA, but people are accessing it on the black market. Why? Because what's happened alongside the GLP-1 rise is that peptides, everyone's like, well, that peptide works, all these peptides will work. So there are, as I said, hundreds of peptides. We typically used to

• 24:59Speaker 01

  think of hormones as just coming from endocrine organs, right? So like, we'd say thyroid hormones from your testes, from your ovaries. But what now, so there's about, about 60 hormones that come from like these typical places. And endocrinology was based on those. It was like, these are the hormones, it's how they work. Since then, so like in the past sort of 30 years, we've seen that there are peptides released from your muscles, peptides released from your bones, peptides released from your fat cells. So we have way more signaling molecules than we thought, hundreds. We, at the moment, it's hard to know how many, like endocrine, how many hormones, how many peptides that are signaling molecules, we don't know about. But we do know that there are

• 25:41Speaker 01

  hundreds of receptors that we have in our body that, and we don't know what they're receiving. So instead of trying to find like what hormones are missing from our list, it's like, well, what are these receptors doing? What's going on here? And when you look at all the proteins that are expressed in humans, you know, when you talk about, when we talk about DNA, sometimes you have this like junk DNA, we're not sure what it's doing, DNA codes for proteins, right? And when we, proteomics, which is a study of proteins, essentially, it's, we know that there's about, there's lots of proteins that we're not sure what they're coding for. So this field of peptides and signaling molecules is just blown up. This is the beginning, right? So when you look at all

• 26:23Speaker 01

  the clinical trials that are happening right now in like phase two and three, so, so nearly done, right? There's dozens of new drugs of different peptide combinations that are going to come to market in the next 10 years, dozens. So you can just imagine, so when you look at this, one of the reasons I wrote this book, it's like, okay, we are literally at the precipice of an entire change to how we treat metabolic health. And so the peptides that you see, the peptide stacks, the Wolverine stack, simply, these are individual peptides that for, for now are only licensed for in lab experiments or clinical trials. They are not licensed for use by the general population or for prescription by a medical professional. So you're not supposed

• 27:07Speaker 01

  to be using them. You know, they're really for, for rats in labs. I'm not joking. So what's happening?

• 27:14Speaker 00

  But people are.

• 27:15Speaker 01

  But people are. So what's happening now is this really strange situation where the clinical trials are here. And, and now they have started some clinical trials, using, looking at these peptide, BCP 157 is one of the most popular ones, right? There's, there's no human studies on safety or efficacy of BCP 157, but thousands of people use it, maybe more. Like honestly, I don't know what the numbers are. Now, here's the problem. Clinical trials and pharmaceuticals haven't really kept up.

• 27:38Speaker 00

  Yeah.

• 27:39Speaker 01

  With the adoption in the general, in the mass population. In America, you can go to peptide clinics. And I'm not sure how that works, like in terms of law legally, but they figured it out. In the UK, you start to see peptide clinics. I have patients in the UK who take peptides, right? So it's happening. And the biggest missing opportunity, we have this, like, what we could do is say, look, we know you're taking these.

• 28:02Speaker 00

  Yeah.

• 28:03Speaker 01

  We know you're prescribing these. Let's collect the data. Because we just aren't keeping up with the adoption of these peptides. So I can stand here and be like, don't take them. We don't know about the safety. We don't know what they do. Like, one of the.

• 28:16Speaker 00

  And we don't know what they do.

• 28:17Speaker 01

  Well, we, we have, like, we know from mouse data or from tissue data, like this peptide is involved in this process.

• 28:23Speaker 00

  Correct.

• 28:24Speaker 01

  But what we know about all hormones is that there is no single hormone that only impacts one system. So even though you think BCP 157 might be helping with your joint pain.

• 28:34Speaker 00

  Yeah, it's also going to be.

• 28:35Speaker 01

  It's also going to be something, doing something in your brain, doing something over in your lung, probably, pancreas. So we just don't know, right? And so like, why don't we all come together and say, let's just collect the data? Because we have enough, there's a huge population study you could be doing right now.

• 28:50Speaker 00

  Yeah.

• 28:50Speaker 01

  Just collecting data from people to say, okay, well, what is, what are your side effects? How often are you taking it? When are you taking it? But the biggest problem here, Jamie, is that.

• 29:00Speaker 01

  Because these preparations are not for humans, they're not medicines, they're not regulated. So why do we care about FDA approval? Why do we care about EMA approval, HMI, all these companies? Because when they approve a product for a pharmaceutical company to sell to you, it has to be produced exactly the same way with strict safety standards. And every single, every single time you buy a paracetamol that says 500mg, it actually has 500mg of paracetamol in it.

• 29:27Speaker 00

  Yes, correct.

• 29:28Speaker 01

  Whereas these peptides right now, you don't know. Like, so there's been some tests, people have gone out and bought a bunch and tested them. Some of them had none of the peptide that it advertised. Some of them had like three times the dose. Some of them had very odd other compounds in it that aren't good for you. So it's like playing.

• 29:45Speaker 00

  It's basically like, it's basically like cocaine on the market.

• 29:50Speaker 01

  I mean, uh, yeah, I can see how you got there. But it's not, it's just like, you, you wouldn't.

• 29:56Speaker 00

  You don't know what you're playing with, you don't know what you're taking.

• 29:59Speaker 01

  You don't know what you're taking. And there are people that are like this, the cleanest, the safest. But imagine doing that. And then if, instead of just playing around with one of them, imagine stacking them and doing three or four or five, which is what's happening with these wolfery stacks and other things. You have five untested, untracked, unregulated peptides that you're taking. If something goes wrong, we don't know which one it was that went wrong.

• 30:23Speaker 00

  You can't tell.

• 30:24Speaker 01

  Cause you don't, there's five of them. So my, I'm very cautious about people trying these out. I've worked with people that have. And to be fair, like luckily they're okay. But it's not a good idea. And, and also it's this classic thing where you're trying to, you're trying to inject yourself with a stack of peptides. For what? Normally it's for something that you could do and improve on with lifestyle.

• 30:47Speaker 00

  Wow.

• 30:47Speaker 01

  It's, it's like, people love a silver bullet. And so if this peptide is going to help me to recover faster from my workouts and it's going to help me to, you know, get leaner. So it's, a lot of it is aesthetics. It's like, will it help me lose weight? Will it help me get leaner? It's never like, oh, this peptide is supposed to be really good for your heart health. It's never that. It's usually aesthetics. And they want to do it to like push that boundary as fast as possible. So it just, it just harks back to the, the issue we have in general. And it's, it's happening with GLP-1s as well. GLP-1s are regulated pharmaceuticals. They're a prescription drug, but people are taking it recreationally. And, and, and honesty, like it's, it's wild to me how this has been allowed to happen.

• 31:30Speaker 01

  Because the regulatory bodies are clear that it has to be prescribed for certain patient populations. But somehow people can just go on TikTok, click a link, fill in a form, never see a doctor face to face and receive a metabolic medicine in the post. You could never do that with thyroid medication or with blood pressure regulation medication. You just, you just can't. You have to see a doctor and have, be like examined. So I don't know how that's happened, but it's opened a whole Pandora's box.

• 32:04Speaker 05

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• 32:36Speaker 00

  Let's talk about some of these side effects. It can make you tired, it can make you all these different things. What does it do to the mind? How does it change your mind?

• 32:42Speaker 01

  Yeah, nice. So GLP-1 receptors are found in the brain. And one of the ways in which these drugs actually change eating behavior is by affecting the brain, the hypothalamus, which is your central control for things like reward, pleasure and drive. So there's agonists, there's receptor agonists on the brain. And when you take this drug, and actually what's really interesting is how many of those is genetic. So some people find the brain effects really strong. And some people are like, it hasn't changed anything for me. And some, one of the pieces of work that's happening now is to try and be able to map who is going to be a better responder to which agonist based on genetics, which is cool.

• 33:26Speaker 01

  So the future, I think, looks like personalizing these drugs so that you get prescribed the one you're most likely to respond to, right? So it affects your brain. What does it do? There's a neuron called POMC. And it basically helps to switch this on and off. If you take GLP-1 receptor drugs, agonist drugs, it dampens down your drive to, to eat. So the lack of appetite, the lack of food searching comes from the brain.

• 33:54Speaker 00

  Okay.

• 33:54Speaker 01

  That's what's really driving it. So your body, actually, most of your peptides that are involved in appetite regulation are there to help you feel satiated. So we have lots of lovely peptides like GIP and PYY that the drugs don't mimic yet. GIP, yes, that's what Monjaro is, GIP and GLP-1. But PYY, they haven't managed to put into a drug yet, but it's a very interesting one because it mostly acts on the brain. These are all involved in helping you feel satiated. So our body is actually wired to help us feel full if we feed it the right things. And we'll get to that later. There's other hormones involved like leptin, which comes from your fat tissue, that it's also involved in helping you feel full. Grelin is the one that helps, that makes you feel hungry.

• 34:38Speaker 01

  And what happens is when you take these drugs, grelin is shouting because you're not eating that much. So, but thanks to the activation in the hypothalamus, can't hear, your brain can't hear the grelin anymore. So it's just gone to the volume, right? So that's what actually changes people's drive to eat or hunger, as you'd call it. Like that's how we, what we would say, it just turns your hunger down. It also turns down your desire for alcohol and gambling and smoking.

• 35:06Speaker 00

  No.

• 35:07Speaker 01

  Yeah.

• 35:07Speaker 00

  It turns down your addiction side of it.

• 35:09Speaker 01

  Yeah, because it's a similar parface, hypothalamus. So actually the, the trials that are happening now, and this is trials only, it's not.

• 35:15Speaker 00

  That is mad.

• 35:16Speaker 01

  It's not in patients yet, this is trials. But the trials that are happening in addiction show that GLP-1 receptor agonists may be one of the drugs that we could help people to reduce their addiction behaviors with. Now, of course, addiction is super complicated and there's lots of other factors. But how amazing to have a drug that literally just turns that down. So it has those effects. It is, I think, I think that, again, it would have to be a different formulation because there's other considerations with physiology with addiction. For example, you certainly wouldn't want heroin addicts to lose a lot of weight because typically they're underweight. So, but it's about the dose. So I think in the future, there'll be different dosages with different combinations that may help with addiction medicine breakthrough. We haven't had anything very successful for a while.

• 36:01Speaker 01

  So that's interesting. It does also change drive for other things. So depending on which paper you look at, some papers report that people have more sexual desire when they take these medicines, whereas others find that their sexual desire is dampened and it affects their relationships with their spouses, with their partners. Now, what's interesting there is that if you're a man and you're, you are overweight, you have excess adipose tissue, excess fat, it changes your testosterone levels because there's an enzyme produced by fat tissue called aromatase, which literally flips testosterone into estrogen. If you lose a bunch of weight, a bunch of fat specifically, the aromatase goes down and your testosterone levels stay up. And so suddenly men have more sexual drive.

• 36:45Speaker 01

  So it's, for me, there's a 50/50 split between the patients who seem to have increased sexual desire and those that don't, that actually have decreased and they consider coming off the medication because of the effect it has on their relationships. And for me, and I don't know if this is true, but this is a hypothesis. It shows you which patients have more of these receptors on their brain. So I think the ones who lose sexual desire have more, are more responsive in their brain. So the reward pathway is so dampened that they start to feel the effects. There's also reports of, yeah, it changes, it changes people's mood. So.

• 37:19Speaker 00

  What does it do to the mood?

• 37:20Speaker 01

  Well, I've worked with people who've had to stop taking it because they felt depressed on the medication. So, you know, there's so much, there's, it's a brain, it's a brain drug. And I think that's often missed in the conversation. So for people who are thinking about buying these medicines to take them recreationally or to take them because their mates are, or because they want to lose some weight before a holiday or a wedding, like just, I would urge everyone to think twice because these, they're not supposed to be used by you, first of all. Second of all, they have an impact on your brain. So it's not, you're not just losing weight. They also impact your pancreas. So this stimulation of the pancreas to release more insulin. Actually, if your blood glucose levels are fairly stable and you don't have metabolic, any metabolic issues, we don't necessarily want to be doing that.

• 38:05Speaker 01

  And then of course, there's the gut, the gut effects, right? So the way GLP-1 changes your gut is that it slows down that lovely peristalsis. You know, the gut motility that keeps your food moving and your, everything moving through. It slows it down quite a lot. In, in very rare cases, it can completely paralyze it, gastroparesis, which is a very serious side effect and it's not very common. But that's how powerful it is. So what happens is when you eat, your food sits in your stomach for way longer than usual. So you'll get full very quickly because actually stomachs aren't that big. And if they're not emptying, then it's just going to sit there. So it sits there. So you've got the fullness in the brain and then you've got that uncomfortable, like my food is right here feeling.

• 38:50Speaker 01

  You stop eating and you really should stop eating. So never eat past the point of fullness if you're taking these drugs. And that slowing down of the entire movement also of course changes how your gut environment is. Because typically a healthy gut has a transit time of about 20 hours.

• 39:07Speaker 01

  So you don't want your food to be in your gut for too long. There's variabilities between people. So if you're really, really tall, your gut's probably a bit longer. And so, and actually gut length varies quite a lot. But, but generally speaking, you want things to keep moving. With these drugs, it slows right down. Constipation risk is much higher. And one of the main things that I'm super passionate about is if these drugs are being prescribed for patients who already have some metabolic dysfunction, right? That's the point. Oftentimes, they already have, not always, but they do already have like not great gut health. They tend to already suffer with some constipation or IBS or potentially reflux. And if you give them this medication without preparing their gut at all, so without doing anything to try and improve that, it's only going to make it worse.

• 39:51Speaker 01

  So that preparation before the drug, taking the drug, is so important for trying to make the whole journey a bit smoother for everybody and not make it such a hard ride. So the constipation can be really painful and uncomfortable. And then the nausea is often associated with like the day that you increase your dose or your first day. And that's, it's just to do with the, with the gastric emptying being so slow in your stomach, your acid builds up. And so you have more increased risk of vomiting and nausea. So it's not, um, I think one of the other myths that I see is online, it's like, this is the easy way out. You're such, you're such a cheater for taking these drugs. You could have just worked harder.

• 40:31Speaker 00

  Yeah, yeah.

• 40:32Speaker 01

  Yeah, I don't think so. These, they're not an easy ride, these drugs. Um, and there's, listen, patients who take them and see the results. Uh, there's one journalist who I adore and she's written about her success story about, on these drugs. And she'll say, oh, I would do it again all day because it's just transformed her life. And this is where the importance of the risk benefit. So if you are someone who has metabolic dysfunction and has struggled with obesity all of your life, obviously.

• 41:02Speaker 00

  This is a good thing, yes.

• 41:04Speaker 01

  Outweighs it. So you, so it's funny, people are online, they're like, it's changed my life. I would do it all again. I love it. I'm like, great, you're the right patient. But if you're not someone who actually has, stands to have this really great benefit risk, uh, like Gray showed. Then think about it. It's not an easy thing. It's not an easy ride. It's not.

• 41:21Speaker 00

  I don't, there's a, firstly, you're, you're so right. And now what's happening, I think, a little bit, which is where if, if someone looks skinny, they're automatically being said that, oh, they must be on these skinny jabs. So Sophie, my wife, who she had a baby and then she worked hard, lost the weight and.

• 41:37Speaker 01

  She's naturally slim as well.

• 41:38Speaker 00

  Yeah, and she was criticised in a way for, yeah, for being on one of these skinny drugs, right? Which is kind of sort of upsetting in a way, I suppose.

• 41:49Speaker 01

  But you know that, that actually there's adverts targeting post, like I'm very angry about this. But there are adverts that target postnatal women with these drugs. And let's be super clear. The postnatal period is not one to start messing around with, with reducing your dietary intake, especially if you're breastfeeding, right? Your nutrient requirements are really important and they're high. Like postnatally, recovery requires a lot of nutrients. So what we haven't spoken about is like what happens with these drugs is that there's all these cool effects on your brain and pancreas and gut, but the result is that you eat up to forty percent less than without these drugs.

• 42:32Speaker 00

  And that's a shock on your body.

• 42:33Speaker 01

  That's a lot. That's a lot of, that's a lot less energy every day. And it's not just about the energy. All the nutrients that come with that food are also reduced, right? So the, the, the risk with these drugs is that you, if you're not guided through and the importance of nutrition isn't highlighted and you don't have a bit of a plan of what to do if you need to come off them and you don't know what things to look out for and how to manage your symptoms, all these things. You're running the risk of medical malnutrition because you're literally halving, nearly halving your food intake. And oftentimes, you know, if you haven't already established the kinds of foods that are important to keep. It's not, not always, actually. I, I've seen people's food preferences change on these drugs.

• 43:17Speaker 01

  So that's a good thing. But the data tells us that generally speaking, it changes the amount of food you eat, but not the quality. So if you don't have a good nutrient dense diet before you start these drugs, the risks are higher. So this is another thing. It's like you actually, taking these drugs means that you really have to double down on your nutrition. You have to work harder to make sure you're getting the right foods than you did before. You have to be consistent with your exercise. If you don't resistance train, then your lean mass has got, is it going to suffer?

• 43:46Speaker 00

  Well, because you lose the muscle.

• 43:48Speaker 01

  And, and bone, yeah.

• 43:49Speaker 00

  You lose muscle and bone?

• 43:50Speaker 01

  Yeah, but, and this is not unique to drugs, to the drugs. So if you went on any massively restrictive diet, if you went on a cabbage soup diet.

• 43:58Speaker 00

  Yeah.

• 43:59Speaker 01

  Which is ridiculous, but it was so popular, wasn't it for a while? Um, if you did that, you would lose a ton of weight. And you would also lose muscle and bone because your body runs out of nutrients it needs. Now, we don't have a reservoir for protein. So protein is essential for all your enzymes, essential for all DNA transcription, essential for your immune system. So if you don't get enough protein in your diet, your body will get it from your muscles. It'll just break it down. And so this is not, but this is, it's a true finding. So in some, depending on which study you look at, between twenty and forty percent of weight lost is lean mass. But this is true of any restrictive diet weight loss. So it's not unique to GLP one.

• 44:41Speaker 01

  I, I, I see Instagram posts where it's like, they melt your bones. No, they don't. It's just any kind of serious dietary restriction. It's not unique to these drugs. But if you undernourish yourself, your muscles and your bones will suffer. And the way to combat that is primarily resistance training. So if you have to give your muscles and your bone that friction, that pressure, that signals the body that you, that it needs to maintain.

• 45:09Speaker 00

  That it's working.

• 45:09Speaker 01

  It's working, that it's needed. So the resistance training does most of the work. And then adequate protein makes sure that there's actually protein to go there and keep the strength.

• 45:22Speaker 00

  What are the long-term effects of taking these drugs?

• 45:24Speaker 01

  This is a great question because also I think now what I'm seeing more and more is like people who have reached their target body composition and they want to come off and they're like, what do I do now? How do I stop taking this?

• 45:36Speaker 00

  Yeah.

• 45:38Speaker 01

  And so that basically what the population data, so the real world data, not the trials. Because the trials we have for these specific formulations, I mentioned earlier that versions of GLP one receptor agonists have been around for a long time. So there's about twenty years of medical practice where they've been used. And they're safe and effective for managing type two diabetes. What we don't know as much about is the long-term use for Manjaro and the, the formulations and the drugs that are used for obesity. So we have about.

• 46:05Speaker 00

  So Manjaro is different.

• 46:07Speaker 01

  Yeah, Manjaro is a dual agonist. So it's GLP one and GIP. And it really, it causes more weight loss than semaglutide, which is the original sort of type two diabetes one, Ozempic, yeah. Ozempic and Wegovy. So we have about five years worth of clinical trial data for those formulations. So that's not really super long term. We don't actually know. What we know from the real world data is that about sixty percent of patients stopped taking it in the first year. For various reasons. Number one reason, do you want to guess?

• 46:40Speaker 00

  Um, don't know.

• 46:42Speaker 01

  Access. So it's expensive.

• 46:44Speaker 00

  They couldn't do, so they couldn't afford it.

• 46:46Speaker 01

  Couldn't afford to keep going.

• 46:47Speaker 00

  Okay, love this.

• 46:47Speaker 01

  Um, the side effects is another reason for people to stop taking it.

• 46:51Speaker 00

  Yeah. Side effects are low mood.

• 46:53Speaker 01

  No, the gastric ones. So the vomiting, the, it's typically, it's reported as the gastric ones, but it's side effects. So it could be low mood. It's, it could be a combination. It's usually more than one. So people stop taking it. And then what happens is if you follow those people up a year later, those who then start putting weight on again or feel their blood glucose is, um, not staying, staying stable, basically not being regulated well, come back on the drug, fifty percent of them go back on. So we have this pattern in people who kind of go on it, then mostly stop, not necessarily because they want to, but they have to. Then they see that they start to regain weight again or that their blood glucose isn't great again and they go back on it. So at the moment, it's quite cyclical, right, for a lot of people.

• 47:33Speaker 01

  But then there are a minority of people who take it and as I said, get to this point where they've pushed past, so plateau, you may have heard that term. All weight loss reaches a plateau at some point because our bodies are so clever. Do you remember we talked a lot about homeostasis last time? Yeah. So at some point, even with this massive calorie restriction, our, our metabolic system adapts to functioning at that lower calorie intake, basically. And so you reach a plateau. So about eighteen months in, for most patients, they stop losing weight. Sometimes it's earlier, sometimes it's like six months. And so they hit this plateau and they're not losing any more weight. And they're like, what? Oh my God, this is so stressful. It's normal. It's a normal physiological response. It's your body trying to keep you alive.

• 48:14Speaker 00

  It's your body saying, we need to.

• 48:15Speaker 01

  In famine.

• 48:15Speaker 00

  Yeah, yeah, okay.

• 48:16Speaker 01

  So, so people, but people push past that, then they sometimes increase dose or change medication at that point. So they might go from Wegovy to Manjaro. Um, and then they get to the body composition that they are trying to get to. And we're talking about people who are losing. You know, twenty, thirty kilograms of of weight. So this is, this is going from obesity to within normal range for, and not just BMI, BMI is a metric, but it's BMI, it's adiposity, it's body comp. So all these things, waist to height ratio, my favorite measure. Um, and they get there and they're like, okay, now you can either stay on a very low effective dose to maintain the weight loss, which is certainly what the manufacturers would like.

• 49:01Speaker 00

  Of course.

• 49:02Speaker 01

  Because it's good business, but and it is genuinely what some people will need. Okay. Or many patients are like, I kind of want to tighten it off and they want to stop taking the drugs and see if they can maintain the weight loss as it is. Let's rewind to the beginning of the conversation where I say, we live in an obesogenic environment. So having to stay on a lowest effective dose to maintain the new body comp may be necessary for some people. And that's not because they're a failure, it's because the environment we live in unfortunately drives weight gain. But for some people, and in my clinical experience, I don't know if there's data for this, but in my clinical experience, people who have lived with obesity all of their lives are typically the ones that may need some maintenance

• 49:43Speaker 01

  dose. Those who have more recent obesity may be able to come off entirely and weight will fluctuate. So it may rise back up a bit and move around as it should, but actually they're able to maintain the body comp, able to maintain a new weight range, which is super exciting. That requires work. The work doesn't finish there.

• 50:03Speaker 00

  Yeah.

• 50:04Speaker 01

  But we don't know what happens to someone who's been taking this drug for twenty years because it just, they haven't been around in this formulation for long enough. What the theory is, is that if you're helping someone to move from the risks that are associated with living with type two diabetes and with obesity, then it's going to be worthwhile. So whatever the side effects or the long term side effects are, then if you, if they're managed correctly, it should help that person live a longer, healthier life.

• 50:34Speaker 01

  Now, that was, that's a good side. What happens when they're mismanaged? So what could possibly go wrong if someone takes this medication and they're not supported properly? The biggest concern is what's called sarcopenic obesity, which basically means that you have more fat mass and very reduced lean mass that puts you at risk of frailty. So this accelerated frailty, sometimes it's called in in the headlines, is the risk of the other side of the story, where if you have somebody who is given these medications and they have rapid weight loss, they don't have supportive nutrition and they don't have supportive resistance exercise, then they stop taking the drug. As like, you know, seventy five

• 51:15Speaker 01

  percent of patients tend to regain weight and about to about seventy five percent of the weight lost. So about you, three quarters of the weight.

• 51:23Speaker 00

  Yeah.

• 51:23Speaker 01

  Some people regain a hundred percent of the weight and a minority regain it above. When you regain that weight, you're not regaining bone and muscle, you're regaining fat. Our body most effectively gains mass as fat, especially when you're exiting a famine. So if your body is in famine mode, which by the way, your body doesn't know if you're taking a medication or you're actually starving. So it, when, when your metabolism kicks back in to regain as much lost energy as possible, it will store this as fat. So the real problem here is that you could actually, and this is a warning for anyone who doesn't

• 51:57Speaker 00

  Wow.

• 51:57Speaker 01

  need to take these medicines. Say you take these medicines because you want to lose a stone.

• 52:02Speaker 00

  Yeah.

• 52:02Speaker 01

  You don't have obesity, you don't have metabolic dysfunction. You take the medicine and you know, I'm just going to lose some weight. I'm not going to resistance train. I'm not going to do the nutrition. I'm just going to do that for the wedding and that. What could happen is that you lose the weight, but you haven't done any of the work to retain the lean mass. And then when you stop the medication, you'll regain the weight, all as fat mass. But you, in the meantime, you may have lost up to forty percent of that weight from your lean mass.

• 52:28Speaker 00

  Wow. So you'll, you'll be, you have no, but you're not getting any more muscle, your bone density has gone down and you're just gaining fat.

• 52:34Speaker 01

  Yes. And so then sarcopenic obesity is where this, this, there's a real disparity between the fat mass and the lean mass. And that's the real danger because

• 52:43Speaker 00

  Why is that a danger? Because?

• 52:45Speaker 01

  Because when you have even more reduced, say, first of all, your muscles are a metabolic organ.

• 52:49Speaker 00

  Yeah.

• 52:50Speaker 01

  So they really help to regulate things like risk of type two diabetes. So if you have reduced lean mass, you're actually increasing your risk of type two diabetes. If you have reduced bone mass in, say, midlife, so this is happening mostly in midlife, then your risk of osteopenia, osteoporosis later in life is higher. And when you get into your seventies, eighties, nineties, falls and fractures are one of the biggest causes of frailty and death in older people. You don't want to have weaker bones. It's not, it's, it's not protective. It's not in terms of longevity. So it's really thinking about some thinking ahead. If you want to have an independent older age, you need to have good lean mass. You need to have really strong, good lean mass. And the best way to do that is to protect

• 53:31Speaker 01

  it. One of the best, best ways to do that is to really go back in time and build it in your twenties. And so where I also get quite worried, there was a famous influencer who posted a video about the fact that she took GLP one receptor agonists for a while and just for aesthetic reasons. And then she came off them and her doctor said, you have osteoporosis. She, so she'd actually malnourished herself enough to get to that point. Now, in your twenties is when you're, you have max capacity to build bone and, and muscle mass, right into your early thirties, right? And so what, the biggest warning for this, and, and it, you know, it's interesting because talking to different healthcare professionals,

• 54:13Speaker 01

  right? Where I sit sort of in the middle, so I get to talk to everyone. Obesity doctors are like, yes, this medicine is everything.

• 54:20Speaker 00

  Because it's one of the biggest killers, right?

• 54:21Speaker 01

  Yeah, because obesity is so hard to treat unless you have bariatric surgery. It's like such a hard thing to treat, right? And now we have a medicine that works. Then you speak to people who work in eating disorders and they are literally like, ah, but I spoke to someone recently who works in a psychiatric unit in London, and she shared with me that they've seen a huge increase in people taking these medication who developed an eating disorder or who that, the medication like resparked an eating disorder for them and they had to check themselves in. So the, the dangers of young people accessing these drugs on TikTok and often they're accessing compound versions. So what does that mean? It means it's not from the pharmaceutical companies. It's like some lab that's making knockoff versions. And so we go back to the risks of the peptides where

• 55:06Speaker 00

  You don't even know what you're taking.

• 55:07Speaker 01

  You don't know what's in there. Yeah. So the fact that they're so easy to access and the most vulnerable population for this is girls in their late teens, early twenties.

• 55:18Speaker 01

  The risk that they are undermining their long term health, but like really long term health with the loss of lean mass

• 55:24Speaker 00

  Wow.

• 55:25Speaker 01

  is huge.

• 55:26Speaker 00

  So it's, it's, it's, it's, it's short term. They're, they're looking short term rather than long term.

• 55:30Speaker 01

  Yeah. And it's very hard to build that back. So, so that's the kind of dangers, right? That I think it's important to point them out. I think it's also important to point out that there's a, there was a paper recently that analyzed the weight loss patterns in people with obesity. And actually what it found is that the first three months of prescription, because you have excess adiposity, so this is critical, the right patient group that was taking Monjaro, they saw that the majority of weight loss in the first three months was fat. So if you have excess fat, as people with obesity do, they will lose that first. And then it will become more about the lean mass to fat mass balance. And it's around

• 56:14Speaker 01

  six to nine months where you really have to put the work in for the resistance training and making sure that you're preserving lean mass. So all these risks of increased lean mass loss are more pronounced in the populations that might be taking this recreationally, who don't really have a, an excess fat mass to lose. And it's really important that we underline that because, as I said, this drug has been taken as a lifestyle drug because we're obsessed with weight. But anyone who thinks about taking this and doesn't need it, I say to them, would you do this with an anti hypertensive? Would you just take a blood pressure medication for kicks? Would you take insulin for kicks? Like, because this is the same

• 56:55Speaker 00

  This is the same thing.

• 56:56Speaker 01

  It's metabolic health, right? And these are very important hormones that do important work. So like, would you, would you do it? Or is it just because we live in a society where weight is so, such a focus? And you know, and actually, weight doesn't always reflect health. So that's another thing. I was like, um, so one of my friends, she's wonderful. And she said to me, and I love this, her name is Rose Stokes, she's, she's a journalist, and she said, you know, health is not a meritocracy. It, people can work really, really hard and be really consistent and go to the gym and like eat really well and have worse outcomes than someone who barely makes an effort.

• 57:38Speaker 01

  And the problem with like pinning weight to healthfulness is that people who are just genetically more likely to be slim and find it quite easy, may be attributed as being more worthy of health than someone who's trying really hard, but just it doesn't live in a very slim body. So we have to, yeah, I think we have to be really clear that these medicines work exceptionally well for the patients who need them. They can be transformative for people who have struggled all of their lives. And you hear so many patient success stories. And in the same breath, they can be really dangerous for someone who doesn't need them and can even, you know, anorexia is already the deadliest psychiatric condition

• 58:20Speaker 01

  in the world. And what we don't need is to drive up that death rate with a medication because access is too easy. So there's always two sides to the coin. So people say to me, oh, are you pro drug? Are you pro GLP one or anti?

• 58:33Speaker 00

  I was gonna ask, would you, would you take it?

• 58:34Speaker 01

  What, for me? No.

• 58:35Speaker 00

  No, but you wouldn't. No, but it's not that you need it, but if you did need it, would you take it?

• 58:39Speaker 01

  Oh, right. Yeah. So if I develop type two diabetes, or if I ended up living with obesity, then I would go to a doctor who could do all the screenings, look at my liver, look at my pancreas, do a really good assessment, uh, look at my history of eating disorders, like really get a good picture.

• 58:55Speaker 00

  And then make a decision.

• 58:56Speaker 01

  Yeah, then make a decision, of course. But it's, it has to be thought of as carefully as that. And so I'm not pro drug or anti drug. I'm pro patient. Like, it's the person, is it depends on the person. It doesn't depend on whether the drug is good or bad, right?

• 59:13Speaker 00

  But could, tell me this. So if someone's listening to this right now, right?

• 59:15Speaker 01

  Yeah.

• 59:15Speaker 00

  And perhaps they're going, shit.

• 59:19Speaker 01

  Shit because.

• 59:19Speaker 00

  Shit because I've been taking it.

• 59:20Speaker 01

  Okay.

• 59:21Speaker 00

  And I've been taking it for aesthetic reasons, or I've been doing it because I have a wedding coming up and I needed to feel that I wanted to fit into my wedding dress, or perhaps a guy's done it because you know, they're being bullied at school. I don't know what, loads of different reasons, right? But they're, they're maybe young teenagers or in their twenties or whatever it be. And they, they listen to you and they go, oh, I want to change it. What steps do we do now?

• 59:42Speaker 01

  Yeah.

• 59:43Speaker 00

  To change it, to make it better.

• 59:44Speaker 01

  Yeah. So the first thing is don't just, try not to if you can. Don't just take, stop taking it. Don't, don't just go cold, cold turkey. Um, try to try, titrate down. Now, if you're not alwa-, if you're not already under the care of a doctor who's responsible in prescription and I can actually speak to you. So if you try and find someone who can, it can be your G P, like it can be, um, they'd be, maybe be able to point you to the right place. So speak to a healthcare professional. Don't just come off straight away and look to titrate down slowly so that you give your body time to readapt to essentially not having that really strong metabolic signal coming in.

• 1:00:24Speaker 01

  We, at, at the moment, it looks like titrating down is better for avoiding that rebound fat gain that we talked about. However, if your side effects that are bothering you are, it's like, yeah, it's that mental health. So if you're finding that you're really depressed or it's affecting, you know, your health, mental health in a way that you can't be a good parent or you can't go to your job, then actually you might, it might be best to stop. Now, the point is, I'm not a prescribing doctor for these medications, right? You, there should be a prescribing doctor who is looking after you. So whoever prescribed you the drug, speak to them and talk about your options, considering your entire medical history. If there isn't a clear path for that, which there really should be for all providers and

• 1:01:08Speaker 01

  I hope that there's more regulation for that, then find a G P, find a doctor that you can speak to um, and try and access a care as soon as you, as soon as you can. If you've bought them off the black market, so if they're compound drugs, stop, stop. Cause who knows what's happening there. Um, and then try, like, I, I, I, I find that people who have uh, side effects that stop them from taking the drugs, do it quite quickly. They like, no, it's not for them. If you've been feeling okay actually, but now you're just worried because you've listened to this and you realise that you potentially haven't been looking after your nutrition, you may have under consumed nutrients, you might be lacking, is your hair falling out? Is, that's one of the classic signs.

• 1:01:47Speaker 01

  Um, of, especially in women, ferritin dropping so low that their hair falls out. So have you had some, some, some, some signs that actually maybe you're not getting what you need from your diet? Skin cracking, dry skin, um, then really start to look at your nutrition. If you haven't done this, like, make sure that every time you eat, it's, it contains lots of nutrient dense foods. Now, one of the worst mistakes I've seen is that people will take this drug and then diet with it. So they.

• 1:02:15Speaker 00

  Oh my gosh.

• 1:02:15Speaker 01

  Because, but that's, diet culture is like, essentially the problem is, is that especially people over the age of, say, I'd say like over the age of thirty five now. They've grown up with this idea that the less you eat, the better.

• 1:02:26Speaker 00

  Yeah.

• 1:02:27Speaker 01

  So actually, if you just don't eat, that's pretty good. That's a good thing. Uh, if you can survive on fumes or, you know, the famous Vogue diet of the cigarette, the steak and the glass of wine, then you're doing really well, right? So that, so it's really hard as a mental switch to say, actually, on these medicines, I need to make sure I'm eating enough, right? Start to make sure you're doing that. If you need to take a multivitamin, you can. Don't fall for these G R P one magic combinations. There is no such thing. A, a normal multivitamin is fine. There is no approved or tested G R P one supplement that's been actually like tested in G R P one patients. So it's all marketing. And then, and then resistance train. So maybe you haven't done it so far, maybe you've never done it.

• 1:03:13Speaker 01

  But certainly if you've had this rapid weight loss or if you're taking these medications, start. And that might look like just doing own body weight squats. It might look like lifting tins of baked beans in your house or buying, you know, those bands from Amazon or wherever you like to buy your bands. And just doing some form of resistance training. It doesn't have to be in a gym or high rocks or any of these things. It just need, you need to put some pressure and feel some strain in your muscles. Start doing that three times a week for twenty minutes and build up from there. And then, as I said, like, please access a healthcare professional who can actually help you change the prescription, titrate down, change, change the agonist or completely discontinue. But again,

• 1:03:56Speaker 01

  people shouldn't be accessing these medicines without appropriate care. And we just haven't had the resource to grow the support around these drugs as quickly as they've grown in popularity. So the way that all of the guidelines live, they all say that every patient should have full nutritional support. That's me. Full exercise physiology support, right? So like, in an ideal world, you actually have someone teaching you how to do this stuff. And psychological screening. And so that's how they're supposed to be prescribed. So if that hasn't been the case for you, then know that there's missing pieces to your prescription. You've only been given like maybe half of what you're supposed to be receiving.

• 1:04:40Speaker 01

  And particularly with these medicines, nutrition plays a really big role because as we said, it just massively drastically reduces your food intake. And just because you've reduced your food intake, it doesn't mean your body needs less nutrition.

• 1:04:54Speaker 00

  Yeah.

• 1:04:54Speaker 01

  In fact, if you are living with obesity, you might, typically people who live with obesity have higher micronutrient needs because they have a bigger body. So it's a really, it's, it's a balance that you have to maintain of nutrient dense foods. What are nutrient dense foods? I hear you ask. It is, it's whole foods, it's fruits, it's vegetables, it's legumes like lentils. It's soy foods like tofu, it's eggs, it's oily fish. It comes back, it's, it's funny, isn't it? Because comes back to the Mediterranean diet as a really clear pattern of eating.

• 1:05:29Speaker 00

  Just, just be Mediterranean and eat.

• 1:05:30Speaker 01

  Just be, just come with me.

• 1:05:33Speaker 00

  Come with you and do that.

• 1:05:34Speaker 01

  Hang out in Italy for a while. No, but it's, jokes aside, like, it doesn't have to be Italian food.

• 1:05:38Speaker 00

  But the Italians have it right. They surround themselves with family.

• 1:05:41Speaker 01

  Yeah, yeah.

• 1:05:41Speaker 00

  And ho-, and great food.

• 1:05:43Speaker 01

  Yeah. Well, Mediterranean diet is actually a lifestyle. It's, it's more than the food. It's the conviviality. So if you look at the pyramid, it's the conviviality, it's, it's cooking from scratch, it's sharing, it's spending time outside and playing. So there's lots of aspects to it. But what's really important here is that it doesn't matter if you're not Italian or Mediterranean. The Mediterranean dietary principles and Mediterranean lifestyle principles are translatable to any culture. It's, it's a way of, it's a philosophy as opposed to being prescriptive with you have to like tomatoes and aubergines. You don't, right? So I think of this as the modern Mediterranean. It's like, actually, we can translate the pattern to any culture. So it's accessible to everybody, but it does depend on whole food diets.

• 1:06:24Speaker 01

  And the, the difficulty here is that we live in this food environment which just purses non-whole food products. So you can buy bars that are made with no food. There's, I won't name the brands, I'll tell you later. But you read the back of pack and none of the ingredients are a food, not one. Not one. They're all additives pulled together. It's, it's not all food. It's not all food manufacturers. There are some wonderful manufacturers. But as a whole, when you go into a supermarket, it's quite easy to see why people consume a majority ultra processed foods. Because they're cheaper, they're, they're sold, they're marketed, they have got like really jazzy, like

• 1:07:06Speaker 00

  Yeah.

• 1:07:06Speaker 01

  signs, there's two for ones and also the marketing is so confusing. Um, and with the G R P one now, there's, there's marketing directly to this population. Can I tell you how angry that makes me? Because can we talk again about the fact that G R P one receptor agonists are prescribed to patients? These people are a patient population with metabolic dysfunction and you're creating like a high protein dessert for them. Shame on you, not you, Jamie.

• 1:07:32Speaker 00

  Yeah.

• 1:07:33Speaker 01

  But do you know what I'm saying?

• 1:07:34Speaker 00

  Yeah, I know, I know.

• 1:07:35Speaker 01

  How are we, it's, it's my, imagine, well, people, uh, it, it just blows my mind how you might create a food product that is fundamentally unhealthy. Slap a high protein, uh, label on it, which by the way is so easy to get. Twenty percent of calories from protein. That's what you get in a glass of milk, right? It's not a hard bar to get a high protein, uh, stamp on the front of your food product. And people then buy it and they'll spend their hard earned cash buying food products, because they're not actually whole foods. Food products that aren't helping them to be micronutrient replete, to get the nutrients they need. So whenever you see a packaged product, now I've started to see nutrient dense on front of pack.

• 1:08:15Speaker 00

  Yeah.

• 1:08:16Speaker 01

  Because, for this population.

• 1:08:17Speaker 00

  Yeah.

• 1:08:17Speaker 01

  Because you know what? G R P ones are changing the food environment. In America, it's gonna happen here because America is just a bit ahead of us.

• 1:08:22Speaker 00

  Yeah.

• 1:08:24Speaker 01

  But as we go, we've hit two million people taking these drugs, it's gonna go higher in the UK, yeah.

• 1:08:29Speaker 00

  Whoa, and that's the people that we only know, right? That doesn't even off the black market.

• 1:08:33Speaker 01

  So these are prescriptions.

• 1:08:34Speaker 00

  These are prescriptions.

• 1:08:35Speaker 01

  Yeah, yeah, not NHS, this is prescriptions NHS in private, but not black market exactly. So in America, they're a bit ahead of us, they're at like eleven million. So they, if you imagine, like, it's now one in six Americans, I think, that take GLP-1 receptor agonists. Their food industry is changing because their alcohol consumption has dropped off a cliff. And

• 1:08:53Speaker 00

  Because people aren't drinking because no one has the appetite to drink.

• 1:08:56Speaker 01

  You don't have the same drive. And so then now food, the beverage companies are like, okay, um, what are we doing? So there's now, if you go to America, the fridge is of like adaptogenic drinks and this sort of like gut healthy pops. And the, there's so many new drinks that are non-alcoholic, it's wild. There's like teas and all sorts of things, right? And then you have um, a change in in actual food preference. So crisps sales are going down. People don't want to eat crisps anymore.

• 1:09:25Speaker 00

  Because you're

• 1:09:26Speaker 01

  Pastries, well, very high saturated fat foods, so like crisps, for example, fried foods as well, doughnuts. Will give make your reflux fire right up, so they make

• 1:09:37Speaker 00

  People aren't consuming it because

• 1:09:38Speaker 01

  Because it makes your symptoms rise. But actually, apparently, and we don't know if this is true, it's not just symptoms.

• 1:09:43Speaker 00

  So GLP-1s are changing the supermarket?

• 1:09:45Speaker 01

  They're changing, yes, and you know why I love that? Because I've been saying for years that your purchasing power is power. So when people feel quite helpless in the face of the food environment and they're like, oh my god, like, how do we change this? Because it really, policy is the best way to change it. If if there are policies in place to restrict the amount of this food that's been made or how it's marketed, if you could just strip out the marketing and stuff, it would change the food environment. But until we get there, I would say it feels hopeless for the individual. But actually, every penny we spend on the food we buy changes the food environment. If you don't buy it, they can't sell it to you.

• 1:10:20Speaker 00

  Correct.

• 1:10:20Speaker 01

  And so this, and I say this, and it's like, yeah, that sounds nice in theory, but you know, advertising is super powerful and so is marketing and da da da. But you see it's happening with GLP-1s, people are genuinely changing what they buy.

• 1:10:32Speaker 00

  So is it, I can't work out if that's a positive or a negative?

• 1:10:34Speaker 01

  Good thing.

• 1:10:34Speaker 00

  It's a good thing. So the GLP's are a bad thing, but actually in

• 1:10:37Speaker 01

  No, no, no, the GLP-1s, but for the population they're intended for, it's a good thing. So these people that are taking these medicines and have struggled with their weight and with eating healthily all their lives, suddenly have a freedom to be like, actually, I'm not gonna buy those.

• 1:10:48Speaker 00

  So the people who typically have a bad diet, so the ones who are eating

• 1:10:52Speaker 01

  Junk foods.

• 1:10:53Speaker 00

  Junk foods. That is now declining because people aren't, they're not consuming it as much.

• 1:10:57Speaker 01

  Yes, so the the purchasing power is actually making the food industry pivot. Now, the bad side of this is that

• 1:11:02Speaker 00

  Predict the, that's a powerful position to be in because you could predict the next wave of craze within a supermarket.

• 1:11:09Speaker 01

  Yes, you can, you can, you can start to see in the data already through survey data of what people are buying more of. So you already know, so the food industry is already responding, maybe like, what do we make next, right?

• 1:11:20Speaker 00

  Wild.

• 1:11:21Speaker 01

  So in some ways, it's good, I think, because it shows the power of purchasing at individual level. And how, what, what happens when, if everybody decided to, you know, stop buying, I'll give you a non-related example, just to, just to show it. If everyone decided to stop buying chocolate that was made using slave trade.

• 1:11:40Speaker 00

  Yeah.

• 1:11:40Speaker 01

  Because, you know, a lot of chocolate manufacturers enslave children to make chocolate. Everyone was like, whoa.

• 1:11:45Speaker 00

  Great thing about Tonys, right, which is where they, they, they

• 1:11:47Speaker 01

  They, they, yeah, so there's, there's good brands that that have actually gone away from this. But if everyone was like, whoa, I'm not doing that, and stopped buying those chocolate brands, they would have to change something. They would have to stop using slaves, for example. So there's, this is the positive. Now, the skeptical side is that the food industry will do something about this and will change something. So there are reports that there are some um, companies that are already looking at how they can bypass the satiety signal and create new ranges of foods that are hyper palatable, even if you're on these medicines.

• 1:12:24Speaker 01

  So I, I haven't seen this work. I, I've been told by reputable sources that it's happening, but to be, to be seen whether it like rolls up. But you can imagine that they'll, they'll, they'll find a solution. These are companies that need to make money, they need to make profit. So like, what are they gonna do to do that? And we'll see what happens.

• 1:12:40Speaker 00

  Can I ask you two questions?

• 1:12:41Speaker 01

  Yeah.

• 1:12:41Speaker 00

  One is, what is, and I remember you told me this step, but I want to remember. What percentage of the food in the UK is ultra-processed?

• 1:12:49Speaker 01

  So what we have data on is the percentage of calories consumed from ultra-processed foods by British people. And it's between fifty-two and sixty percent on average. Now, it gets worse for toddlers, teenagers, it's up to seventy-two percent.

• 1:13:01Speaker 00

  That is, what, what, what is an Italian?

• 1:13:04Speaker 01

  And also older people.

• 1:13:05Speaker 00

  What in?

• 1:13:05Speaker 01

  Um, fourteen. Yeah.

• 1:13:09Speaker 00

  Do Italians live longer?

• 1:13:11Speaker 01

  On average, yeah, we have an average life expectancy between eighty-six and eighty-eight years, which is about ten years more.

• 1:13:15Speaker 00

  And the UK is

• 1:13:16Speaker 01

  Seventy-eight.

• 1:13:17Speaker 00

  And you think it's down to diet?

• 1:13:19Speaker 01

  Definitely, it's definitely part of it, right? I mean, a big, a big part of longevity is diet, which is why I was furious when, well, when I see books on longevity that have like a page on diet, I'm like, are you okay?

• 1:13:30Speaker 00

  All on diet.

• 1:13:31Speaker 01

  Diet is so important, but it, and you know, diet is important, I think it's, it's so important, not because it holds like superpowers, but because you do it every day. So when you look at, when you look at, Jamie, the six things

• 1:13:42Speaker 00

  Yeah.

• 1:13:42Speaker 01

  That are well understood to essentially structure eighty percent of your chronic disease risks, that's quite a big number.

• 1:13:50Speaker 00

  Yeah.

• 1:13:51Speaker 01

  They are all free and they're all to do with what you do every day. So we have diet, and if I had to like encapsulate it into one sentence, it's eat mostly whole plants. That's, that's the way to make it easy. So it's a plant-forward, not vegan, but plant-forward diet, mostly from whole foods. Great, and then Mediterranean diet, if you wanna see the kind of food groups. Exercise, and that doesn't mean going to like a Barry's Bootcamp every day, although I used to love that in my twenties.

• 1:14:18Speaker 00

  Love that.

• 1:14:19Speaker 01

  Now, I'm like, it's very loud in here, isn't it?

• 1:14:21Speaker 00

  Yeah, I'm in the nightclub in the morning and everyone's topless.

• 1:14:25Speaker 01

  So, but it doesn't have to be like, do what you like.

• 1:14:28Speaker 00

  Yeah.

• 1:14:28Speaker 01

  The most important thing about exercise is that you do something where you can move your body every day and enjoy it.

• 1:14:33Speaker 00

  A walk around a jog.

• 1:14:34Speaker 01

  Because then it means you do it. Dancing, it can be, it can be groups, like, it's actually, there is some nice evidence that if you do exercise in a group, it's really good for social cohesion too, which is number three. So social cohesion is one that is hardly ever spoken about. I've not yet seen an influencer, a topless influencer in a supermarket telling you how important it is to look after your friends and spend time with them. But it's actually one of the biggest levers, right?

• 1:14:58Speaker 00

  I'm gonna, this is my, this is my, I'm gonna, this is my next LinkedIn post. That, that is so great.

• 1:15:03Speaker 01

  It's the six pillars of lifestyle medicine, and they are literally, so when we look at risk factors for um, chronic disease, these six pillars account for eighty percent of risk. If you can achieve four or five of them, you reduce your risk.

• 1:15:17Speaker 00

  What are the six I go through?

• 1:15:18Speaker 01

  So you've got diet.

• 1:15:18Speaker 00

  Diet.

• 1:15:19Speaker 01

  Mostly plants, whole foods.

• 1:15:20Speaker 00

  Correct.

• 1:15:21Speaker 01

  Exercise, move your body every day, throughout the day. Another thing that is really common, unfortunately, now is people who have eight hours a day at a desk and they do like a one-hour Barry's, or like one hour really stressful workout, and then they don't move throughout the day. We, our bodies actually do need to move. So walk after lunch, a walk to work if you can, like, find ways to move your body every single day, several times a day, not just once in the morning. Social cohesion, social connection. It's so important. So for my PhD, one of the things that I put forward in my thesis was that we should be measuring social function as a health outcome when we look at patient success. Because disease cutoffs are interesting and they're useful, but actually, if someone's social function improves, their overall health improves.

• 1:16:06Speaker 01

  So social function, and that means talking to someone you love, lots of data about, it's not about the number of friends you have, it's actually having like four or five really good friends that you can call up, have a chat, and they're there for you, and when you spend time with them, it recharges your battery. And this one, there's one, avoiding risky behaviours, which are really, this doctor in America, who's got a book out at the moment, he calls it, don't be a schmuck.

• 1:16:31Speaker 01

  But yeah, it's basically like, don't drink loads of alcohol.

• 1:16:33Speaker 00

  Yeah.

• 1:16:34Speaker 01

  Don't smoke cigarettes.

• 1:16:34Speaker 00

  Don't gamble so much.

• 1:16:35Speaker 01

  Don't, don't like, you know, don't go out and take cocaine every weekend and etc. So there's risky behaviours that we know are bad for health and just reduce them as much as you can, or avoid them if you can, right? Um, then, so we've done diet, we've done exercise, social cohesion, avoid risky behaviours, sleep, a big one. So sleep is, I think now we've moved away from this idea that like, I'll sleep when I'm dead.

• 1:16:58Speaker 00

  Yeah.

• 1:16:59Speaker 01

  When I was growing up, that was definitely the narrative.

• 1:17:01Speaker 00

  Yeah, yeah, yeah, you should, yeah, exactly, don't sleep.

• 1:17:03Speaker 01

  I'll sleep when I'm old.

• 1:17:04Speaker 00

  It's terrible, terrible, James Dean, live fast, die young, what, this is terrible things.

• 1:17:09Speaker 01

  So it's like, so genetically speaking

• 1:17:11Speaker 00

  Very slow.

• 1:17:12Speaker 01

  And sleep lots.

• 1:17:13Speaker 00

  And sleep lots.

• 1:17:14Speaker 01

  And it's interesting because there are what's known as um, super sleepers. It's a very small percentage of people, and I would encourage everyone to think that they're not one of them. So these are people who only need sort of maybe five hours of sleep, and actually, that's enough for them, very rare. Not, most of us are not like this. So sleep, seventy-nine hours on average for most people, look after your sleep, it's important for you. And then the last one, again, I'm very passionate about this as I nearly hit forty, Jamie, stress mitigation. What does this mean? Stressful events will happen in your life, people will die, people get sick, you lose your job, all sorts of things happen. You can't really change that, although I do like the influencers who are like, just don't let stress happen to you, so you can't do that. But how you handle the stress has a huge impact on your life.

• 1:17:59Speaker 01

  So in the same way that you go to a trainer to learn how to exercise, and you might go to a nutritionist and learn more about your diet, learning how to manage your stress requires a toolbox, and there's no shame in learning how to manage it. Whether it's meditation, walks in nature, art, journaling, there's so many modalities that can help with stress management. Of course, seeing a good psychotherapist is a huge one too. So those six pillars alone explain like eighty percent of chronic disease risk. And as I said, if you can get four or five of those in your life, you're actually doing really well and you're reducing your chronic disease. None of them cost any money, none of them are a supplement, none of them are a specific diet or regimen. And the thing about it is that it's simple, but it's not easy.

• 1:18:44Speaker 01

  So again, if we live in the UK as we live, trying to do all those six things, if you live in an area where there's plenty of places to walk and it's safe, and you have access to green space to exercise, and you can afford to buy healthy food, and you can afford to see your friends and hang out with them because you're not working twenty-four hours a day, so therefore you sleep, and you have access to tools, then you can do it. But there is also disparity in access to these pillars in our society. So whilst it's simple, it's not easy for everyone. But it should be, it should be a human right to be able to do that.

• 1:19:20Speaker 03

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• 1:19:53Speaker 00

  Okay, so we'd like to end our conversation with eight quickfire questions. What's a saying or phrase that you would like people to take away from this conversation with?

• 1:20:00Speaker 01

  That just take away that being healthy and staying healthy is actually something you have to put effort into. And so anything that is trying to sell you a quick fix or something that's a miracle cure is not looking after your health. And it can be harder for some people than others to be healthy. So don't blame yourself, that's a structural issue.

• 1:20:19Speaker 00

  Best compliment someone's given you about how you've changed the way you think about food?

• 1:20:23Speaker 01

  Yeah, so by far, it's when people say to me, "Thanks to you, I really enjoy food again now." And I have, I know that it's good for me and it can help me feel better.

• 1:20:32Speaker 00

  Amazing. What's the scariest thing about people's knowledge or lack thereof when it comes to nutrition?

• 1:20:38Speaker 01

  The scariest thing is just how vulnerable people are to misinformation. It's nutrition misinformation is rampant at the moment.

• 1:20:45Speaker 00

  What's your guilty food pleasure?

• 1:20:46Speaker 01

  There's no such thing as a guilty food pleasure. Food is great. One other thing, well, you know this because I've told you so many times, but it's not mine, but my girls love candy kittens. Is it candy kittens? Kitten candies, I call them both.

• 1:21:01Speaker 01

  So we actually, yeah, we have them in my house and they love them. And I'm just, I like that they're made well, basically. I love dark chocolate, which is not at all guilty. I love food. What, I don't have any guilt about it.

• 1:21:15Speaker 00

  What's one thing we can all do today to build a healthier relationship with food?

• 1:21:19Speaker 01

  Learn to cook.

• 1:21:20Speaker 00

  Yeah.

• 1:21:21Speaker 01

  So if you-

• 1:21:22Speaker 00

  I'm in that space at the moment.

• 1:21:24Speaker 01

  If you, because most of us aren't taught. And if you didn't have a family that taught you, which is quite common, it's a really good skill to gift yourself. So learn to cook and it will transform your enjoyment of food and your kids as well.

• 1:21:36Speaker 00

  Love that. What's something that people are most embarrassed to admit about nutrition?

• 1:21:40Speaker 01

  I think people are quite embarrassed to admit that they don't know what to do next and that they feel lost and that they feel like they're doing everything wrong. That's what I hear a lot.

• 1:21:49Speaker 00

  What's one thing you've learned whilst researching your new book, The Appetite Reset, that generally surprised you?

• 1:21:53Speaker 01

  I think one of the things that really surprised me was in pregnancy, exposure to some of these hormones that are associated with appetite, it changes the hypothalamic structure of the baby, the baby's brain.

• 1:22:08Speaker 01

  What's really interesting is just the transgenerational effects of how our appetite has been handled by the food industry. Yeah, basically.

• 1:22:18Speaker 00

  Last one, what are you most proud of with all of your work?

• 1:22:21Speaker 01

  Anytime someone says that I've helped them in any small way. So I'm actually, I'm very lucky because I feel proud most days. If I can help someone feel like they can be healthier and happier and less stressed about their health, I feel like I'm doing my job.

• 1:22:36Speaker 00

  Dr. Federica, thank you so much. You are beyond great company. I really appreciate it. You are amazing.

• 1:22:54Speaker 03

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