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EP02 Dr Max Gulhane - Holistic Diet & Lifestyle Medicine
126 Plays2 years ago
After graduating medical school, Dr Max Gulhane began taking his health into his own hands when he realised his acne, low energy and poor health were a result of a misinformed narrative around health.
He stopped taking the medications he'd been prescribed by his own doctor and began focusing on animal based eating
Max now shares his own research and experienced based learning with his patients in his daily practice and is seeing impressive results
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Transcript
Introduction and Guest Reintroduction
00:00:00
Speaker
All right, so welcome back to episode two, everyone. My name's Nick Tasky, and today I'm joined by Dr. Max Gullhane. We shot an episode yesterday, but I felt a little bit pressed for time, and so we decided to rerecord today. I'm grateful to have you back again, Max. Yeah, thanks, Nick. Introduce yourself, tell us about yourself.
Dr. Gullhane's Health Journey and Lifestyle Medicine
00:00:19
Speaker
Yeah, so I'm a general practice registrar here in Albury, New South Wales, and I've got an interest in lifestyle medicine and health optimization.
00:00:33
Speaker
And I guess where I've arrived to in terms of that position has been a bit of a mix of my own health journey and I guess seeing that maybe current approaches to prevention of disease and current disease don't seem to be working very well and everyone kind of
00:01:00
Speaker
has an inkling of this because a lot of people are overweight and that is a trend that doesn't seem to be stopping anytime soon. But basically, I had a brush with the pharmaceutical-based medical system myself when I was in my early 20s and mid 20s. And I never ate a heap of junk food, but definitely emphasized and ate plenty of grains.
00:01:29
Speaker
and as everyone's told to do and I developed some quite bad acne on my skin and on my forehead and you know I would be going for a bike ride and always have a large up-and-go
00:01:42
Speaker
uh, you know, sugary chocolate up and go and be eating things like oats and lots of rice and this type of, um, pasta, just, just generally a more carbohydrate based diet. And so I, I dwelt, yeah, as I said, acne in my late early twenties that basically persisted. And, you know, I've, I've got referred to a dermatologist and had a succession of treatments that were based on, on topical
00:02:12
Speaker
topical medications, topical antibiotics, topical retinoids, and without mention of diet or the contribution of diet to my condition.
Dietary Changes and Discoveries
00:02:26
Speaker
And that eventually became oral antibiotics, oral roxycycline, oral minocycline, and then oral isotretinoin or what your listeners might know as roacutane.
00:02:37
Speaker
And that journey as being a patient was an interesting one and ultimately a very informative and beneficial one because I found that that process of going through all these prescriptions and still not having my problem fixed made me realize that a couple of things.
00:03:00
Speaker
lifestyle is key and doing our own research is also very important. To cut a long story short, I basically stopped the raw Accutane and went on my own journey and realized that it was my diet and it was things like fruit, things like grains, sugar that were really provoking my symptoms.
00:03:22
Speaker
And after a bit of a detour doing, I guess the nadir of that whole journey was basically a plant-based diet. And thinking that that was the best thing for my health, the environment, you know, all those kind of narratives that are popular at the moment. And there had been
00:03:39
Speaker
since the mid-2010s. I guess that was an idea, which was I was following this plant-based diet, I was eating heap of grains, and not only did my acne not improve, it just got worse. That trough or diving into a trough was a catalyst to then bounce myself out of that, because I learned about low-carb down under the YouTube page with
00:04:05
Speaker
a whole bunch of doctors presenting on lifestyle medicine and low-carb diets and then eventually found my way into a very low-carb and carnivore eating and a whole bunch of symptoms, not only the acne but irritable bowel syndrome and all these other symptoms disappeared.
Medical Education vs. Effective Practices
00:04:24
Speaker
So that was kind of happening at the same time when I was at medical school and I was resolving the dissonance in my head about
00:04:32
Speaker
what we're being taught and how insufficient and inadequate that framework of knowledge was for understanding what was causing the acne and how to actually resolve it at its fundamental layer. Then after graduating medical school and working in emergency medicine for a couple of years,
00:04:54
Speaker
I was doing my own private research and private study the whole time and understanding more and more and more about what is causing disease and what's underlying chronic disease and all these lifestyle problems that people seem to be having. And then eventually ended up down here in Albury to study with a mentor of mine, Dr. Rob Sabo, who's
00:05:18
Speaker
one of the most experienced lifestyle GPs who has amazing depth of knowledge in reversing type 2 diabetes with diet, low carbon and carnivore. So
Integrating Lifestyle Medicine with Farming
00:05:30
Speaker
I came down to Aubrey and since being down here and practicing in this way, I've also hooked up with Jake Walke, who is a regenerative farmer down here.
00:05:41
Speaker
And at the moment, what we're doing is really trying to blend health and this idea of preventative lifestyle health and lifestyle medicine with regenerative farming. Because obviously, if we want to operate our bodies in the healthiest way, we're going to have to use the healthiest food.
00:06:01
Speaker
And we can, we can maybe talk a bit later in the interview Nick about why that's the case. But I think regeneratively farmed animal meat is, is the foundation of the healthiest human diet. So, so that's a bit of an overview about where I came from and where I am at the moment. So we're, we're building some momentum down here in Albury and.
00:06:19
Speaker
helping and helping to build this idea that you know holistic preventative health is something that is dietary and lifestyle related and there's lots you can do rather than just say taking medications to improve that health.
00:06:37
Speaker
That's awesome. You know, it's the word holistic and your, I guess your newfound friendship with Jake Walke and your investigation of regenerative agriculture. Those things all come together under the word holistic, right? Like how can you separate human health from the soil? How can you separate the health of the soil from sunlight or from water?
00:07:05
Speaker
you know, when you when you investigate deeply into what creates health, it all begins with sunlight in the soil, right? So if we're not eating food from healthy soils and we're not getting a
Soil Health and Human Health Connection
00:07:15
Speaker
healthy sunlight, then, you know, how can how can we build anything holistic on top of that? Talk a little bit about this. Yeah, yeah, exactly. And relax your time because. Sorry, you continue.
00:07:37
Speaker
Oh, sorry, just lagged a little bit. Can you just repeat the question? Yeah, no worries. No, well, I'm happy to keep going down the tangent of soil health as it relates to human health because I think that's a topic that a lot of people miss. And it's kind of like, to me, if you were studying nutrition and dietetics or even as a doctor, you should have some foundational idea about soil health.
00:08:19
Speaker
Man, can you ask that again? Have we? Yeah, I really lagged badly. I couldn't hear the question. Sorry, that...
00:08:27
Speaker
No, that's all right. What I was saying was, I think we miss a lot with our kind of narrowing down of our focus when we study. So what I was saying was, when we choose to study a particular field, say to become a doctor or to become a nutritionist or a dietician or whatever field in health we choose to go down, we kind of segregate our studies into particular fields.
00:08:55
Speaker
In my way of thinking, and probably I assume your way of thinking as well, we can't have a full understanding of health without an understanding, at least a basic one, of soil health.
00:09:11
Speaker
Yeah, yeah. Look, and the point that you made about not being able to disconnect human health from soil health, that's a key point. And I think it's the siloing and the fracturing of different parts of
00:09:29
Speaker
human health, in medicine as well as in agriculture, and in lack of holistic thinking is kind of one of the main reasons why we're in the position we are now collectively with regard to lifestyle and chronic diseases.
00:09:45
Speaker
Because in medicine, we have a specialty for every body part. People see a kidney specialist, they see a nephrologist, they see a neurologist, they see an endocrinologist, they see a cardiologist, they see a gastroenterologist. And each one of these medical specialties is treating an individual body system, but not in a way that is appreciating the totality of the body as a whole.
00:10:13
Speaker
And when we're looking at human health, I guess that's magnified on another level, like a fractal level, when we think that this current paradigm isn't taking into account the human body's needs and things like sunlight, things of.
00:10:30
Speaker
nutrition, the type of nutrition, the sourcing of the nutrition, the absence of chemicals and industrial herbicides that might be perturbing or disturbing the function of the microbiome.
00:10:45
Speaker
So I think the problem is that everything is being looked at in isolation rather than holistically. And to go back and appreciate or to zoom out and appreciate this reality, which is we as a species can't be healthy.
00:11:07
Speaker
if the environment of which we're driving out nourishment is poisoned or is depleted of nutrients. So that's where the interest in the regenerative agriculture came in because it's a simple corollary of the thought.
00:11:23
Speaker
path or the thought pattern of what do we need to become optimally healthy. We obviously need to eat an animal that is well. If you eat a sick animal or you eat an animal that's not eating its species appropriate diet, then it's like putting ethanol into a Ferrari.
00:11:42
Speaker
And so you're just not putting the correct fuel in there.
Nutrient Sources and Misconceptions
00:11:45
Speaker
So once we appreciate the fact that we need to be eating an animal that is eating its appropriate diet, then already we're kind of crossing off. We are ideally not favoring animals that are fed.
00:12:00
Speaker
you know commodity grains and and and are acquiring all these kind of inputs like Antibiotics and their feed and and other kind of inputs just to maintain their you know a state of exit of not dying so and yeah, their soil health is critical because and
00:12:19
Speaker
And to support the growth of livestock that is consistent with their optimal health, then we need to be thinking about the soil and the nutrient density of the soil and how to cultivate the health of the soil. So that's, I guess, the progression of the idea all going all the way back.
00:12:38
Speaker
And you get to things like regenerative agriculture, and as you mentioned, Alan Savory, because the process of rapidly moving cattle to mimic that kind of prey herd dynamic
00:12:55
Speaker
is the cyclical form of grazing is what is needed to heal the land and then provide us with this healthy food. So I guess that's how I think about the soil health as it relates to human health is that it's all interconnected. Nothing is disconnected. Everything is connected with each other.
00:13:24
Speaker
There's an analogy that I like to make and that I kind of always envision in my mind's eye now. As it relates to human health and agriculture, on one side of the spectrum, you've got bare dirt and when you pick up a clump of that dirt, it may fall apart in your hand. There's no organism that you can see within that dirt.
00:13:48
Speaker
And then perhaps you might say on the regenerative agriculture spectrum, when you grab a clump of that dirt, it may have come from compost. And so you've got this mix of soil and humus and you've got living organisms within that soil. And on the conventional side, you know, you apply your your agrochemicals or from another perspective, you could call them pharmaceuticals for the agricultural for the land.
00:14:15
Speaker
And on the other side, you've got this health within the soil and this robust health that builds as you contribute your compost and as you graze animals over that land, as you put chickens and cattle and pigs on there. And you kind of have this idea of if you know who Joel Salison is, that's the kind of method that he's using. And I think Alan Savory probably does something similar to that, but
00:14:40
Speaker
You know, that's kind of an analogy that I like to think of when on one side of it, you're talking about people who are eating, like you say, a species-specific diet. That's someone who's building the compost within themselves. They're creating that robust internal health within themselves. And then on the other side of the spectrum, you've got probably someone who doesn't see it the way you and I see it, but someone who's more like that sand or that
00:15:08
Speaker
that more lifeless soil that you have to add a lot of external inputs to. Yeah, yeah. And I think the analogy is very fitting, which is in agricultural inputs and conventional agriculture that requires inputs in the same way that humans require pharmaceutical drugs to, I guess,
00:15:36
Speaker
treat chronic diseases like high blood pressure and diabetes is that they're only required, they're conditionally required, and they're conditionally required upon the organism or the animal not occupying its appropriate evolutionary niche. What I mean by that is that if the cow is moved regularly, as say a regenerative farmer does like Jake Walkey, it obviates the need for drenching because
00:16:06
Speaker
they're not sitting and grazing in their own feces. So they're breaking the parasite life cycle. So the requirement for the drench and these other antibiotics is not there. So you simply, it isn't needed if the animal is doing what it evolved to do. Similarly with humans, if humans eat a species appropriate diet, which
00:16:33
Speaker
is animal meat and fat predominantly, then need for pharmaceutical drugs like blood pressure medications, like glucose lowering medications, it goes away.
00:16:49
Speaker
essentially putting that animal back into its evolutionary niche, again, removes the need to add in any kind of input. So that's kind of a theme that I think about and work off. And I think to me that provides first principles evidence for the efficacy and the appropriateness of a carnivore and very low carbohydrate diets, which is they reverse disease. That is the dietary protocol that reverses disease.
00:17:18
Speaker
And then we can talk about the scientific and paleoanthropological evidence that backs up that kind of empirical finding that I notice in my patients who go on an all-meat diet. But the reality is that the need for a lot of medications and for agricultural inputs
00:17:41
Speaker
is both coming from using these organisms, whether they're animals or crops or people, in a way that nature didn't intend.
00:17:55
Speaker
Let's talk a little bit about, so there's one side of the spectrum that says, you know, we need these nutrient dense foods. And I'm someone who very much believes that. And so you're seeing guys like Paul Saladino and, you know, there's probably a million people on the bandwagon now who say that you should eat liver. And then there's another school of thought that say,
00:18:19
Speaker
You know over consumption of organ meats or nutrient-dense food Can actually cause toxicity and you know people will cite this I think there I believe there was one specific study that said that it was done on pregnant women I believe and they said that over consumption of vitamin a caused vitamin a toxicity and when I when I research that a little bit further
00:18:41
Speaker
What I found was that there are two different forms of vitamin A, right? So I believe it's retinol and beta carotene. And one, this study they were talking about vitamin A derived from retinol, sorry, beta carotene, which is the plant-based form of vitamin A. And they really had, when you broke it down, they had really nothing to say insofar as what the effect of retinol was on the body. Do you know about that study?
00:19:09
Speaker
Yeah, so the recommendation to avoid liver in pregnancy is based on studies that used synthetic vitamin A. So retinoids are compounds that resemble vitamin A, and if they are isolated and purified, and taken again, not in the context of natural food,
00:19:36
Speaker
then they have teratogenic potential. And the evidence isn't consistent with naturally occurring vitamin A at the dose that you would get in grass-fed ruminant liver with having any kind of teratogenic effect. So the nuance here is that when consumed in a way that
00:20:02
Speaker
would be appropriate, which is a small amount of ruminant liver, not carnival liver, not polar bear liver, not, you know, all these other types of liver that have incredibly high concentrations of vitamin A, as in, you know, carnivores would. If you're eating a small amount of grass-fed ruminant liver, there's no evidence that that is in itself any way teratogenic. And in fact,
00:20:30
Speaker
that is precisely the food that is offering people the most dense and wide array of bioavailable trace minerals, fat soluble vitamins, and water soluble vitamins. So the distinction is synthetic versus naturally occurring retinols. And beta carotene is a plant-based precursor to vitamin A and it has a very, very
00:20:59
Speaker
poor conversion rate as a basically biological precursor to biologically active vitamin A in the body, essentially meaning that we need to ingest animal sourced vitamin A through things like liver or through seafood to meet our body's requirements. But the point also is that when present in food,
00:21:28
Speaker
These substances, these minerals and these nutrients are being co- ingested with co-factors. So when you're eating preformed vitamin D, it's there with magnesium. So, you know, the absorption is going to be massively increased. When you're eating iron in the form of animal food, it's in heme iron.
00:21:48
Speaker
and the structure of the heme molecule protects that Fe, that iron molecule, all the way up until the point it gets absorbed into the mucosa of your gastrointestinal tract. Whereas if you're trying to absorb
00:22:06
Speaker
in the form of a ferric compound, as in an organic ion or in plants. It's liable to be complexed with phytic acid and other kind of compounds that are going to inhibit its absorption.
00:22:25
Speaker
Yeah, exactly. So the mother nature has kind of worked this out and it shows us that when we eat foods that we evolved eating, all these details have kind of already been worked out.
00:22:44
Speaker
Yeah, it's kind of interesting for me having dived down that rabbit hole and you know, you look at things like vitamin C, like I was taking a vitamin C that was from a reputable brand, at least I thought, until I found out that it had ascorbic acid in it. And you know, it's no wonder that these synthetic vitamins cause toxicity because to derive the amount of say vitamin A that you would need for a serving from
00:23:13
Speaker
A plant-based food or from genetically modified corn. How much of that product do you need to create a serving of vitamin C or a serving of vitamin A? Like it's an unbelievable amount.
00:23:30
Speaker
Yeah, it's it's fraught and there's so many things that are kind of tied up in this whole complex of the pharmaceutical industry. And it's funny because it almost mirrors the pharmaceutical industry in that
00:23:47
Speaker
You know, people led to believe that they need to consume all these multivitamins and other forms of isolated vitamin for good health. But essentially, they don't. They just need to be eating a fresh food. Very few do. And most people would be best off just eating
00:24:05
Speaker
very, very fresh, high-quality, locally sourced, well-raised food of predominantly animal origin, in my opinion. So it's a little bit frustrating, I guess, to see people
00:24:23
Speaker
get tied up in expensive ways of taking in nutrients that they'd be better off getting if they ate a dozen oysters and a small amount of beef liver or a bit of bone marrow and some high-quality steak or pastured eggs.
00:24:43
Speaker
And it kind of carries over, again, like you said, from the pharmaceutical industry back into agriculture. And I guess they're kind of a much for muchness. They're the same companies. And so you see the application of NPK fertilizers and these things are synthetically
Understanding Organic and Food Labels
00:25:03
Speaker
derived, right? And so putting a synthetic fertilizer on a soil
00:25:08
Speaker
He's not creating the same health in that soil as running a pack of pigs through there and then having your cows go and graze out and your chickens. It's a totally different thing, putting a cover crop through and all these sorts of things. They're not the same although they sound so on paper.
00:25:30
Speaker
Yeah, and look, the answer is, Nick, why is that the case? It's because no one's making money when the farm is fertilizing its field with his own chicken trapped, like mobile chicken caravan, and getting the chickens to poop on the field instead of paying a corporation to buy in heaps of super phosphate. Similarly, no one is making money other than
00:25:55
Speaker
the local fishmonger when you get your zinc from a dozen fresh oysters instead of buying your branded expensive zinc multivitamin. So I think that the answer to why everyone's getting recommended a complicated and in many cases unnecessary solution to their health or agricultural problem
00:26:20
Speaker
is because the most effective way is not making money for any third party.
00:26:30
Speaker
Mm-hmm. So this this kind of leads me down a similar topic and it's This is something that I've seen firsthand having worked in agriculture and it's something that I've seen Probably spread across to more functional medicine and and probably more your naturopath types and that sort of thing as well But you know if you look at The the Australian certified organic label it means what it really means is that what's been applied to your food is
00:27:00
Speaker
is more natural. So you don't have any artificial chemicals per se added to that. So they're using certified organic fertilizer. They're not putting things like agrichemicals on the food. But what it doesn't mean is that that food was grown in a way that is close to the way it would grow in the wild. And so, you know, you see people going to naturopaths in a similar way where
00:27:30
Speaker
they present with a disease say for example i go to a naturopath and i say i have recurring sore throats and that and that naturopath says to me okay well um let's put you on a natural vitamin c like let's get you on on a you know orange juice concentrate or something like that where it's got high levels of vitamin c and and that's the bandage solution and so
00:27:53
Speaker
what you're really saying is a like for like. Instead of building health like you're building that compost, and instead of building health like you would in a human being by looking at the foundation principles, you're really applying a Band-Aid solution. Does that make sense?
00:28:13
Speaker
Yeah, it does. It definitely makes sense. Let's continue this agricultural analogy. If you're running a paddock in a set stocked way with all your cattle just living in a big paddock for months on end, and you start having thistle growing it, it's the equivalent of going around with some Roundup and spraying each individual thistle or removing them.
00:28:40
Speaker
But the deeper question is, why was the thistle growing there in the first place? And the answer is because the agricultural technique isn't allowing that
00:28:53
Speaker
ground to thrive with a cover crop or different species of grasses that would prevent the thistle from arising in the first place. So to analogize with the human is like, okay, yeah, we can just give you some vitamin C, but what are you doing in your life that is impairing your immunity or other than just simply a hit of vitamin C? What else can we do? What lifestyle changes can we make?
00:29:22
Speaker
to reduce your susceptibility to even getting that cold in the first place. I guess to make it clear for people, what I saw when I worked in agriculture was we converted some fields to organic. We converted some conventional cane to organic sugar cane.
00:29:44
Speaker
Basically, what the agronomist did was he treated it exactly the same as a conventional field, but he put organic certified organic applications on there. So instead of fertilizing with NPK fertilizer, we used, you know, mill mud or we used, you know, some something, you know, that was supposedly natural organic. And so when people would drive past that and when workers would see the field, they would say, well, organic
00:30:14
Speaker
is, you know, it's a fast, it doesn't work. And it was evidenced by the fact that that was completely full of weeds. The cane was smaller than all of the other conventional cane and it, you know, it appeared to be a failure. And, you know,
00:30:30
Speaker
What you see is a label put on that certified organic label that says, this is healthier than other produce. But you really have to dig deeper and do your own investigation and kind of come to the realization that when something has a, just because it has a label doesn't mean that it is what it says.
00:30:53
Speaker
Yeah, totally. And, you know, you'll talk to regenerative farmers like, you know, Jake Wilke and he pastures, he puts his broilers, his meatbirds on pasture and, you know, moves them every couple of times a day and they have access to fresh grass and all this kind of thing. And, you know, you can buy organic chicken, but that's from another farmer. But that simply just means that the
00:31:21
Speaker
chicken was fed organic grain and it doesn't have any stipulation for the chicken to be outside or allowing it to express its natural instincts and to peck outside. So the crux of the issue is that
00:31:40
Speaker
Anytime you're outsourcing your decisions with regard to food choice to a label or to some kind of industry body, unless you know for sure what that entails, then you're just maybe just a little bit less, but you're still liable to be getting something that isn't necessarily what you think it is. And the best approach to circumnavigate or solve that problem
00:32:09
Speaker
is to find someone and meet the exact person that you're buying your produce off and you can verify for yourself their practices, you can verify the animal welfare, you can visit the farm, you can ask your farmer what type of grain are these pigs and chickens eating,
00:32:29
Speaker
I mean, you can have input into the whole process. And I've interviewed a couple of farmers so far on my podcast, Regenerative Health Podcast, and all of them have said that they're highly responsive to the demands and the requests of their customers. And when the customers say, we want sausages, but we don't want any preservatives in them,
00:32:48
Speaker
The next batch, they've cut out all the rice flour and whatever else they were adding in because that's how it was done just by their butcher. So all that to say is that the opacity of the health of the food system
00:33:05
Speaker
and disconnect from the food system, it can be solved, but it just involves a bit of effort on your behalf to meet the person who is raising that food and yeah, verify for yourself what is going into or what is not and what is going into that process. Yeah, and for some people that might be
00:33:32
Speaker
you know, like you said, actually traveling to a farm or, you know, it's easy today. You could look up, you know, who Alan Savory is or who Joel Salatin is and look at the way they farm in comparison to what some mega corporation who's got an organic certification does. Like they're totally different. They're completely different things.
00:33:55
Speaker
Yeah. And look, any time there's these labels or these accreditations, they're susceptible to influence of stakeholders and where profit becomes the main kind of
00:34:11
Speaker
domain driver, then what seems to be a pure and reliable accreditation can get watered down and they accept a small percentage of certified organic but still maintain the label. It becomes very easy for there to be, I guess, perversions of what you think you're getting.
00:34:35
Speaker
Um, yeah, it's very, very, again, the antidote is to simply, um, do your due diligence and do the research for yourself. Because if you don't, you just simply aren't able to know exactly what you're putting on your family's plate. Yeah, I think that's a great point. Yesterday we talked a little bit about.
00:34:57
Speaker
If someone was to go down this rabbit hole for themselves and, you know, I guess one of the problems that we all come across inevitably when we begin is that there's so many different voices and there's voices on the vegan side that say vegan diets have cured my cancer, which may be true. And, you know, there's voices on the carnivore diet that will say the same thing, which also may be very true. How would someone
00:35:26
Speaker
How does someone begin to cut through the chaff or to forge a path for themselves and actually determine what voices are actually truthful?
00:35:42
Speaker
It's a great question. And as you said, there's just more and more people out there having a public opinion about diet and about lifestyle and about nutrition. And I guess the noise that is as a result of that is just, again, getting louder and louder and louder. I think at the crux of it, which follows on for our last point,
00:36:09
Speaker
is verifying for yourself.
Personal Experimentation in Health
00:36:12
Speaker
And as that applies to lifestyle advice is to actually listen and tune into your own body and what you feel subjectively from a health point of view and putting on or having the approach of being an experimenter on yourself and finding out what different approaches make you feel good and which approaches make you not feel good.
00:36:37
Speaker
And I had a tweet about this recently on Twitter because Andrew Huberman made a post of, he made the comment that it's interesting to see what level of evidence people rely on before making a health decision or about a health protocol. And at the top of that pyramid are people that only rely on randomized controlled trial data to inform a lifestyle choice. And then at the bottom of the pyramid is people that only rely on personal experience.
00:37:06
Speaker
to inform a health protocol or a decision about their lifestyle. And the question that I had rhetorically was that if you're only relying on randomized control trial data to inform your health lifestyle choice, then you're making the implicit assumption that you're represented in that trial's intervention group.
00:37:32
Speaker
in a way that contains all the relevant factors.
00:37:37
Speaker
And what I think is that often the case, that isn't the case. And because, and basically the nature of the randomized controlled trial is it's only gonna give you an aggregate kind of answer. It averages out the treatment response in the intervention group and gives a kind of aggregated effect estimate. But it doesn't account for the fact that there could be
00:38:06
Speaker
30% of people in the intervention group that responded amazingly and 40% that responded horribly and everyone else just had no effect at all. So there's a real loss of granularity, a really loss of resolution if you're only relying on aggregated RCT data to inform a health choice. So eventually,
00:38:33
Speaker
you come to the realization that we do have to treat everyone as an individual. For a long period of time, that was this promise of N equals one medicine, personalized medicine. I don't think it's incongruent with
00:38:52
Speaker
with medical best practice to really go back to that and say, yes, you are an N-1. You are completely unique. You are not going to respond the same way as the person next to you or the person next to them. So you have to rely on subjective experience and how you feel when you try a different diet, a different routine, a different workout regime.
00:39:14
Speaker
in a way to inform what you should do. So I guess that's a roundabout way of agreeing with you, Nick, that you need to listen to yourself and maybe start with a couple of people who have an evidence-based backing.
00:39:32
Speaker
And like I guess like people like human or people who like Dr. Cruz, like people like Dr. Amara, people who can marry evidence with with empirical and experience and then continue to ask yourself,
00:39:51
Speaker
when you implement their recommendations, does this make me feel better? Does this make me feel worse? How do I feel? And that's like an iterative process that will eventually allow you to come to a lifestyle protocol that makes you feel the best. And yeah, I think that's probably the most effective approach. But having said that, Nick, it takes effort and it takes attention. It takes cognitive bandwidth.
00:40:17
Speaker
often, which is in short supply in today's day and age. So if you can't outsource that, or you can't make all those decisions yourself, then there is a degree of outsourcing that. And I guess it's about being very careful about who you kind of outsource that reliance on here.
00:40:40
Speaker
And it's really consistent effort. Personally, I haven't found that it kind of ever stops. My needs for nutrition and for sleep and for everything in between can change from day to day. If I do deadlifts one day, then
00:41:03
Speaker
Perhaps the next day I'll need to eat some carbohydrates or I'll need to eat You know, you know some rice or some potatoes or something like that because I feel lethargic if I don't And on the opposite end of that if I don't do any heavy movement for a few days, then I'm probably okay to just stick to something very minimal maybe small amounts of meat or Small amounts of you know
00:41:27
Speaker
some protein-based food or maybe vegetarian for a day as crazy as that might sound. It can change from day to day. I'm in favour of a seasonal approach to eating and for people who don't have metabolic disease or any kind of obesity or fatty liver and diabetes,
00:41:53
Speaker
I mean, it's appropriate to eat what grows at that latitude that you live in. So cyclical ketosis is a good approach in my mind and not necessarily being completely dogmatic. But again, it also depends on the individual. It depends on
00:42:13
Speaker
what your needs are. Are you using something like a diet for a therapeutic protocol or are you simply just trying to optimize your lifestyle? All that to say is that there's not one size fits all and everyone has to take these considerations into account in order to find the right thing for them.
00:42:37
Speaker
We did talk a little bit yesterday about a sort of a triangle that you described where you had, on one end of the spectrum, you had someone in the hospital bed, maybe at the point of the triangle, you had just the average person who probably doesn't have a whole lot of energy. They kind of feel lethargic, but they're not on death's door. And then you probably got the smallest amount of people on the last point of the triangle, which are at optimal health.
00:43:05
Speaker
It's very difficult for the people who aren't at death's door, who are on that second point of the triangle, to actually know what health looks like. They might feel lethargic, but their blood tests come back normal, and they don't present with any chronic or acute symptoms that make them fit into that disease category.
00:43:33
Speaker
I guess a long story short, you've got this huge amount of people who are struggling with things like low energy and suboptimal health, but because the majority of people fall into that category, no one actually knows that things could be better than they are.
00:43:54
Speaker
Yeah, exactly. And it's a conceptual framework that I guess use to inform or describe how I think about health. And it's actually stairs. There's like three stairs. And at the bottom of the step is someone dying. And then the middle step is someone who's just surviving, getting by.
00:44:16
Speaker
Yeah, and the top step is thriving and living in an optimally health optimised way. And the point about it is that
00:44:27
Speaker
When you're dying and you're going between surviving and dying, that is when you need antibiotics, that's when you need emergency surgeries, that's when you need all the aspects of modern medicine that are so helpful and beneficial. No one can dispute how beneficial they are.
00:44:51
Speaker
What they can't do is they can't get the person who is merely surviving. As we talked about yesterday, that is the majority of the population who are proceeding through life with brain fog, with fatigue, with low libido, and their honor with increasing amounts of visceral fat.
00:45:11
Speaker
ever enlarging. Those people are in a slow march towards chronic disease, but as you said, they might not yet have manifested biochemical problems by blood tests. That's the majority of people, but unfortunately, the medicines can't get them from a state of surviving up to thriving. To get to thriving, you need
00:45:36
Speaker
optimal diet, optimal lifestyle, sunlight and exercise. So what I learned in medical school and what most of the
00:45:49
Speaker
the healthcare system or sick care system, if you want to be skeptical about it, is predominantly associated or preoccupied with that bottom to middle step transition. The ironic thing is that
00:46:07
Speaker
There's no, there isn't an appreciation of how to get to that thriving step. And that's when you see the overweight doctors, you know, that you see them that they're, you know, in their, on their own having their own health problems that, you know, doctors taking antidepressant medications. So, and to suggest that
00:46:28
Speaker
I guess healthcare industry is able to potentiate optimal health. It isn't correct. It's a missed opportunity, I think, for medicine and for doctors because it's just meant that other people, and you mentioned naturopathy, and there's a range of other industries have simply filled that vacuum, and maybe they haven't necessarily offered the most evidence-based
00:46:53
Speaker
solutions or advice in that regard. But what it means for most people is that when you're sitting on that middle step and you're there because you're eating a species in an appropriate diet, you're deficient, you're not meeting your needs with regard to sunlight and exercise, is that, as you said, you often didn't realize how you got
Motivation and Effort in Health Maintenance
00:47:18
Speaker
there. And it's just like the glasses that gather a progressive amount of grime,
00:47:23
Speaker
that build up over time, people are unaware of forgotten what it feels like to thrive. I remember when I was a kid, you go to sleep and you wake up like a light switch.
00:47:37
Speaker
And you just jump out of bed and you'd be ready to ride your bike or do something fun outside. And before I went through my own journey, which I described to you at the beginning of the podcast, I was just feeling so fatigued and so tired and getting up was an absolute chore. And I remember
00:47:57
Speaker
you know walking thinking like man is this what it's supposed to be like is this what health is what life is and that just drag and that drained feeling so i'm i'm i'm here to i guess reinforce with you nick to to your listeners is that
00:48:13
Speaker
you can feel like that five-year-old again and you can feel like that and it's about getting the diet and lifestyle fixed in an appropriate way and then it's like cleaning those glasses and suddenly you're back at an optimal thriving again and you can experience everything and your waking up is easy, you have energy throughout the day, you don't need to nap,
00:48:37
Speaker
you've got a healthy libido, you look forward, you have a joyful outlook on life. So all that I guess is to say,
00:48:46
Speaker
People are occupying this middle zone. They've forgotten about what it feels like to be optimally healthy, but don't despair because you can get up to that third level. That's what I'm interested in professionally, and that's what you're interested in. The more we talk about it, the more we promote an optimal lifestyle strategy, the more we can help people clean their glasses and get to optimal thriving again.
00:49:12
Speaker
And it brings me back once again to that compost analogy, right? So I often have, you know, I use what's called six foundation principles and they're breathing, thinking, movement, nutrition, hydration, sleep. And so, you know, you have to have all of those things to create optimal health. If you're missing a piece of that, then you're going to fall back into that suboptimal category.
00:49:36
Speaker
One of the things that I find most challenging for most people is consistency with those things. And so, you know, first of all, you need a motivation to get there, but then you also need to become aware and committed to the fact that compost doesn't form overnight. And so you can put your, you know, your waste, your banana skins in your eggshells and your coffee grounds in a compost bin and, you know,
00:50:02
Speaker
close your eyes and go to bed and wake up the next day, but they're not gonna be compost yet. And so the analogy spreads over to our own health. And so it takes time, it takes heat, it takes energy, it takes bacteria to begin to break down those materials to make the healthy compost. And so you're not going to get into a position of optimal health overnight. And so I think that's one of the things that people find most frustrating because
00:50:30
Speaker
When you enter the medical industry, you are promised a quick fix solution most of the time and you might experience reprieve from your symptoms for a certain amount of time because you get that quick fix solution but it's so difficult in a low dopamine world for people to make a commitment to change.
00:50:52
Speaker
I think one of the most important things, in fact, I know one of the most important things in my own work with my own clients is establishing what I call a dream for them. And so what we do is we sit down together and we work out.
00:51:08
Speaker
What's your ultimate life goal? Beyond saying, I wanna lose weight or beyond saying, I wanna be out of pain. What's the motivation? What's the end goal? And maybe that's for some people to be able to play with their children when they're mid-life or to be able to play with their grandchildren. And for other people, they have a goal that's as high as Mount Everest. But without that goal,
00:51:34
Speaker
they struggle to maintain the compost heap, maintain the inner garden, perhaps.
00:51:44
Speaker
Yeah, I love it, Nick. We call that blue sky thinking in terms of helping people motivate dietary lifestyle change to reverse their diabetes or lose weight. And yeah, from a psychological point of view, it's so helpful to anchor the change in a future goal of
00:52:05
Speaker
What you can what you'd like to be able to do if your health improved and as you said playing with grandchildren Going on a you know going to Antarctica, you know, whatever it is was simply just being pain-free to drive a caravan around Australia there the there's enormous value in psychologically anchoring to that in terms of
00:52:27
Speaker
the discipline of carrying out things on a day-to-day basis. Because, as you said, to make that compost or to have any kind of long-term success, it's made up of micro-decisions on a daily basis. And all of them aggregate together to either result in success and failure.
00:52:46
Speaker
And it sounds not to put too much pressure on people, but every single decision does matter. Every single decision to reach for the processed food instead of the high quality food, every decision to
00:53:02
Speaker
line the sofa and watch another episode of Netflix at 11pm exposed to blue light instead of going to sleep. They all add up and they make the bed that eventually people lie in for better or for worse. So that blue sky thinking or that anchoring to a future imagined state is incredibly powerful in terms of
00:53:30
Speaker
helping people maybe make a better choice when it comes to the time that they're stressed or anxious and so tempted to just eat a block of chocolate. So yeah, I would definitely agree with that, Nick. I think it's powerful. And look, it actually comes to my approach when I think about helping people, particularly with weight loss.
00:53:51
Speaker
is that there's two facets here. There's the physiology and the psychology. Within the physiology, we could talk about ketosis, we can talk about circadian rhythm, we can talk about visceral fat, we can talk about that until your ears fall off.
00:54:10
Speaker
Someone can understand those concepts at an intellectual level, but that that means nothing if their psychology part of it hasn't also been addressed and for that reason or for tied up in that idea of psychology is
00:54:25
Speaker
reasons why are people overeating? Why are they addicted to sugar? Why are they in the situation where they are from a lifestyle point of view? And so many things that could be comfort eating, there could be unresolved childhood traumas emotionally, there could be in a situation where it's normal to
00:54:47
Speaker
to just drink beer after work every day. It's normal that when you catch up with this group of friends, we eat chocolate and watch movies and nothing to say bad about that because there's value in getting together and being social.
00:55:05
Speaker
understanding whether there's a habit in your life that is leaning you further away from your optimal health. It just helps people be a bit more conscious about decisions to maybe hang out with that group of friends or to
00:55:20
Speaker
go work at a particular job when we understand that those habits and those lifestyle choices or the psychology is directly impacting our physiology and our ability to achieve our health goal or our ideal state of health.
00:55:40
Speaker
It's kind of funny to think I often come across this conversation and we talk about discipline and the discipline of being able to maintain a healthy diet or a healthy lifestyle. And for me and for I guess some of the clients who I've worked with more long-term and for you I'd imagine as well, it doesn't become discipline anymore. It doesn't become a difficult thing to do because what you inevitably find is that
00:56:09
Speaker
After a certain period of time, the gut microbiome changes and you stop craving the things that, you know, you originally craved. And the other side of it is you feel so good and so energetic all the time that for one, you don't want to lose that. And two, you don't need the things that you previously needed to feel that good. Yeah, look, I couldn't consider it better myself, Nick. That is such a good point.
00:56:39
Speaker
Yeah. And then, so I think beyond that, it's, it's, it's only a matter of, uh, like you say, when, when the psychology, when there's, when there's a psychological factor that comes into play that could potentially, uh, derail the train, um, you know, and, and that is also inevitably going to happen for everyone. I think, uh, I think there's, heh.
00:57:04
Speaker
You're going to fall off the wagon, but the other side of it is if you go to a party and you want to have a beer or two, or you know, you overindulge, it's not going to be the end of the world either. And I think there's also utility in overindulging at certain points of time, right? You don't want to be... I think there's nothing worse than a zealot either.
00:57:30
Speaker
Yeah. And so I think a couple points. I agree with you that when you get to a stage of, you know, thriving, you're so in tune with your body that you you're acutely aware of what how you feel when you, you know, say eat something or you, you know, have a blowout on the beers or or any kind of
00:57:55
Speaker
any kind of deviation from optimal lifestyle. But that's powerful in itself because what it both does, it allows you to continue on your current lifestyle and as you said, it becomes easier to just simply exist because again, it's not a laborious decision, it's simply how you live. But it also allows you to occasionally make a decision to actively say,
00:58:22
Speaker
screw it, I'm going to have a blowout tonight because X, Y or Z reason. And sometimes you don't even need a reason. But at least being aware of how these things affect you rather than mindlessly or not even being consciously aware of how that kind of individual food choice or lifestyle choice is impacting you. That's the kind of the problem because when people
00:58:47
Speaker
aren't consciously making a decision. That's when you get on that slow march towards visceral fat and chronic disease. But look, I agree. And I think that being part of having a healthy approach to lifestyle and feeling good is, yeah, occasionally having a time where you let your hair down, so to speak. But the power is in actively and consciously making that decision based on an empowered position and self-knowledge.
00:59:17
Speaker
Yeah, absolutely. And it doesn't, it's no longer the binge every weekend type of blowout. It's an active choice, right? It's not a blowout because we're not feeling good in our work or in the rest of our life or we're feeling lethargic and low energy. It's like you say, a conscious active choice. One of the things that I found that
00:59:45
Speaker
Sorry, one of the things that I was going to say that I found interesting in your conversation with Cruz, and I've heard other people talk about this well, is the changing of textbooks as time goes on.
01:00:00
Speaker
there's a certain group of people who would describe what's happening as de-evolution in a way. So I think what, I don't know if it was your podcast with Cruz or another podcast that I heard him on, but he was talking about calcification of the pineal gland. And he was saying, look, back in old textbooks, you know, probably early mid-1900s,
01:00:23
Speaker
Uh, there was, you know, this, this calcification of the pineal gland was abnormal. Um, and he said it, you know, you can even go back and purchase these textbooks. And he named the books where this, this wasn't normal. And as time progresses and as people become less healthy,
01:00:40
Speaker
the textbook starts to change and they describe disease as normal things. I think another example of that is as we look at anatomy textbooks and people's posture starts to change, we start to see the head migrating forward in anatomy textbooks and we start to see lumbar curves increasing or decreasing as the population starts to decline. And so all that is to say that
01:01:09
Speaker
Again, it's very difficult for people to actually know what normal is and for even the experts to know what normal is when our point of reference is a textbook and the textbooks, I guess when normal becomes disease.
01:01:28
Speaker
Yeah, and there's multiple examples of this in medicine, and you mentioned that idea of maybe pineal calcification is now becoming normalized. I haven't listened to this specific episode that you're talking about, but I've previously heard Cruz talk about the fact that people aren't making endogenous melatonin because of their exposure to blue light and non-native EMF as a contributing factor to
01:01:56
Speaker
to pineal calcification. But it's essentially what you're describing is when you've got most of the population on that middle step. We've fallen into a quack category. If we went there already. Yeah.
01:02:21
Speaker
No, that's okay. What I was saying is that when you have most of the people in that middle step of simply surviving, and you know, there's multiple papers, I think, you know, there's papers showing that 88% of citizens in the US have got one marker of metabolic syndrome, at least one marker of metabolic syndrome. When you then derive a textbook or
01:02:46
Speaker
reference range for a blood test from an unhealthy population, you start to normalize disease. The examples that I can think of
01:02:59
Speaker
off the top of my head is something like fasting insulin. The reference range when they get reported in the labs can be anywhere up to 20. If someone's got a fasting insulin of 20, then they're obviously working very hard to keep their blood sugar under control. In healthy population, it should be closer to three or four.
01:03:26
Speaker
And then there's other examples. I mean, the number of follicles on ovaries that were used to be considered normal, I believe, was anything above.
01:03:40
Speaker
I believe it was six, six or eight, was abnormal, but now it's much, I think it's 12. Sperm counts, everyone knows that's a common one. That's a very big one in social media to comment on the declining trends of male sperm counts, what is considered to be normal in terms of sperm count compared to 60 years ago.
01:04:06
Speaker
So the theme of what we're talking about is a progression or a moving of goalposts in terms of what is common, but is what is not necessarily healthy. And I think that it's an exciting thought that we really should put together or
01:04:32
Speaker
really build up more of a reference based on people who are optimally healthy and to kind of keep that as a reference point to really compare people against rather than continually accept these changed markers or these changed goalposts when thinking about optimal health.
01:04:58
Speaker
So there's, that's something to keep in mind. And again, it's like what is normal is not necessarily optimally healthy. I don't know if I said this to you yesterday or if I said it to someone else, but speaking of follicles on ovaries and male sperm count and fertility overall, as it relates to our conversation on health in general, it's kind of interesting to me that
01:05:29
Speaker
you know, the field of IVF is continuing to grow and people are very desperate to have children and all the power to them. But, you know, the comment is often made that it's difficult to afford organic food or to take the time to exercise or to, you know, to live an optimal lifestyle.
Cost of Health Investments vs. Medical Expenses
01:05:50
Speaker
And yet these same people who claim that it's
01:05:52
Speaker
too expensive, we'll go out and spend 20 or 30 or 40 or $50,000 even on in vitro fertilization. And to me that that is almost nonsensical when we know that the factors that contribute to low fertility are lifestyle factors almost always.
01:06:09
Speaker
And I mean, there are examples of where that is not the case. But I think probably for the grand majority of people, that would not be true.
01:06:30
Speaker
Yeah, no. There are obviously situations of infertility that are unrelated to lifestyle, things like structural abnormalities, a range of other kind of maybe genetic issues. But
01:06:52
Speaker
As you said, for the vast majority of people, there's modifiable lifestyle factors that are impacting their fertility. I guess that's almost a whole episode or discussion on its own, but the prevalence of things like endocrine disrupting chemicals in the food supply, the fact that
01:07:18
Speaker
polyunsaturated, you know, highly oxidized seed oils are the norm in terms of the most consumed fat or fatty acids in society, you know, the prevalence of visceral fat and, you know, metabolic dysfunction. All these are, all these are modifiable and they're all contributing to sub-fertility in people and
01:07:47
Speaker
What I say when when people say to me, you know, regenerative meat or this is very expensive, that's very expensive, you know, costs twenty seven dollars a kilo for high quality regenerative meat. Well, what I say is, you know, you can pay that farmer now.
01:08:05
Speaker
Or you can pay your doctor, your orthopedic surgeon, your IVF specialist, your geriatrician. You can pay them later. It's up to you. So you're not kind of getting away with it. There's no avoiding the cost.
01:08:23
Speaker
you're simply paying now and investing in your health, or you're going to be paying that and more when you manifest disease, you manifest infertility, you manifest ischemic heart disease down the track. So it's a point that is very important that I don't think people realize. And I think maybe that's simply another reflection of short term thinking and short term mentality that
01:08:52
Speaker
pervades all parts of society and not necessarily just with regard to dietary choice. But yeah, I think it's a mindset shift that happens and needs to happen when people invest in their health through things like
01:09:08
Speaker
Time to work out time to be in nature and time to eat high-quality food rather than seeing it as a burden or a cost because It's it's never a decision that's made in isolation if you're choosing to not eat the regenerative and the Beef and the pasted eggs you're choosing to eat the lower quality food and if that cost is not obvious now as I said, it will be obvious in 5 10 15 20 years and
01:09:35
Speaker
Yeah, I think there's a few different perspectives on that. Like I've seen research that suggests that the higher quality food that you eat, then the less caloric intake that you need or the less quantity of that food that you need to eat. So potentially, you know, the more high quality food that you eat, you're kind of balancing the extra cost against the fact that you have to eat less of it.
01:10:00
Speaker
And I think the other side to that, and it's kind of slipping my mind right now, is no, it's totally gone. It'll come back to me sometime. But yeah, it's a fascinating topic. Here it is. It's back again. So I think if people actually saw what the cost of
01:10:23
Speaker
of their medical expenses was, if they had to pay for their medical expenses themselves, they would soon become acutely aware of the difference between buying high quality food, spending time in nature and exercising as it comes up against paying hundreds of dollars per hour to see a clinician and then paying for the drugs and the surgery on top of that, which enter the tens of thousands of dollars very quickly.
01:10:53
Speaker
Yes, I agree with that. I think that when there's a disconnect from the cost of health care, then it's psychologically either consciously or subconsciously possible to
01:11:07
Speaker
kind of absolve oneself of immediate responsibility because they'll be able to get prescriptions, they'll be able to get a knee replacement, they'll be able to have all these procedures done as part of a publicly funded healthcare system.
01:11:26
Speaker
But when that cost is solely borne by someone as an individual, I do agree. I think the psychology shifts and people will be much more inclined or willing to engage or participate in preventative health decisions because they're simply bearing that cost themselves, personally.
01:11:52
Speaker
And so, yeah, it's something, and it's a little bit of a fraught topic because, you know, socialized and public healthcare system is the crux of, has been, in Australia, it's been something that everyone has become used to, and I wouldn't even hazard the use of the word entitled to for quite a long time.
01:12:19
Speaker
But is that necessarily a system in their best interests? And sure, when it comes to emergency care and a whole range of care, it is. But when it comes to things like preventative care and people are very easily
01:12:39
Speaker
accepting of the high blood pressure medication, perhaps, or they're not as questioning of of layering these prescriptions as they would if they had to bear the entire cost themselves. The other point I want to make is about choosing lower quality food over higher quality food. And this is a point that my friend Jake Walke mentions, is that when you decide to buy that
01:13:05
Speaker
coals chicken, barbecue roast chicken. The reason why you're paying $8.99 for it is because the animal itself is picking up the tab. And what he means by that is that
01:13:22
Speaker
It is subsidising by the fact that it lives in a big shed without access to pasture, without access to its natural ability to express its natural pecking behaviour. It's paying the cost for that cheap chicken.
01:13:39
Speaker
of the price you're paying because it's able to be stuffed into a shed with thousands of its cousins at the same time. So when someone is saying, I can't afford regenerative meat, what they're not consciously saying but expressing with their purchasing decision is that I'm condoning the
01:14:02
Speaker
basically the poor treatment of animals, particularly chicken and pork, in the form of factory-raised and factory-farmed techniques. And I'm pushing the cost, or I'm subsidising my own diet by pushing that onto the animal.
01:14:24
Speaker
So, not to sound like I'm, you know, moralistic or high-horsing or judgment, judging people, but I think that is the reality of why that food is so cheap. And there's always hidden costs. The cost is not only represented in that label, on that barbecue chuck. There's unseen costs that someone is paying for you to get that chicken at that price.
01:14:57
Speaker
We talked a little bit yesterday about pathology testing and I mentioned to you that with all of my clients, I use a series of questionnaires and it can take them between like one and two hours to fill out these questionnaires. And basically what it does is I'll do a physical assessment on them and a lot of the time that's a biomechanical one, but I'll also break down
01:15:21
Speaker
their bodily systems and so these questions categorize the symptoms that they're experiencing and they basically surmise a score and put that score into the bodily system that the symptom is associated with.
01:15:39
Speaker
I guess the reason why I do that is one, what I find with writing programs for people or creating exercise prescriptions is that if someone is unhealthy, if their organs are already taxed, then giving them intense exercises is not an intelligent idea.
01:15:58
Speaker
Um, and the other reason that I do that is, uh, is, is because we're doing the lifestyle coaching side of things. And so we're doing these things in conjunction. And, and one of the things that I often find with people is that, um, they will have recently come from a doctor and you know, the blood tests come back perfectly fine. Uh, liver function is a, okay. But yet when they answer the questionnaires, uh, they have all these.
01:16:24
Speaker
the symptoms that are associated with a backed up liver and maybe that soreness under their right ribcage or maybe it's pimples, maybe it's, you know, the stool is smelling fair or it's not well formed or whatever symptom you can think of that is associated with poor liver health. But all that is to say that, and you answered my question yesterday, but just for the audience,
01:16:54
Speaker
Sometimes the symptoms don't align with the pathology reports. Yeah. And the reason for that could be multifaceted, but essentially these individual biomarkers are reductionist and incomplete and not very granular representations of optimal function.
01:17:23
Speaker
So when we measure your ALT or your AST or your GGT, which are all, they're basically enzymes. They're enzymes that exist in or on the cell membrane or inside the liver hepatocyte, the liver cell. They get expressed or detected in the serum when there's cellular damage.
01:17:52
Speaker
And it can be the case that a patient might have to be far, far along or far down the track in terms of dysfunction before those biomarkers are flagging kind of positive.
01:18:10
Speaker
And in some cases with reference, we talked about reference ranges, some labs have a pretty high reference range for an ALT. So, you know, cases of suggestive of fatty liver with mild elevated ALT will go miss. And perhaps that clinician isn't aware of what is, you know, a healthy ALT in a non-obese, non-metabolically dysfunctional population. But often the case is that simply
01:18:39
Speaker
The test itself is an imprecise proxy of optimal health. And it is, again, it's a reductionist view and it's useful. It's useful for us when we're detecting and treating Frank hepatitis, when we're monitoring drug responses and monitoring adverse effects of certain necessary medications. But as a tool of
01:19:07
Speaker
assessing optimal health, it's incomplete and it's not necessarily something to be relied on. And again, it's something that is giving us information about those bottom two steps between the dying and the surviving. And if someone is trying to get to that next level,
01:19:28
Speaker
it's not necessarily something to rely on. I think it's a good opportunity to think about or to talk about what are the most optimal biomarkers for health.
Beyond Standard Health Metrics
01:19:42
Speaker
If your listeners are interested, I'd recommend checking out my podcast with Dr. Sean O'Mara.
01:19:49
Speaker
because he is a lifestyle optimizing physician in the US. What he does with his patients and what I'll be looking to do as well is basically whole body MRI with particular emphasis on the abdomen and the pericardium and the liver and I guess the upper quadriceps. What we're looking for is ectopic fat deposition.
01:20:18
Speaker
And in that situation, the indication of visceral fat in the abdomen or ectopic fat around the pericardium is a great indicator for proxy for optimal health. And if people are carrying visceral fat, it's metabolically active tissue, it's
01:20:41
Speaker
pro-inflammatory, then all manner of obscure and nagging symptoms will disappear when that visual fat is lost. All that to say that certain biomarkers are better than others for indicating disease or helping us get to optimal health
01:21:03
Speaker
And I'm more and more inclined to believe that instead of pathology, as in blood testing, things like visualizing visceral fat directly with a modality like MRI is probably not only the best way to identify or show people where they can improve, but also to help track progress and I guess stimulate behavior change and lifestyle change.
01:21:32
Speaker
And so I guess what you're talking about is a multifaceted approach where you're using perhaps, well, the method that you just referenced, but also, you know, asking people what their symptoms are and then combining that with pathology testing. So you're getting more of a holistic view to overuse that word once again.
01:21:56
Speaker
Yes, but also not trying to rely too much on the pathology in the way that, as you said, people might feel crap, but the pathology is pristine. What that I have to often say to patients is,
01:22:15
Speaker
Again, this is just telling me that you're not having an acute severe problem right now, but it doesn't necessarily mean that you're feeling amazingly. If we're thinking about, again, it's like, what's a better biomarker?
01:22:33
Speaker
And as long as people are maintaining a degree of visceral fat, which is what I use at the moment is simply a waist to height ratio. And if you measure your waist and your height, and if your waist is more than half your height for guys or more than 4.48% or 48% for women, I'm not surprised if there's a range of nagging symptoms.
01:22:58
Speaker
that can be anywhere from irritable bowel, diarrhea, predominant irritable bowel to just for general fatigue. All of these kind of can get tied up or can spring from the carrying of excess visual fat and a degree of insulin resistance that goes along with that. So again, rather than fixating on specific blood markers, let's assess
01:23:27
Speaker
appearance and performance. And let's look directly, if possible, at, you know, the presence of something like visceral fat. And I think that that is probably a more robust way of of helping people health optimize.
01:23:51
Speaker
And by the sounds of it, I probably should have asked you this earlier, but you're not a one and done doctor. You're not a revolving door counter doctor. I can't imagine like you're not getting the results that you're getting with your patients by seeing them in 15 minutes and then, you know, see you later. Thanks for the advice.
01:24:13
Speaker
No, not at all. I have 30-minute slots, so I see patients and some people, if it's just a regular GP issue, then yeah, it doesn't take very long. But for people who want to go into or explore why they're feeling unwell or they want to start,
01:24:33
Speaker
getting rid of visceral fat then yeah i take the time too and it does take time so no i'm not i'm not just uh you know printing out a piece of paper and hustling people out of my room in in seven minutes that's for sure
01:24:49
Speaker
And so I guess you fall slightly into the coaching category with that, right? So your coaching skills are, is that something you're working to develop over time? Like is that a field of interest for you? And what are you pursuing right now insofar as your fields of interest? Like is it purely metabolic health and light and things like that?
01:25:17
Speaker
Yeah, you're right. And it's it's a good point because when we're going again, like we to reference those three steps, if we're helping people go from, you know, just surviving to to thriving, it is a coaching. It's a lot of it is coaching. And so, yeah, it's something that I'm working on and always, I guess, learning and learning off learning off my patients as well. That's a very interesting thing that they don't tell us in in
01:25:46
Speaker
medical school or any kind of other formal training is that the amount that we learn from hearing our patient's stories and hearing their experiences in response to advice that we've given them and what works and what doesn't work, that is incredibly powerful.
01:26:02
Speaker
So I'm definitely emphasizing the coaching and lifestyle coaching aspect to things in terms of reversing metabolic disease. But my interests are quite broad and they lie in weight loss, again, reversing
01:26:20
Speaker
diabetes, type 2 diabetes, fatty liver disease, polycystic ovary syndrome, helping patients come off high blood pressure medications and come off diabetic medications, but then also just general health optimization for younger people. Commonly that looks like helping people, again, reverse acne and optimize their health prior to falling pregnant.
01:26:48
Speaker
and for men and for women, because I believe that if you have optimal health, you're going to be optimally fertile. And absence or sub-fertility is simply a reflection of a sub-optimal environment and sub-optimal lifestyle and sub-optimal diet. So those are kind of my interests, which are, I guess, going from
01:27:15
Speaker
Yeah, the various facets or shades of reversing disease, but also optimizing health. I guess I'm lucky and I feel grateful that I am in a position where not only can I do
01:27:30
Speaker
you know, health optimization in coaching in the way that you can Nick, but also help people who are much sicker and people who are on medications, guide them in a medical way to get off some of the medications that they don't need to be taking if they had made the changes to optimize their lifestyle. So,
01:27:53
Speaker
It's very broad and I'm the opposite of a specialist and I guess that's why I fell into general practice training because I think that the holistic approach needs a general approach and to hone in on only one organ system is to miss the forest from the trees.
01:28:18
Speaker
You know, my, my ability to comment on this is probably limited, but I think, uh, I think the medical field has, has, you know, it's, it's, it's hip to be, or it's cool to be a specialist. And, you know, we have a lot of admiration for specialists, but, um, if you, if you don't understand how these systems interrelate with each other, then you can't, you can't, uh, you can't help someone as much as, as someone like you could.
01:28:46
Speaker
Yeah, and I had an interview with a really lovely GP, Dr. Penny Figtree, who works in Port Macquarie.
01:28:55
Speaker
Um, and she makes the point that, you know, she sees patients and again, they've got a specialist for every disease system. Uh, and she just watches them, you know, year after year, get sicker and sicker and sicker. And the specialists are just increasing their dosages, their, of their medications, adding new medications to simply treat, um, their own siloed interpretation of what's growing wrong with the patient.
01:29:24
Speaker
When Dr. Victory puts these patients on a low carbohydrate diet and gives them effective lifestyle advice, their need for these medications evaporates and their need for specialist input evaporates. What that just shows is that
01:29:44
Speaker
This siloing approach clearly isn't working in terms of helping people optimize or to live a healthy life. It takes someone who can see everything and all the parts of it to really make progress and to achieve an optimal outcome with regard to that patient holistically.
01:30:11
Speaker
Yeah, I think we could chat forever on this topic and one of the things that I've seen fairly commonly is premature referral to orthopedic surgeons and there's the old saying, you buy your orthopedic surgeon and you Mercedes or a new BMW, but I've literally seen people who haven't been to
01:30:32
Speaker
Haven't even had a referral to a physio get dyscectomies and, you know, and fusions and all these sorts of things. And they're told it's the only option. And, you know, it's even funny for me to see, even without prescribing corrective exercise for someone or, you know, working on their transverse abdominis, like getting the pelvic floor working and that sort of thing for back pain again, just changing someone's diet and lifestyle can have a significant impact on
01:31:02
Speaker
their pain because when you reduce inflammation and perhaps when you reduce abdominal distension through bloating and all of these things, then you no longer have the pain or the pain becomes less because of the reduced inflammation.
Awareness of Health and Lifestyle Impact
01:31:16
Speaker
And so what you may find is that
01:31:21
Speaker
Perhaps you no longer have to get surgery just for diet and lifestyle changes or perhaps you delay the need for it. It's not something that you have to do immediately because you're no longer in acute or chronic pain. And so again, I'm just highlighting.
01:31:41
Speaker
The holistic nature or the, you know, the body, I like to describe it as a system of systems and so, you know, or a cybernetic system. Fixing one system or working on one system affects the rest inevitably.
01:32:03
Speaker
Dr. Amara went through his process of identifying visceral fat as his target of his work because he worked with a doctor who was MRIing people for lower back pain in the US and the reason or the key
01:32:21
Speaker
I guess associational factor with the severity of the back pain wasn't in fact pathology in the spine it was or it wasn't in terms of disc degeneration it was the presence of visceral fat.
01:32:36
Speaker
And as you said, it's highly, as I mentioned, it's highly inflammatory. And the state of having that kind of inflammatory tissue in your body and around that area was kind of provoking symptoms. So yes, it 100% makes sense that we can do so much before
01:32:55
Speaker
And we need to operate to improve people's symptoms. And the onus is on, that's why I do what I do is because I believe that the onus is on the doctor to actually give patients effective lifestyle advice. And we have a protocol in our training about
01:33:18
Speaker
you know, smoking, nutrition, alcohol, physical activity in terms of, you know, box ticking exercise to tell patients. But I don't think in so many cases that that that advice that's been given is actually meaningfully helpful.
01:33:34
Speaker
And again, it's not the individual practitioner's fault, and I'm not blaming colleagues by any means, but it's simply what we were taught and what is being pushed down from higher up. The point is, though, that when the patients are empowered with that correct lifestyle advice,
01:33:52
Speaker
they do really make often make things like surgery either unnecessary or highly delayed. And another good interview, I talked to orthopedic surgeon Sydney Dr. Doron Schur and he has that exact effect because he puts his joint replacement patients on a lower carb diet and often sees them not needing to even need replacement or in many cases delaying for many couple of years.
01:34:21
Speaker
So yeah, there's lots to be done and there is so much that can be done before you go for the nuclear option like surgery for sure.
01:34:32
Speaker
One of the things, and you may be already aware of this, but I'll share it anyway, is what I found, and I found this, I found it in practice, I didn't come up with it myself, is that oftentimes food intolerances or allergies can cause such abdominal distension that it actually shuts off the transverse abdominis and the pelvic floor. And so you see people with abdominal distension and bloating who can't activate that transverse abdominal.
01:35:02
Speaker
And as a result, uh, incur injury at work or, you know, develop a chronic back pain and the root cause of it is a food intolerance. Crazy. Yeah. Fascinating. Hmm. So is there anything else you'd like to discuss before we wrap it up? I think we've had a pretty in depth conversation. I've thoroughly enjoyed it.
01:35:29
Speaker
Yeah, no, it's been great, Nick. I don't think there's anything other than I guess I'd re-emphasize the point that we made earlier, which is I'd encourage everyone to tune in to their own
01:35:45
Speaker
i guess body and their own symptoms and make a mental note of how they feel and how when they eat certain food or when they're i guess going about their their their life and what once that
01:36:02
Speaker
that ability or that sensation is tuned and you're able to start making changes and be more aware of how they are making feel and how they are benefiting you. So yeah I would encourage everyone to
01:36:19
Speaker
cultivate that inner doctor in themselves, especially when it comes to dietary and lifestyle. Obviously, if you're medicated, then come and see someone like me before you change your medication protocol. That's very important. But if you're simply on that middle stage, if you're just surviving, you're not thriving, then the first step is to realize what
01:36:44
Speaker
that you don't feel well realize or have an idea that you can feel better and then start making a mental note of of what different factors in your life make you feel and then as you make changes and even a small smallest
01:37:01
Speaker
cutting out some processed food to start with, reducing the amount of refined grains you're eating, even just making those minor changes and seeing how that makes you feel, that is kind of the first step to getting to that thriving state. So yeah, I guess I'd emphasize that point.
01:37:21
Speaker
Yeah, and I think I take that to mean like simplifying, right? Like just make things a little bit more simple and, you know, instead of having to be perfect today, try cutting out refined foods or a refined food.
01:37:39
Speaker
And, you know, I think that the simplicity of a carnivorous diet is exemplified by the fact that it's also an elimination diet, right? So, you know, you're cutting out a lot of the bad stuff straight away and people start to feel really good pretty fast. Exactly. Yeah. Yeah. And big fan of the carnivore diet here for those reasons.
01:38:07
Speaker
Very good. Well, thank you for your time. I appreciate it. And I hope to talk to you again soon. Thanks, Nick. Where can people find you, Max?
01:38:17
Speaker
Yeah. So if you go on to, uh, find my podcast, the regenerative health podcast, where I'm interviewing, uh, doctors and lifestyle doctors and, uh, health optimization practitioners and regenerative farmers. So that's, um, can be found on Apple podcast, Spotify, and all the major podcasting platforms. And I'm also on Twitter.
01:38:41
Speaker
at MaxGulhainMD and Instagram, Doctor underscore Max underscore Gulhain. So yeah, that's where you can find me. And yeah, you can send me a DM or send me an email regenerativehealth at proton.me if you want to get in touch.
01:39:04
Speaker
Awesome. And I thoroughly recommend or really recommend giving your podcast a listen. You have some great guests and you got a great line of questioning and I think that people could learn a lot from it. So thanks for your time. Thanks, Nick.