Latest / The Dr Louise Newson Podcast / 23 - The truth about GLP-1s, weight loss and nutrition with Dr Jack Mosley

Transcript

23 - The truth about GLP-1s, weight loss and nutrition with Dr Jack Mosley · The Dr Louise Newson Podcast

• 0:00
  Some of you might know already, but this podcast has been
• 0:03
  nominated by the British Podcast Awards for the listeners choice.
• 0:08
  So we really need your votes because it would be such an
• 0:11
  honour and thrill to do well in this.
• 0:13
  So if you go to the show notes and click on the link, it won't
• 0:16
  take you long. Please just vote for us.
• 0:19
  Thank you so much. On my podcast today, I've got
• 0:25
  Doctor Jack Mosley, who's AGP registrar and an author.
• 0:29
  He's also the son of the late Doctor Michael Mosley.
• 0:33
  We have a conversation about nutrition, about GLP ones, what
• 0:37
  they're good at doing and what perhaps they're not so good at
• 0:39
  doing. And we talk about fat, the role
• 0:42
  of fat, how it can be detrimental for our future
• 0:44
  health, and also obviously talk about hormones.
• 0:48
  So it's a great conversation. Hope you enjoy it.
• 0:53
  So Jack, great that you're here from Manchester, which makes me
• 0:57
  feel very nostalgic because I spent many a happy year in in
• 1:01
  Manchester. And actually you did some of
• 1:04
  your GP training where I did my GP training.
• 1:06
  So small world. Yeah.
• 1:08
  Thank you so much for having me. And like you were saying, we've
• 1:11
  we've worked in some of the same hospitals, some of the same GP
• 1:15
  practices as well. Which is.
• 1:17
  Very interesting. But you know, medicines really
• 1:19
  changed. So it was 25 years ago that I
• 1:21
  became AGP and you know, we didn't, we had a bit of obesity,
• 1:27
  but not much. The NHS was not on its knees as
• 1:31
  it is now. It was, we were really, we've
• 1:35
  always been really holistic in our care.
• 1:37
  But it now it's just everyone's shattered, everyone's, the
• 1:41
  system's broken. And I was in hospital a year ago
• 1:45
  when my, my middle daughter fractured her pelvis.
• 1:47
  And I was really shocked by not just the patients, really a lot
• 1:53
  more overweight than patients that I looked after when I was
• 1:55
  in hospital, but the staff as well, actually.
• 1:58
  And then it's impossible to get food in a hospital, like
• 2:01
  impossible to get fresh food in a hospital, you know.
• 2:04
  So it's, the system is, is set up to fail us in the way when
• 2:10
  we're thinking about obesity and being overweight.
• 2:14
  It's so easy to put on weight, isn't it?
• 2:17
  Without a doubt, I think we live in this toxic food environment.
• 2:21
  We're surrounded by these processed junk foods wherever we
• 2:24
  look. And these foods are, they're
• 2:27
  designed to be addictive and they're designed to overwhelm
• 2:30
  our, you know, unnatural satiety sense and that, you know, sense
• 2:35
  of fullness. And like you say, it's actually
• 2:38
  very relevant for the NHS on so many levels.
• 2:41
  And not just the patients, but the staff too.
• 2:44
  So when you go to hospital, a lot of the canteens, they're
• 2:48
  very beige food. You've got, you've got, you
• 2:52
  know, vending machines all over the hospitals.
• 2:55
  So especially when people are so stressed, they are, they're not
• 2:59
  reaching for the broccoli. They're not reaching for the
• 3:01
  veg. Yeah, they are reaching for, you
• 3:04
  know, those unhealthy snacks like the Mars bars, the
• 3:08
  chocolate bars, the crisps. And it's easy to eat badly.
• 3:12
  You know, I've always looked at my diet, but I wasn't taught
• 3:16
  much at medical school about nutrition.
• 3:17
  Most of what I've done is I've learnt myself.
• 3:21
  But I had pancreatitis a few years ago and was really ill.
• 3:24
  And I really, really then looked at my nutrition.
• 3:27
  Was there anything I could do to help the pain and discomfort I
• 3:29
  got after? And then I have migraine as
• 3:31
  well. So if I ate ready meal, it would
• 3:34
  trigger a migraine. So I'm sort of lucky and not
• 3:36
  lucky that I can't just eat awful food.
• 3:39
  But it is so easy now, more than it ever has been.
• 3:44
  But sometimes it's when we have something that happens to us and
• 3:47
  we realize that we feel so much better eating well then it it
• 3:51
  spurs you to think about your patients.
• 3:53
  And I know you know, your late, your late father Michael was an
• 3:56
  incredible, incredible man, educator, like just the way he
• 4:01
  thought it beyond the books. But he had an experience, didn't
• 4:05
  he, where he changed his nutrition and, you know, looking
• 4:09
  at type 2 diabetes and trying to prevent disease as well with and
• 4:13
  treat disease with food, which was a bit out there when he was
• 4:18
  started to talk about it, wasn't it?
• 4:20
  Yeah, without a doubt. So he famously was able to
• 4:24
  reverse his own type 2 diabetes through diet, which the medical
• 4:28
  establishment at the time thought you know, type 2
• 4:30
  diabetes is this chronic condition.
• 4:33
  You just take more and more pills and eventually end up on
• 4:36
  insulin. After around 10 years, he was
• 4:39
  able to lose around 10 kilos. It's a loss of weight.
• 4:43
  Yeah, no, it's a significant amount of weight and a lot of
• 4:46
  that weight goes, you know, initially actually off your
• 4:49
  liver and your, your visceral fats.
• 4:53
  And he was able to lose that weight and keep it off and stay
• 4:57
  in remission of type 2 diabetes. And I think I completely relate
• 5:00
  to this. Having their own personal
• 5:03
  experience makes a huge difference.
• 5:04
  In fact, you know, I've, I've always been quite skinny.
• 5:08
  I, I thought I couldn't put on weight, but I, when I started
• 5:11
  work as a junior doctor and I managed to put on 15 kilos of
• 5:16
  weight in, Yeah, within the first year of work as a junior
• 5:19
  doctor. And like I said, it comes back
• 5:21
  to that. It's that you're very stressed
• 5:23
  as you don't know your place in the hospital.
• 5:26
  I was commuting to work a hour each way, you know, munching on
• 5:30
  sweets and, yeah, again, eating beige food in the hospital,
• 5:35
  eating celebrations given by. Really grateful.
• 5:39
  Patients because. Exactly.
• 5:41
  No, without doubt. So I think it's so easy to put
• 5:44
  on weight in this in this day and age.
• 5:46
  And I think that's a lot to do with the environment, really.
• 5:48
  That's a lot. I mean, I know you're tall, but
• 5:51
  yeah, but that's a lot of weight.
• 5:52
  And so how did you lose it? I, I lost it just by making kind
• 5:57
  of small changes over time. I, you know, I started cooking
• 6:00
  some of my own food. I, I stopped eating sweets on
• 6:04
  the way to hospital. And, you know, I think I was
• 6:07
  lucky that my, my parents taught me quite a lot about, you know,
• 6:10
  cooking and eating well and that sort of thing.
• 6:12
  So I didn't make any drastic changes, but I just, you know,
• 6:16
  made a few small changes and started.
• 6:18
  I'd kind of stopped exercising as well, which I think was
• 6:22
  adding to my stress. Yeah, it's, it's interesting
• 6:25
  because obviously your, your mum's amazing cooking because
• 6:28
  she's devised so many recipes and everything else.
• 6:31
  And it's very easy to look at your mum and dad, you know, your
• 6:35
  mum's really lean, she's got probably got a very good
• 6:37
  metabolism as well. But knowing your father in later
• 6:41
  years, he just looks so healthy and lean.
• 6:44
  So it's easy to think, oh, he's lucky.
• 6:46
  But actually he worked at it and really changed his nutrition,
• 6:50
  didn't he? He definitely, you know, he was
• 6:53
  addicted to chocolate and he had a massive sweet tooth.
• 6:57
  So, and I think that's what made him so relatable because, you
• 7:01
  know, he was saying, you know, he thought willpower was
• 7:05
  overrated and but you had to his whole idea was really ingraining
• 7:12
  these healthy habits and making sure that, you know, you set up
• 7:17
  your own food environment so that you weren't tempted by
• 7:21
  these foods. You know, he, like I said, he
• 7:23
  famously ate all our chocolate eggs.
• 7:26
  This was before he, he changed his ways, but he was definitely
• 7:31
  a chocolate addict and he he just managed to really change
• 7:35
  his diet and lose his weight and keep it off.
• 7:37
  And I think that's what was so made him so inspiring to people.
• 7:41
  And I do think, you know, as a doctor and a patient, as
• 7:46
  patients, we have to have responsibility for our health.
• 7:48
  We can't just expect people to medicalise us and treat us all
• 7:51
  the time. And I mean, I used to have
• 7:53
  really sweet tooth and I've never been particularly
• 7:57
  overweight, but I was bigger as a medical student as I than I am
• 8:01
  now. And that's probably because I
• 8:01
  was drinking alcohol, which I don't drink now, and eating
• 8:05
  rubbish like you say on the wards you're doing on call.
• 8:07
  Like what else do you do? It's really difficult.
• 8:10
  So you go to the vending machine.
• 8:12
  You get some stuff from the, you know, the nurses station if it's
• 8:15
  three in the morning and you just want to keep, keep awake
• 8:18
  and then having three children when you're awake, you know, I
• 8:22
  just didn't look after myself in the same way.
• 8:24
  But then you start to feel better.
• 8:26
  And now my blessing and curse is migraine because it stops me
• 8:29
  eating junk food and I have to be really prepared.
• 8:33
  I always make food and I always have it in a little yoghurt pot.
• 8:35
  So I'm out and about and I've got something there or I've got
• 8:38
  nuts or whatever as a snack. But for most people it's not so
• 8:43
  easy. And I can see, you know,
• 8:45
  whenever you go and fill up with petrol, like there's nothing
• 8:48
  that I would eat in those places or drink actually, other than
• 8:52
  maybe some water. But it's, it's impossible often
• 8:56
  for people to access food. So we do have an obesity crisis,
• 9:01
  don't we? We definitely do.
• 9:03
  And like you say, well, for you, I mean, you've gone through some
• 9:07
  horrible experiences, like pancreatitis is extremely nasty.
• 9:10
  You know, migraines are very, very nasty to some people.
• 9:13
  Can leave you incapacitated for a few days.
• 9:16
  I think, you know, not everyone even knows how big a role
• 9:18
  nutrition does play in that, which is interesting as well.
• 9:22
  And yeah, the petrol station example is so relatable to
• 9:26
  everyone because how easy is it to, I mean, how hard is it to go
• 9:31
  to the petrol station and not pick up that bar, the the sweets
• 9:35
  or the chocolate bar on that long journey?
• 9:39
  And I think it's also interesting when when you are
• 9:41
  stressed. So, you know, stress serves a
• 9:46
  useful evolutionary benefit, especially in the wild, because
• 9:51
  you get that sugar rush and you're prepared for the fight or
• 9:54
  flight. But when it's chronic, then you
• 9:56
  have that constant sugar in your bloodstream and the cortisol, it
• 10:00
  can really lead to these maladaptive eating habits.
• 10:04
  And that, like what you're alluding to is either a vicious
• 10:06
  cycle or a bit of a virtuous cycle of when you're not feeling
• 10:11
  well and when you're feeling stressed, you can, you know, you
• 10:13
  eat rubbish, then you feel worse and then it gets into this
• 10:17
  vicious cycle. It's very hard to get out of it.
• 10:21
  And I'm, I'm very interested in, you know, the role of insulin
• 10:24
  with other hormones as well. So cortisol and insulin are very
• 10:28
  closely together, don't they? And, and, you know, it's, it's
• 10:32
  sort of since I qualify, people talk more and more about, you
• 10:35
  know, the, the sugar peaks and troughs, the insulin being
• 10:39
  coming squeeze out of the pancreas.
• 10:41
  And, and that has a real effect on the pancreas.
• 10:44
  The pancreas gets tired, the system gets tired.
• 10:47
  And, you know, this metabolic syndrome that occurs is actually
• 10:52
  very common, but also fat cells. Lots of people think that fat is
• 10:58
  just a bit of blubber. And you've already said
• 11:01
  something about visceral fat. So the internal fat around our
• 11:04
  hearts and our digestive system is very different to the fat on
• 11:08
  our externally, sort of on our thighs or bottoms or whatever.
• 11:12
  But fat is metabolically active, isn't it?
• 11:15
  Yeah. So the yeah, so you've got
• 11:18
  those, some of the two kind of key fats that we talk about are,
• 11:24
  yes, visceral fat, which is that nasty metabolically active fat
• 11:28
  that clings to your organs and causes, you know, it clogs up
• 11:31
  your liver, it clogs up your pancreas and can lead to all
• 11:34
  sorts of health problems like type 2 diabetes, but can also
• 11:38
  lead to, you know, cardiovascular disease, heart
• 11:40
  disease, stroke. And then you've got, the more
• 11:44
  you've got that subcutaneous fat that's under the skin, which is
• 11:48
  a lot safer type of fat. And actually that's not really
• 11:52
  metabolically active in the same way.
• 11:54
  And yeah, there's the, there's a kind of concept of the personal
• 11:59
  fat threshold where people beyond a certain weight, you
• 12:06
  know, that fat kind of starts over spilling.
• 12:09
  So it goes from the subcutaneous fat and starts clogging up your
• 12:14
  your belly really. And that's really the dangerous
• 12:16
  fat. Yeah.
• 12:17
  And I'm very interested in inflammation and we've got lots
• 12:20
  of cytokines that chemicals from our fat cells, our adipocytes
• 12:24
  that that get released into the system and increase inflammation
• 12:28
  in the body even more. So it's so it's important.
• 12:32
  It's not just how we look, it's what's going on in our systems.
• 12:36
  And as doctors, obviously we treat diseases, but we want to
• 12:39
  prevent diseases as well, don't we?
• 12:41
  And it's, it's so important. So you've written this book,
• 12:45
  Food Noise, how weight loss medications and smart nutrition
• 12:49
  can silence your cravings. And I really like this smart
• 12:53
  nutrition because like, I really enjoy food, but I think the
• 12:57
  trick is being able to eat and then not feel hungry.
• 13:01
  It's quite a good hat though, isn't it?
• 13:03
  Exactly. Yes, I wrote that the book Food
• 13:06
  Noise, because I was kind of, I was seeing how the GOP ones were
• 13:11
  really sweeping the world. There was this fascination about
• 13:15
  that and for for good reason, because they are very effective
• 13:19
  at weight loss. But people, you know, people
• 13:24
  don't a lot of people don't necessarily understand the risks
• 13:27
  and rewards, the side effects and how to manage them.
• 13:30
  And that these are they're not magic bullets.
• 13:34
  These are really powerful drugs. So we really need to approach
• 13:38
  them with kind of care and knowledge, I think and.
• 13:41
  I think that's crucially important.
• 13:42
  So when I was at Manchester Royal Infirmary in the 1990s, I
• 13:46
  was working with an upper GI surgeon and they started in
• 13:51
  gastric bandings, which shows how old I am.
• 13:53
  But it was a revolutionary weight loss treatment.
• 13:56
  And so they would see the patients, would see a
• 13:57
  psychologist beforehand and then they would have this banding and
• 14:01
  that. I'm sure you know, the first
• 14:03
  branding operations, they were far too tight.
• 14:05
  So literally people could only have a thimble full of food and
• 14:08
  women would come back to go, this is amazing.
• 14:10
  I've lost X number of dress sizes.
• 14:13
  I'm really slim. But then their hair would start
• 14:15
  to fall out, their nails would split.
• 14:17
  They couldn't get any vitamins in.
• 14:19
  And then we realized a lot of people were using things like
• 14:22
  having things like quavers crisps and liquidizing them to
• 14:26
  get them so that they were, you know, really small volumes.
• 14:28
  So they would still be eating rubbish, but they were
• 14:30
  nutritionally they would not be well at all.
• 14:33
  And a lot of them then had their banding reversed.
• 14:36
  So then it made me really, we need to think about this
• 14:39
  relationship with food. It's very different to alcohol
• 14:42
  and and smoking, which are optional.
• 14:45
  No one has to drink or smoke, but we have to eat.
• 14:49
  But if you haven't had, you know, you've grown up in a
• 14:51
  household where food is really important and it's cooked from
• 14:54
  fresh. But if people haven't and then a
• 14:57
  lot of these foods, like you say, they are addictive.
• 15:00
  We know they're addictive, but they also then people crave it
• 15:04
  if there's an addiction. So they've got this cycle.
• 15:07
  So GLP ones like you say do have a role, but but they're and I
• 15:12
  think in the book you're very clear that they're not really
• 15:15
  the first go to a lot of people. Yeah.
• 15:19
  So, and that's what I kind of tried to highlight in the book.
• 15:22
  I'm, I'm not necessarily for or against these medications, but,
• 15:27
  and they can be really beneficial to certain people who
• 15:30
  are living with obesity, who living with an obesity related
• 15:33
  diseases and have tried a lot of these other dietary options.
• 15:38
  Because it is like we talked about earlier with the food
• 15:40
  environment, it is very difficult for some people in
• 15:42
  this food environment. And as well as some genes also
• 15:47
  play quite a big role in weight with regards to, I think the key
• 15:53
  with these weight loss medications, if you are to do
• 15:55
  them is to make sure you are eating this nutritious food.
• 16:00
  We're we're overfed, but we're undernourished.
• 16:02
  So people are really eating these kind of calorie rich but
• 16:06
  nutrient poor foods. So like you say, back in the
• 16:09
  day, you know, you'd be liquidizing Mars bars, eating
• 16:13
  Quavers. So that can lead to its own form
• 16:17
  of problems. And they did a study in America
• 16:20
  that showed half of people living with obesity have some
• 16:23
  micronutrient deficiency already.
• 16:25
  So you could be exacerbating that problem if you don't change
• 16:27
  your diet and if you don't change your lifestyle.
• 16:30
  So I think if you are thinking of taking these weight loss
• 16:32
  medications, you need to really think about as an opportunity to
• 16:36
  change that those lifestyle behaviours without that pesky
• 16:41
  food noise that can. Yeah.
• 16:42
  And that food noise is, is really, it can take over a lot
• 16:47
  of people's lives. And what some people who I know
• 16:50
  who have taken GLP ones has said that they just don't feel hungry
• 16:53
  and they love it. But then they don't go out for
• 16:56
  for to the restaurant. They don't go to people's for
• 16:58
  supper or, you know, they've had to adjust the amount that they
• 17:01
  eat, but then they're not enjoying food in the same way.
• 17:04
  And that that can be really restrictive, actually content.
• 17:07
  Yeah. I think it's a very interesting
• 17:11
  time that we live in, in that, you know, already people are
• 17:14
  probably become a bit more socially isolated.
• 17:17
  I think food is a very binding experience.
• 17:21
  You know, a lot of our socializing does revolve around
• 17:24
  food. So once you remove that, then
• 17:26
  that could be an issue. And especially, yeah, people may
• 17:31
  not be going out for dinner. They may not be doing dinner
• 17:33
  parties in the same way, that sort of thing, or even having a
• 17:36
  kind of family dinner in the conventional way.
• 17:39
  So, so there are, you know, this is going to have a massive
• 17:42
  impact on the whole of society, I think.
• 17:46
  Yeah. And so with with sugar cravings
• 17:49
  and food cravings, I see it a lot in women.
• 17:52
  Obviously I see a lot of women in the clinic and we see a lot
• 17:55
  of menopause of women, perimenopausal women, but also a
• 17:58
  lot of women with premenstrual syndrome, PMS and premenstrual
• 18:01
  dysphoric disorder, PMDD. And I used to get it before I
• 18:05
  had my periods this few days before you're just like, oh, I
• 18:07
  just want to eat chocolate. I just want to eat a real carb
• 18:09
  craving. And I thought, oh, maybe it's
• 18:11
  just in my head. But then my period would come
• 18:13
  and I'd feel fine and I wouldn't wouldn't make wouldn't need that
• 18:17
  in the same way. But we know that these hormones,
• 18:20
  estrogen, progesterone and testosterone actually have
• 18:22
  really important cardiometabolic functions.
• 18:26
  And so insulin can be really altered when we don't have
• 18:31
  estradiol and progesterone in our bodies.
• 18:34
  So a lot of women that we see when we balance their hormones,
• 18:38
  their metabolism can change, their cravings can reduce, but
• 18:43
  also their ability to just function, You know, their brain
• 18:46
  comes back, but also their bodies as well.
• 18:48
  They're more likely to exercise, more likely to have the
• 18:50
  motivation to cook. And I feel it's a shame if
• 18:53
  they're going to like the GLP ones before having their
• 18:56
  hormones balanced. Yeah, I mean, it's really,
• 18:59
  really important because like you say that period around
• 19:03
  perimenopause and menopause, your hormones completely change
• 19:07
  and the the decline in estrogen and testosterone and
• 19:11
  progesterone, they can have big effects on you, especially
• 19:15
  changing in body composition. So we kind of talked about that
• 19:20
  visceral fat and the subcutaneous fat a lot before
• 19:24
  menopause. A lot of it that fat is more
• 19:26
  stored in subcutaneous, but it can kind of navigate to visceral
• 19:29
  fat through menopause. Also things like muscle loss can
• 19:34
  accelerate at menopause and other things like osteoporosis.
• 19:41
  So that's where there, you know, these GOP ones, there are some
• 19:46
  beneficial effects potentially if people are able to lose
• 19:50
  weight on them. But then you also have these
• 19:53
  other factors like we know one of the risks of GOP ones is that
• 19:58
  a significant amount of the weight you lose is is muscle or
• 20:02
  lean body mass. And I do also have some concerns
• 20:06
  for it could. In certain people who aren't
• 20:09
  eating the right nutrition, it could actually potentially
• 20:12
  exacerbate things like osteoporosis, especially I think
• 20:16
  in menopausal women. And that's a real concern
• 20:18
  because we know osteoporosis is really common.
• 20:20
  Some some people quote one in two menopausal women.
• 20:23
  And certainly one of the reasons I take hormones is to protect my
• 20:26
  bones and try and keep them strong.
• 20:28
  But osteo sarcopenia, long word bone loss and muscle loss as we
• 20:35
  don't have hormones is really, really common.
• 20:38
  And it's sort of been ignored for a long time.
• 20:41
  You know, frail old ladies with their Zimmer frames, but
• 20:43
  actually they've lost their muscles, they've lost bone
• 20:46
  density, they've lost their hormones.
• 20:49
  So thinking about preventative medicine, giving hormones will
• 20:52
  help their muscles, it will help their bones.
• 20:55
  But with the GLP ones, if they're losing bone density,
• 21:00
  they're losing muscle and their menopausal, it's like a double
• 21:04
  whammy, isn't it? It can be.
• 21:06
  Yeah. And I think there are.
• 21:08
  Yeah, there are exactly. There are definitely risks
• 21:10
  there. And, you know, we know from the
• 21:14
  studies that 25 to 40% of the the weight you lose is is lean
• 21:21
  body mass. And a main component of that is
• 21:23
  muscle. And you know, muscle is so
• 21:26
  important for longevity, but also, you know, living healthy
• 21:33
  independent life in later age. Yeah.
• 21:35
  So kind of living happy and independent, which is just
• 21:37
  obviously so important to so. Many people, but also muscle is
• 21:41
  metabolically active. We've talked about fat cells
• 21:43
  being metabolically active in a negative way, yeah, but muscle
• 21:47
  is actually very metabolically active in a positive way.
• 21:50
  So people who have more lean muscle, yeah, their metabolism
• 21:54
  is going to be different actually.
• 21:56
  And muscle can produce lots of hormones as as well and very
• 21:59
  anti-inflammatory substances. So people might look the same
• 22:03
  externally, but their body composition and we, we have a
• 22:07
  DEXA scan in the clinic and you can see the difference
• 22:10
  internally. So where that visceral fat is,
• 22:12
  where their muscles are, it's really important, isn't it?
• 22:15
  Yeah. No, it really is.
• 22:17
  And I think that the body, yeah, body composition, I mean, there
• 22:22
  are limits to BMI, which is a kind of normal assessment of who
• 22:26
  is health described as healthy, overweight, living with obesity.
• 22:30
  But that body composition is so important because some people
• 22:34
  unfortunately do have more visceral fat than others.
• 22:36
  Some people like say, have more muscle than others.
• 22:39
  And during that perimenopause and menopausal period, so from
• 22:46
  the age of around from the age of your early 30s, you start to
• 22:50
  lose 5% of your body weight every decade.
• 22:55
  So 5% of your muscle mass every decade.
• 22:58
  And that can really accelerate from 60s onwards.
• 23:00
  So you've all these compounding factors.
• 23:02
  So that's why I think it's so important to consider, you know,
• 23:06
  so firstly, you know, eating, yeah, eating enough protein
• 23:09
  because your, your appetite is really restricted if you are
• 23:12
  taking these GLP 1 weight loss medications.
• 23:15
  So getting enough protein is, is important, but also these other
• 23:18
  things that are good for bone health, like, you know, calcium,
• 23:21
  magnesium and vitamin D is really important.
• 23:25
  And then thinking about doing some strength training actually
• 23:29
  is is very important for some some people and weight bearing
• 23:34
  exercises that can so weight bearing exercise.
• 23:38
  What I mean by that is kind of obviously a, you know, things
• 23:41
  like dancing, running, racket sports, all of these things that
• 23:45
  put pressure, healthy pressure on your on your bones and can
• 23:49
  help really with things like osteoporosis.
• 23:51
  Yeah, it's really important. My my husband's a surgeon, and
• 23:56
  sometimes he sees people with ABMI body mass index of 50, like
• 24:00
  they're morbidly obese and they need surgery.
• 24:02
  And GLP ones certainly have a role there.
• 24:04
  But when he talks to them, they're like, yeah, there's no
• 24:07
  way I can change my diet. Yeah, there's no way I'll
• 24:09
  exercise. And they just think this is
• 24:11
  going to be a magic drug, which, yes, it could be, but it's not
• 24:15
  helping internally. And I think looking at the
• 24:17
  nutritional status of our patients is crucially important,
• 24:22
  isn't it? But so I was talking to someone
• 24:26
  last night who he wouldn't look at him and say he's overweight
• 24:30
  at all. He drank a bottle of wine as he
• 24:33
  came home and sort of eats maybe a little bit more than he
• 24:37
  should. And he said, you know what, I
• 24:38
  think I might just take a GLP one.
• 24:40
  I'm just going to have a micro dose and just see how that goes.
• 24:44
  And I just told him that he was really stupid and everyone's
• 24:48
  doing it and he's not medical. He he's just been reading stuff
• 24:53
  about it. But I see quite a lot of
• 24:56
  patients. I don't prescribe GLP once and
• 24:58
  we don't prescribe them at clinic, but they're sort of my
• 25:01
  shape. But they want to get in their
• 25:02
  bikini for the summer and doctors giving them GLP ones
• 25:07
  without any nutritional advice, without looking at their
• 25:09
  exercise, without thinking about cutting down their alcohol.
• 25:12
  Maybe I just feel a bit uncomfortable with that.
• 25:15
  I don't know what you think. That's and that's why I kind of
• 25:18
  wrote this book. At the end of the day, it's the
• 25:19
  Wild West out there. Online pharmacies, you know,
• 25:23
  people are not provided that much information about these
• 25:25
  medications. They're not provided that much
• 25:27
  advice about nutrition and lifestyle strategies.
• 25:31
  So these medications, they're not a cosmetic drug and they're
• 25:36
  not a medication to get, you know, lose a few kilos for the
• 25:39
  wedding or get beach body ready. These are powerful drugs which
• 25:43
  have some potential downstream consequences, especially for
• 25:47
  people who are described as a kind of healthy BMI, but and
• 25:52
  especially for people who don't change their diet while they're
• 25:55
  on them. I think that is so crucial to
• 25:58
  have the right nutritional strategies in place.
• 26:01
  I think this is where your book does come into play really well
• 26:03
  because, you know, you've got some even lovely pictures as
• 26:06
  well and you know how we can still eat.
• 26:10
  And they're not particularly difficult things to cook, are
• 26:12
  they? And you know, they're not like
• 26:14
  got loads and loads of ingredients, but there's nice
• 26:17
  color. There's going to be vitamins in
• 26:19
  these and nutrients, which is really important because a lot
• 26:23
  of people when they lose their appetite will just have little
• 26:26
  snacks of things that like you say, then nutritional state is
• 26:30
  probably be worse than it was before they started these drugs
• 26:32
  sometimes. So, So what you're really saying
• 26:35
  is if you are going to take them, it has to be done in
• 26:38
  conjunction? Well, I would say with hormones,
• 26:41
  if they need hormones, but that's fine.
• 26:42
  You agree with that. But it looking at nutrition as
• 26:45
  well is crucially important, isn't it?
• 26:47
  Like you, I would say, yeah, I'm a kind of, you know, diet, diet
• 26:50
  first approach because I think that is clearly very, very
• 26:53
  important. And there are kind of several
• 26:57
  ways of doing that that I kind of discussed in the book.
• 26:59
  But like I say, for some people who who have really struggled
• 27:03
  with their weight, they can be beneficial.
• 27:05
  But I just think you do need that right dietary approach.
• 27:09
  And, and yeah, like you say, I think other, there's lots of
• 27:13
  other factors involved in weight, in weight gain and
• 27:17
  hormones are clearly a massive factor.
• 27:19
  In that, and for men as well, you know, I've, there's quite a
• 27:22
  lot of people who are younger as well that have low testosterone
• 27:27
  and they've got into this cycle. And in fact, I saw a lady in my
• 27:30
  clinic on, on Monday who'd had really bad PMDD, premenstrual
• 27:33
  dysphoric disorder and she had no hormones and I'd given her
• 27:37
  some hormones. She also had some endometriosis
• 27:41
  as well and a lot of urinary tract infections.
• 27:44
  So I, I'd given her some hormones and her testosterone
• 27:47
  level was really, really low as well.
• 27:49
  So she had that and she felt amazing.
• 27:51
  And then she's lost 7 kilograms in weight and she's just changed
• 27:55
  her whole new, She's only 22, but she changed her whole diet.
• 27:58
  She's been on the contraceptive pill for 6-7 years.
• 28:02
  She's off that. Obviously she changed her
• 28:04
  exercise, changed her nutrition and I did her hormone blood test
• 28:07
  and they were on the high side and she's on a really low dose
• 28:10
  of hormones. And I said, you know what, I
• 28:12
  think your ovaries have just started working again.
• 28:15
  So she stopped her hormones and she's, but she's got this new
• 28:17
  lifestyle. And you know, you see that in
• 28:20
  men as well who take testosterone sometimes taking
• 28:23
  that testosterone means that they're metabolically things are
• 28:27
  changing and improving. Then they exercise more, they
• 28:30
  lose weight. They, you know, they, their
• 28:32
  whole lifestyle changes and then they don't need testosterone
• 28:36
  forever. But I think it's looking at
• 28:38
  everything in conjunction. And yeah, that doesn't always
• 28:41
  happen in medicine because it's very siloed, isn't it?
• 28:44
  No, exactly. Yeah, that's what we, we were
• 28:46
  kind of, Yeah, talking about before this started, really how
• 28:49
  unfortunately a lot of medicine is quite siloed.
• 28:52
  There's not anywhere near enough nutritional teaching at medical
• 28:56
  school and all the way along. I think it is so important, you
• 29:01
  know, to look at clearly, yeah, clearly modern medicine has made
• 29:06
  massive impacts for the goods to people's lives.
• 29:09
  But I think the nutritional and lifestyle side of things is
• 29:13
  somewhat ignored really. And and I think it's people are
• 29:19
  kind of starting to understand that a little bit more over the
• 29:23
  last decade, only really over the last decade I would say.
• 29:25
  Yeah, it's taking a while. So it's it's great.
• 29:29
  I've really enjoyed this conversation but I always leave
• 29:33
  with three take home tips. So you're sort of at the
• 29:36
  beginning of your career in some ways as GP, writer, educator.
• 29:41
  What three things do you think your work is going to make the
• 29:44
  biggest impact on over the next decade?
• 29:47
  What 3? Sorry, what?
• 29:48
  3 areas? Yeah.
• 29:49
  What things in 10 years time, what three things do you think
• 29:53
  that you'll will make a difference to as many people as
• 29:56
  possible? Because clearly you're doing
• 29:57
  great educating, but what would you like to see change to
• 30:01
  improve the health of people? What I would like to see, I
• 30:04
  think firstly we talked about this kind of toxic food
• 30:08
  environment. I think you do need some more,
• 30:11
  something does need to change with, you know, putting some
• 30:15
  regulations and making some changes to how we, you know,
• 30:21
  advertising of these highly processed junk foods and some of
• 30:25
  the taxation of these foods. I think that could make a big
• 30:28
  difference. Secondly, I would say I'm so
• 30:33
  passionate about nutrition and teaching, you know, what makes a
• 30:37
  healthy diet. And I think that is so vital,
• 30:43
  you know, to for for everyone. But actually, I think especially
• 30:47
  for clinicians who are seeing people in in primary care, in
• 30:51
  hospitals, being able to be armed with up to date, up to
• 30:57
  date understanding of how these things work is so important.
• 31:02
  And I think thirdly, these GOP ones, they, they're not a
• 31:07
  passing fad. They're not going away anytime
• 31:10
  soon. So I think we need the right
• 31:13
  advice and the right information out there with how to deal with
• 31:18
  them and how to and how to use them safely and effectively.
• 31:24
  Like I say, they're not for everyone, but for some people
• 31:26
  they can be beneficial. But I think you still need the
• 31:29
  right nutritional and lifestyle strategies alongside it.
• 31:32
  Absolutely. So if you are thinking of taking
• 31:34
  them, don't just do it on your own.
• 31:36
  Make sure you get really good advice.
• 31:37
  Exactly. Yeah, so as well, thank you so
• 31:40
  much. I've really enjoyed it.
• 31:41
  Thank. You.
• 31:41
  Yeah. No.
• 31:42
  Thank you so much for having me. No, it's been great.
• 31:43
  Yeah, thanks.