 Welcome to Ancestral Health Today. Evolutionary insights into modern health. Welcome to the Ancestral Health Today podcast and today with us we have Miguel Casale. He's a medical doctor who practices in Ireland and Spain. Welcome, Dr. Casale. I'm really glad to have you with us. Thank you very much, Isabel. Thanks for having me here. Yes, absolutely. So I'd like to have the guests do their own extensive introductions and it really helps the public, you know, get to know where your mindset comes from and what your thought process is when we go a little bit back. So tell me a little bit about, you know, how you decided to become a doctor even. Okay, I am Miguel Casale. I was born in Pamplona in Spain, a small town in the north of Spain, maybe well known for the world running. And well, I was just living in this quiet town all my life. And well, I have no tradition about medicine in my family at home. So when I was in the last year of my studies, I can't even tell you how was it that I felt I had to try to be a doctor. And definitely, now I really know why was that, but there was no tradition. And so in my studies, I really enjoyed them a lot. I started to love medicine. But until the last year, I didn't realize my real, real vocation was to work in the community to be a family doctor, not to go for hospitals. So in Spain, we pass a quite interesting heart exam called MIR. And then when you pass this exam, you can choose to be a specialist. And well, it was a heart exam. I was the number 548. And there were more than 18,000 candidates. And I decided to choose family medicine when I could have chosen many, many specialists, specialties of cardiology, dermatology, any of them. But I really realized I wanted to be a family doctor. And this is what I've been really preparing to, trying to be in the last three decades, a general practitioner, a family doctor in Spain. The training of family doctors is very, very good. And then it hasn't been so easy to practice medicine. So in Spain in the decades of the 1990s and the beginning of the 21st century, there was no job for the doctors. There were very difficult times. And I think also these times make me be very conscious about how really I wanted to be a family doctor. So how is medicine in Spain maybe different from medicine in the United States? What type of situations are you seeing within your family medicine practice? What are some of the frustrations that you get? Well, family medicine in Spain is a public, 100% public for universal and public for the population. This is characteristic. And also it's very characteristic. The doctors are saddered. We work for the government and we are saddered. This is very good for the population. And this is also very good for the standards of the medicine we give. On the other hand, I can tell you that when you are working more than two decades, three decades, you also feel that sometimes you can't do many things you'd like to do inside the public systems because there are some limits regarding the management, regarding the sometimes more the it's a political management, more than a clinical management or a public health management. And so, well, it's comfortable to have your salary. But for example, regarding other countries, you can't choose the people you work with. So you are a civil servant. You work in a civil service. And so now I'm working in Ireland and I'll tell you that later. So you realize the good things and the things that are not so good of our Spanish system. So I think I can tell you it has been hard to not to be able to work every day because there were no jobs in Spain. It's difficult to believe that for a medical doctor. But it was true, it was real. And then I think to finish already, I can't create inside the public system as much as you'd like. So it's more protocols, public health, or it's very well organized, but it's not as creative as I'd like. And I think I like to be creative in my profession. And yeah, that's that's although we don't have a public health system, we have the same limitations with the insurance bottles that we have, which the doctors are confined to only what is approved, what's in the guidelines, what is, you know, tiered into the insurance model. So it is, it can be very frustrating. So how has that helped you evolve in the type of medicine that you practice? I find there is a very interesting model of family medicine developed in Spain in the 1980s after the Alma Ata WHO meeting, starting the primary health care. This is around the 1970s. So I think I joined in the practice of medicine in the early 90s, 1990s, when in Spain was just after the in Spain, many, many people don't know in the 1970s, we changed it from a dictatorship to a democracy. So in the justice, it's hard to believe that I was born in a in Franco's dictatorship. And so in the 1980s, we were just starting to dream with everything public, everything for everybody, just about democracy. And together with the beginning of the primary care and the family medicine of the bio-social, bio-sico-social medicine as primary care. And when I started to listen about, wow, bio-sico-social, this is really what I love. This is really my understanding of the medicine. This model not only biological. And so there is a very interesting person like a called Amando Martínsurro, has a very, very good book in primary care called Martínsurro. And wow, they explain very well all the systemic, the interactions of everything and the person, the atom, the molecule, the cell, the tissue, the organ, the body, and then the family, the community, all this, we are all interacting. So this systemic model of medicine really fascinated me. And this is the one I am yet looking for, because I really love it. And in Spain, I think there are many places where you can feel this school of medicine is powerful. And so I think I was like surfing this wave of this post Alma Ata conference, starting the bio-sico-social model, and then the practice of the family medicine in Spain in the 1990s was really my, it's really my background. So what brought you to also practice in Ireland? So, well, when you get a permanent position in Spain, and you are like me in the early 50s, like as I was used to say, oh, now, well, the, the, it's not so stimulant. So it's already all done. So, and you're starting to join your colleagues and you say, oh, we are in the beginning of mid 50s. And maybe you have some dreams you haven't been able to get. And you know, in this system, you won't be able to get. And the conversations start to go out, starts to be around, well, we are born out just calculating the months and years for the retirement, talking about pensions. And you say, oh, I love medicine. So, and also medicine is definitely changing so much. I think the decade, the second decade of the 31st century, you start to realize because of the technology of many things. And of course, after COVID, start to realize that many things were changing in the, in the medical profession. And you say, oh, am I going, am I going to, to work all my life on my professional life? Like, like I've been working now, or will I be able to participate in some changes? So I knew I need to practice my English. I need to try to go to other countries to, to, to practice my, to practice medicine. And that's what I did in the 2021. Yeah, wonderful. So I met you in, at Lowcar, Denver, in Colorado, at the, at a group meeting that we were having for people who spoke Spanish. So what brought you to Lowcar, Denver? I think here I kind of start to mix my professional and my personal background. I mean, because from the personal background, I also come from, come from a background of like many people fighting, fighting with or struggling to through your mental health, struggling with your weight. I was, I was around 30, 35 kilograms more, just 10, five years ago. And, and well, and so they come, I think that from the professional point of view, Ireland gave me the opportunity to start to separate the earning of money, I can earn money in Ireland. And I can also, I can also invest my money in my training and in my professional development. That's very difficult, very difficult in Spain. So from the personal point of view, and after many years struggling with diets and with, and with, always many, I think I can tell you physical and mental problems. I, I started to follow the people in Lowcar keto community. And I said, oh, I really, I really would like to go and see what's going on in, in, in USA, in Denver, in Lowcar. And I was able to do that because I was already working through my company in Ireland, not as a civil servant in Spain, would have been impossible to do that in my, in my professional status in, in Spain. And, and I felt I needed to, to go to this conference. And really was the starting point for many, many things. And the last thing I can tell you, when I was in Denver, 13 degrees minus zero, in a hotel, in a hotel in downtown, waiting for the conference, I, I did my strategy to communicate because I was alone, completely alone. And I, I create a group in a, in an app called actually Boa or something like that. You can, and I create a group for the Spanish speakers, participants in Lowcar Denver. And, and was for me the opportunity to, to meet you, for example, yes. And others people, the person as Mariela Glant, the Argentinian, who is also working with me now in, in projects related to Lowcar. And wow, I can tell you, Lowcar Denver was like the, the beginning of a, of a new, new understanding of my professional life. Wonderful. So did your weight loss journey include Lowcarb or is that something that you learned after? My weight loss journey started like everyone with just counting calories, exercising, being hunger all day, hungry all day, spending 80% of your energy in, in the buying, buying food cooking and exercising and eating five times a day. Well, first of all, it's, it's, it's, it's a decision when you decide I, I'm going to change it. This is something very deep when you realize you, you are not going to be the same anymore. And, and then, well, I, there is a very relevant person, a nutritional therapist in Spain called Salvador Talón, who started to introduce me in just such a simple theory of this auto molecular nutrition, where you just need to, to eat nutrients and not toxic. So, that's so simple, so simple. And, but no one has, have told you, have told me before. And even in studying, studying as a doctor or, or what I was doing, even with my patients, something as simple as that, I, I, I have never done. And I really started also this nutritional therapist to introduce me in the low carb, not, not, not at the keto stream, but in the, of course, carbs should be reduced definitely. And when, but then through videos, YouTube videos, watching American doctors, many of them, I, I met them in, in low carb Denver and started to, to watch, for example, diet doctor channel, Dr. Berser, all the interviews they have, starting to, to, to note the, the movement in this in, in UK with Dr. David Alwin and, and well, I started to be fascinated and, and tried myself. I tried myself and tried myself the low carb diets and also the fasting and, and finally the keto. And I can tell you, this is for me like a new life. It's a new life because it's the first time in my life, I started to feel, I was able to control what I, what I eat. And I was able to, to, to stabilize my, mainly my mind, mainly my mind that was to realize my body was quite more stable, but mainly my mind. And so I can tell you, everything works in the moment in every moment in different moments. But finally, for people relate more with what now can be understood as food addiction or difficult to control the impulse to, to, to eat in the low carb keto diets are very, very helpful. And for me, definitely the lifestyle, I can follow all my life, I think. So you've been exposed to medicine in Spain, you've been exposed to medicine in Ireland. And to some degree, you've been exposed to medicine in the US and, you know, the rest of the world through talking to colleagues and watching interviews and so forth. Why do you think there's such a big disconnect between practice in medicine in so many places and nutrition? Why do you think we've gotten into a place that we've got and where, you know, the medical system doesn't seem to understand and, and know how to advise patients we're struggling with different metabolic issues, not, not just necessarily weight, but yeah. So why do you think that's a problem? Well, this is a fantastic question. And you see, I can tell you the training is very important. The medical training is very important, the content, the biomedical approach we are, we are taught in the universities is, is understand the symptoms, give a name to the symptoms that diagnose and the diagnose for the doctors we are trained to, to give, to go straight to some medical, to some medicines or to some, something that the medical system can offer. So regarding lifestyle is not really considered a powerful tool to, to work with. And, and for, I think, for many reasons, because the way we practice medicine with many patients, not many, not much time. So if you want to really educate people, it's quite difficult to, and, and then on the other hand, I think the, the nutritional regarding the macronutrients, mainly the macronutrients, I think we haven't, we haven't been having the right answers to the question of which macronutrients are the best to eat. And so I think we are, we have been taught that we have to eat five times a day and 550% of carbohydrate rates. As a doctor, do you realize people are getting sick with this, this message we are giving to the patients? But you are like in, in a, is you can't even, you can't even think about changing that if you are inside every day system. The reasons are related to the tradition, to the training, to the, how, how difficult it is to, to change this, this mentality, because it's not even taught at the universities now. And it's just starting to be understood, many things just, and this is lower than all the process to, to get the science and then put the science in, in a, in a, in a medical, in a medical school, for example. So it's, it's a very good topic to talk deeper, really. Um, so you touch upon, um, the benefits of the low-carbon keto diets for mental health and there's a whole new, um, movement, if you will, that is, um, that is named, uh, metabolic psychiatry, new sort of branch of medicine. Um, why do you think that the keto diet is beneficial for mental health? Well, uh, my, my, my, I think my main surprise last year in low-carb Denver was when I was just looking there for diabetes, obesity, and some other metabolic problems. When I saw, uh, I think his birth chart, uh, giving here his speaker, he's, he's, uh, speaking and, and, and I, I knew very well him, uh, in the, uh, about, uh, watching the diet doctor channel and started to say, oh, metabolic mind, metabolic mind. Oh, Dr. Berserk is a cardiologist and has, is talking about metabolic mind and I just started also to realize myself. The main change, I, my main change was in my, in my mind through the, the, the, the, the abstinence of carbohydrates mainly and, uh, and so, um, well, um, uh, I, I started to be fascinated about that really. And it is just one year ago, no more. And I, I, I really think it's really, really powerful. The movement around metabolic psychiatry and, uh, and well, I, I, I, I'm, I'm getting ready. I've worked now, of course, from Georgia eat, uh, and, uh, I follow metabolic mind channel and I started to be involved in some projects with my, even with my family, with the projects I, I'd love to be involved, but just now get being trained. Uh, I, I'm getting the, the training and observing how powerful it is. And also it's fascinating how I, in, in my last summer, I was able to do, I traveled to India. I also have met the community in India and, uh, and the people already working in powerful, uh, projects in metabolic mind, which in another country like India, completely different. And so, um, I'm just starting to think about, uh, offering services on that is complicated. It's not easy. You need to be trained. Uh, but, uh, from my personal experience and, and also, uh, understanding many, many, uh, medical problems, make minor mental health problems. I see every day in my practice, I'm sure there's a, uh, a powerful relationship between what you eat with your metabolic health and, and your mind in many, many senses. Yes. And yeah, Christopher Palmer, Palmer wrote the book, Brain Energy, who speaks about all of this. So it's, it's a really fascinating feel that we've just started to tapped into. Um, so how are you approaching your patients now with all of this knowledge and this new understanding and the training that you're getting? Well, uh, I continue working as a GP, as a general practitioner in Ireland and, uh, but of course, uh, is every day I see patients with, uh, blood test results, uh, asking you about what to do with the diets, what to do with it, with the lifestyle. And of course, when you understand the low carb approach in medicine, you see like, uh, different glasses, people. Uh, uh, so, and, uh, of course in my everyday practice, I am, so I cannot advise people about the, mainly the macronutrients, because of course, anti-inflammatory, bad quality food is, is definitely everybody knows is bad. But many people is thinking that things they are eating are, are good because they are taught. The, they have been told they love to take this, for example, fruits is very common for, for many people, eating out of fruit because they think every kind of fruit is good. And so in my, in my current practice, every day in the GP practice, I cannot advise people, for example, if a person comes with a high triglycerides, I, I don't tell them to reduce the fat intake. I just, I tell them to reduce the carbohydrate intake or the fructose intake that is the, is, is what I now understand is, is, is different. And, but, and then I am starting to get ready to offer a metabolic care clinic online and maybe in a hybrid mobile model in virtual, virtual clinic. This is what I, I've seen is that it's really the, the future. And I'm prepared. I'm just getting ready to, to participate myself with my company, with my own self-employment or, or developing with other colleagues. I, I'd like to, to meet. So, and I, but I would like to, to abandon the medical, the routine or general medical practice because there is the place where people also, I, I love general practice. So, and you can give very good advice in general practice, but also offer for the ones who are looking for maybe a more, more relevant or more decisive change in their lifestyle to tell them, I think it's, it's good to be able to offer alternative, the alternative for anti-inflammatory, low-car keto diets, understanding how they work, who are, who are mainly they from, who can do them. Of course, everybody can do absolutely, but, and, and, and organize like clinics, train, train myself, train other colleagues and offer also the virtual practices that, I think the hybrid model also being able to come face to face, but, but also maybe just online in the, because it's, it's, it's 100% possible to be done online and offering the tools for the patients to, to be able to follow this, this, this lifestyle because I believe you definitely can revert the mechanisms involved in your, in your in your disease, mainly insulin resistance and inflammation. And if you can get it sustainable for months and for years, the benefits are huge. And, and I, this is the way I love to work, but not abandoning the general practice and also trying to integrate this new science in the general practice. I think this is a challenge. It's not easy, but this is the way I'd like to work. Now, do you find that your patients have a difficult time implementing these changes? I know that other countries are different, but for example, in the United States, in order to see a doctor, you know, that practices metabolic health is, is all private. So there's a lot of people who cannot afford it. And then even for people who can afford the, the, the doctor or, you know, another practitioner, there's also the challenge of how many hours we work, you know, being able to implement these changes is, is rather difficult. It's a, there's a lot of barriers to entry. Yes. So I know two countries, Spain and Ireland in this moment better. In Spain, I can tell you, I'll, I know very well Spain, the practice in Spain. And for me, it's been to be very difficult to find one colleague, medical doctor or pediatrician or to, to motivate this doctor to, to try to work on low car keto diets or metabolic health, because it's not at all spread this spread this information in Spanish, in, in the, in the Spanish general practice. In Spain, it's more common, the nutritional therapist or some coaches to offer that, but disconnected absolutely from the public system. This is not offered at all. And I, I, my, I'm working to try to, to join some colleagues and start doing some research, some projects, research showing that the same results, but for example, David, David Darwin is getting in UK about a remission of diabetes type two. We can get the same results sure in Spain, but it's very difficult in Spain. No, no, no general practitioner is, is doing that, maybe some of them not, not known. So of course a few of them, but it's not, it's not a, well, it's not easy. And I like to offer a private practice with people, but affordable, affordable. Okay, I like to, but and, and then give tools to people in Spanish. And I like to, to have like a website, blog, LinkedIn profile, social network, at least to spread all this, this so good people working in the world on that. And just tell this is the, what they are doing, this is the science is behind that. I think it's just to know that in Spanish, like translated or adapted by a family doctor like me. In Ireland, this is the same, but in Ireland, this is an English speaking country. And of course, everything that is done in UK, the States, in Australia is, can you do it? Can you easier do in Ireland? Because the, if you show them a video or a, or a website in the UK is like, like more, oh, they're doing there. So, but so I, I think for me is, I practice general practice in Ireland. And I like, I'm started to practice telemedicine, online medicine from Ireland in Spain. And I love also to, to, to, to work in Ireland in, in metabolic health. But it's not going to be easy because people for many years, for many decades, the people are really needing the, the changing lifestyle in the 40s, 50s, 60s. And they have been for decades being told other messages. And so it's like shocking, like shocking if you tell them about, well, reduce so much your carbohydrates, even forget about bread, forget about it's a breast, pasta rice for a while. And they say, Oh, I didn't told other things. So well, I think it's, we need everything we need to organize the science, the science is powerful now, organize the clinical practices on that in many, many good experience in many countries. We need to spread the news in a, in the right way. We need also to organize good clinical settings, virtual, hybrid, face to face. And also we need to participate in research. And so we have loads of work ahead. Yes. Yes, absolutely. Tell me a little bit more about what you saw in India, because I know that the increase in tattoo diabetes in India has been massive. And there's a big struggle with that. So how is that effort going? What are they doing? And what are the results there? India is another world is fascinated, fascinated. I don't know why it's one of the countries I went to where I was just 20, because I had a rank missionary, Catholic missionary, and I went to, to stay with him. And then I went back, which I was working for an NGO in leprosy in the late 90s in management. And this is a familiar country for me. And I'm amazing. My son went one year to work in the Spanish embassy last year. I went last year. And it was funny because I could meet the local community in India. And I'm still fascinated with what I found there. Absolutely fascinated. So, because it's a country without a health system. They don't have a health system. Only the public system is for half of the population who can't afford nothing. And the other half, they have to, to spend their own savings in Dave if they get sick. So it's completely different in Spain. If you get sick, you will have a doctor, you will have a nurse, you can go to a hospital, and it's all included in your universal health. In India, you start spending your savings if you get sick in the 50s. So lifestyle medicine has a huge future in countries like India. And on the other hand, in Spain, it is also regulated. So you are a family doctor. You have the endocrinology in hospital, the cardiology in hospital, the phyrology in hospitals, they follow the guidelines. And maybe if you prescribe or you give some guidelines, you need to discuss with them. In India, people with very simple training courses, they are already reverted diabetes much more than many endocrinologists in the Western world. Because, and of course, diabetes is, I think, is a mix of the of course, carbohydrate intake, insulin resistance, of course, low, low-income countries and like India, very bad quality flavors, very bad quality seed oils. So inflammation plus insulin resistance is a disaster. I'm accepting a lot of metabolic health. If you are interested, I can tell you about maybe my next trip to India and the people I went to meet in Bangalore working already in metabolic mind. Yeah, absolutely. Go ahead, because I think a lot of our audience would be interested in learning what's going on and perhaps joining the efforts in that community. Yeah, so it was so, so fascinating, so good, too, because I was in a conference with David Irwin, talking to him, and I told him, I'm going to go to India. He told me, oh, yeah, and you have this email of this person, Sashengari Yajangar. Yes, and I sent a message to him. I was so good. They met me in a hotel in Mumbai. I came in from all around India for different persons involved in the low-carb community, and wow, I just start to feel the strength. You can follow all the Indian movement. They are powers for you, I think, in low-carb. I think the most from this community. And while Sashengari Yajangar is based in Mumbai, he comes from the pharmaceutical industry that has realized himself. All history is from type-to-diabetes revisions through low-carb lifestyle, and now he's an excellent coach doing great fix, trained by nutrition network, the American training in low-carb. And Anup Singh is another person. They started more than 10 years ago with a, I don't remember exactly the name now. I can double check and I can send you later. They have 10 years of experience with a wonderful movement in low-carb in India, and I think many people in the world need to know what's going on in India, really. And the other person is called Poshini. Poshini is a coach in Bangalore, and I think his history is so interesting because her mother has mental issues, mental health issues. I don't know if she's happy to, if I tell that here. Just tell you that she has massively improved, just reducing the inflammatory seed oils and reducing the bad quality flavors, bread and less rice and changing because they eat, and even in India, they are vegetarians, many of them just sit there as an animal source. And the massive improvement of her mother changing the diet has encouraged her to create a center in Bangalore for mental health and metabolic health where they are doing great things. I'm very happy to tell you that next month of April, I will visit her again because I've started to be involved in some projects in India. I'd love to participate in projects in India. I hope I will be able to do, and maybe she has started a podcast. I think you can perfectly interview her or because she has started her own podcast and because she will be involved in spreading the message. And definitely India is another world, it's so energetic, it's so massive population and where things are different. I'm just starting to be in touch with them, but I can tell you the place where you can get faster results with less investment, maybe countries as India. As India were, for example, I was talking to Sasingar Ayengar told me, I am offering people, I know they are bipolar or depressive for many years and I see how they may start to go out home when they are for some weeks in a keto diet or things like that. Of course, there are many other things involved around the mental health. This is not only this metabolic exclusively, but I'm sure it's relevant and I've seen there are even some people like working with poshini, they are carnivore yogis, some carnivore yogis. Many yogis are vegetarians, but even there are some many carnivores in India, in the country where there is also the religious situation. If you eat some, someones don't eat even eggs, only eggs and dairy and so I think we have a lot to learn because they get very good results, not with extreme keto diets because of the religion, for example, but also I think the system is not so powerful like in other countries to control what everybody does. So I think they are very creative and the energy of India is different. Yeah, that will be interesting to see how fast that tide can turn because like you said, there's no interference from the massive regulatory bodies and it's probably easier in that sense, although I'm sure there are other limitations that they face, but if they can have these interventions from the get go, then it can definitely, we can definitely see fast results, right? I definitely want to be in touch with them and follow what they are doing. I love them to come to Europe. I think they have many things to show us. Yeah, that'd be amazing. So you'll be back there in April. Yes, I'm planning to go back to India in April, back to Bangalore, and Pochini has offered me an interview in her podcast. I've told her I love to do this interview but face to face, they are in their studio. Oh, wonderful. Yeah, that'll be fun, I'm sure. So anything else that you would like to tell the audience in regards to metabolic health, any message to the doctors listening on how they can improve the health of their patients, anything else that you'd like to say before we go? I think we should believe in the lifestyle. Lifestyle changes, lifestyle is what is making many people get sick and is the way many people can get remission of many problems. I think we should like just enjoy learning that. I think we should be open to check the science around the last few years and of course all related with microbiome but also all related with macronutrients or related with I think we have the same questions but maybe we need to be open to different answers just to be open. I think just to be open and consider that the people who are involved in in this kind of movements or new ways of working is because we would love to be able to have the right tools for the people to be the owners of their own health. I think this is the message I can give to be open and be able to have different answers for the same questions. Wonderful, thank you so much for being with us today Dr. Kessely. Oh it's a real pleasure, Isabel. Thank you. Thanks for joining us on this episode of Ancestral Health Today. We hope you enjoyed our discussion on how evolutionary insights can inform modern health practices. Be sure to subscribe to our podcast to catch future episodes.