 So I'm joined today on the YouTube channel doing another interesting medically themed interview. So I came across Dr. Sandra Evans who goes by Dr. Sandy has an amazing video up on YouTube, which I will link to in the description about basically post gallbladder and why challenging the consensus view that colisysctomy or gallbladder removal is this harmless harmless operation that myself and I would say tens of thousands of post people that have had this surgery kind of see themselves putting on weight and having other problems and kind of say this doesn't feel like such a harmless operation. So Dr. Sandy, your video talked about stuff that for non-scientists like me is a little we kind of get the basics about this thing called GLP1 and signaling. And I guess I thought it would be amazing. And thank you very much for for doing this video interview. I thought it'd be great to firstly discuss in a bit more detail what you were saying, talk about in that YouTube video. And secondly, maybe for people for whom this information is too late. We've already had the operation. We're not getting our gallbladders back any time soon, i.e. ever. If there's any thoughts, any thoughts you have about ways we could achieve as your slogan goes, better body chemistry. OK, let's just go back to the principle of how bile is working. So as soon as you eat, what happens is there is a signaling system that goes to actually tell you that you have eaten. And what's very interesting about it is that one of the first signals is in actual fact, the release of bile acid. So within five to 20 minutes of you eating something, what has already happened is the gallbladder has contracted and squirted the bile into the duodenum. And it begins to do all sorts of signaling. OK, the duodenum is the first part of the small intestine, right? Justine, yes. So they are in fact signal that they are receptive inside of the duodenum. They pick up the message that the bile acids have arrived. So there are two of them that they know a lot about. So one is the FXR and the other one is it's called the tachyta 5G protein. So these guys are actually sending messages and they send messages to the liver, they send messages to the pancreas. They send messages all over the place. So one of the places they send a message to is the pancreas. And that then causes an increase in the release of that hormone that you asked me right at the beginning, GLP1. So GLP1 is actually released and it then tells the pancreas to produce insulin. So bile acids are very much involved in glucose regulation. OK, does this process of the messaging, the release of bile, something I've struggled to find out is whether this is just something that happens in response to fatty meals or if it's like literally every time that we eat. Is there any data about that? It's actually every time we eat, all right? Because it turns out that there are two signaling systems that tell the gallbladder when to release the bile. So the one is actually the I think called the sphincter of OD, which is a connection. So as food arrives into the gut, that connection is going to trigger. But on top of that, the more fat there is in the meal, that also is going to cause the gallbladder to trigger. So there is a hormone called cholesterol tachyne, which does that. So the two actually work together. So if you're not eating a meal that's very fatty, you're still going to get bile acids released. But a much smaller quantity, the more more facts that are there, the bigger the quantity. And it makes sense because you are looking for those facts to actually digest all those bile acids to digest the fat. Yeah. OK. So I mean, that probably makes the situation, I guess, even worse for post-colossus tachyne, because even if we eat a low fat diet, we're not we're not just kind of getting rid of the job of bile. It would already have been working if we had a gallbladder. So I guess we have even more work to do. The problem, if we just look at it, is it's actually a concentration problem. So if you have a look what the job of the gallbladder was, the gallbladder essentially your body is actually producing bile acids pretty much all the time, although it does have peaks. So there's times that it produces more, more in times it produces less. But what happens is it all gets channeled to the gallbladder, where it gets stored. And actually inside of the gallbladder, it doesn't just get stored. It also gets concentrated. So by the time it's squirting into your duodenum, the level is much, much higher. And the typical levels that are reached in somebody after they've eaten a meal, an average meal is in the 13 millimolar range. So the levels are extremely high. OK, it's it's the fact that they go high for a very short period of time is part of the signaling. So as they go high, they then going to not sort of knock on to all of those receptors. The receptor that I told you about the FXR receptor. The FXR receptor then sends a message back to the gallbladder and says, oh, well, you know what? Food has arrived. Does it make sense? Yeah, sure. So so the difference between someone with a gallbladder and someone without is not that how much bile acid is produced. It's the fact that there's a peak and a trough every time you eat. And as a consequence of that, you get different signaling. So when you haven't got a gallbladder, the levels are actually kind of at the same level all of the time. They estimate it's around eight millimolar. So it is actually very interestingly enough, probably enough for you to metabolize fat. Maybe not well, but you can metabolize, which is one of the reasons why doctors have said, oh, well, you know what, you can take the gallbladder out. Because the bile acids are still there. And you know what? They're also enough for you to digest fat. It's not a problem. And it's probably true. The problem is you needed the signaling. The signaling required a high and a low level. And you've lost the ability to get that high and that low level. Makes sense. Amazing, I guess. The obvious question is for people who've already had the operation. We don't have this kind of elaborate signaling process. And as you say, our bile levels are flat lining. The liver never knows it's eaten. The pancreas never doesn't get that message as well. So obviously, you know, everybody is going to react to the operation differently. And all this area is very uncertain. Do you have any ideas what people who've had this operation could do to try? I don't know, supplements or diets to try to replicate, maybe artificially, this signaling process, or at least to make the best of a unfortunate body chemistry situation. Yeah, well, I think the first bit of advice that I would give is not about food because what's happened is essentially you've lost that signaling system. It's not there. So the food is not or is not going to be that good at being able to set the circadian rhythm. So I think for somebody who has had their gallbladder out, if they understand the fact that they are now no longer in the same position to actually control their circadian or their rhythms. So they've lost that feeding rhythm. It becomes much more important that you do other things to make sure that your circadian rhythm is tight. You you need to actually work on your rhythm because you've lost one of the players that helps to set that rhythm. And if you look at how is the rhythm set, the official term for it is it comes from German. They call them zeitgebers, which are time setters. So feeding was an important time setter and the bile acids play a role in that time setting. But probably the most important way of setting the time in your body is actually through light. So somebody who has had their gallbladder out, they need to be very, very careful and manage their light exposures very well so that they can help their body know to now is daytime and now is nighttime. And unfortunately, as we're living in the modern era, most of us are actually not that good at knowing whether it is daytime or nighttime because what is happening to us is we spend a lot of time indoors. Now you said that it's like indoors during the day. What's the problem? The problem is that the level of light inside is nothing like the level of light outside. So even if you're in a really well lit room, they measure light by the way in a thing called lax. So if you're in a really well lit room, so you're in a nice fancy office, it's got good lighting, you're probably at the best of times getting around 300 to 500 lax. If you go outside on a really lousy day, I know you came from Ireland, so you probably can identify cloudy days all the time, right? If you go outside on a really lousy day, you would be getting 10,000 lax. Oh, I see you. If it's a sunny, lovely day like I live in South Africa, so it's a nice sunny day, sunny, it could be 100,000 lax. And this now has a big impact on your circadian rhythm because your body is expecting to get a big boost of light, particularly in the morning. If you are now inside all the time, you aren't getting that boost of light. And so it actually becomes a problem. Your body actually doesn't realize that it is, in fact, daytime. So that's our first problem. But then we have a new problem. At night, what do we do? We have the electrical lights on. And although maybe we tone the lights down so it's not as bright a light, we still have the lights on and even a tiny little bit of light. Although it wasn't enough to give you that knowledge that it was, in fact, the middle of the day. It is enough to confuse you and to think that it's not the middle of the night. So managing your circadian rhythm through light is probably it's important for everybody. It's not just for somebody who doesn't have a gold lady. It really is important. But for someone without a gold ladder. You've lost the other zyte gerber. You've lost the bile acid. So you must make sure that you use the zyte gerbers that you actually have access to and light is very important. Maybe what I should just say is when you put on weight and you have all the metabolic problems, they talk about it as being insulin resistant. They also talk about it as metabolic syndrome. There are many people who are trying to have the name of metabolic syndrome changed to actually say it's a circadian metabolic syndrome. In other words, part of the problem in somebody who is insulin resistant is that they are already not going through that cycle well. They find that the insulin levels are high during the day and at night. So it's already a problem. It's setting a problem in normal people. Now with the gold ladder out, it's going to be even more important that you actually get that rhythm. Does that make sense? It doesn't make sense. Yeah, I'm I'm it's funny that I'm actually doing this interview from outside. I don't usually do in the morning, but I guess as these little habits you can get into another one I do that's probably going to sound crazy to a lot of people. But you've you've you've made me feel a bit less a bit less insane. I've actually always had sort of difficulty in getting to bed at a healthy hour. So something I started doing a few years ago is I presume in South Africa, you have this black insulation tape, the kind of stuff they sell in hardware stores. So I actually started it again. It sounds crazy covering up LED lights in my bedroom so that when it's time to sleep, but I'm asked as well, it's like completely black and probably the most effective thing I've ever found for getting to sleep is that it's just being surrounded by blackness, letting the natural melatonin, the pineal gland do its job. So awesome. Yes, it's it's good. I've got at least one thing on my side already. So so yeah, in actual fact, it was very interesting. It was a big study done in Britain where they interviewed ladies and they asked them a very simple question. What they just said was how much light is in your bedroom at night? And obviously they can't say in luck. So they said, well, you know, just tell us one of three possibilities. If when you're in your bed, can you see your hand? And if you can't see your hand and they would say, well, you know what? You are sleeping in the dark. Then they said, well, you know, can you see a little bit? And I must say, well, you you're sort of sleeping in like intermediate light and then can you see everything? You know, could you actually find something in the middle of the night? And a lot of people can. And I live in South Africa, security is a big issue. So we've got lights everywhere, everywhere, because you it's a security thing. But it turned out that the ladies that were sleeping in the dark were the thinnest. Interesting. So as soon and those that were sleeping in in much more light were actually the fattest. So definitely circadian rhythm is so, so important. So sleeping in the dark is important. You identify there's ways of doing it. So you said you are using a mask, right? It's a bit of can be a bit irritating initially. But you know what? You get over it and you you essentially are able to cover up. The other thing you are also using, you said tape, you can buy very expensive curtains. They call them blackout curtains that block the light so that when you get into bed, you are genuinely in the dark and that will help to maximize the release of melatonin and help to set that circadian rhythm. Also, your behavior just before you go to bed are important as well. So if you're watching TV or the computer or whatever, you are getting a lot of light. So there are ways that you can sort of mitigate that as well. I don't know if you've ever heard of the blue at the blue block of glasses. Yeah, yeah, I'm sure. Also, just turn the thing off before you go to bed. Hello, it's like, you know, you don't actually have to be on or worse, still people get into bed and then they look at their phone for, you know, catch up on Facebook or whatever. And then they turn it off. But you've been exposed to light all of that time. So that's going to impact how quickly you fall asleep. So I think for somebody who's got no book, no gold ladder, setting the timing is much, much more important than maybe for someone with. OK, so you're saying the people who've had the gold ladder, I should take a trip to IKEA, get themselves some black blackout curtains. Definitely. And also, I think also change your morning behaviors because let me tell you what I do personally. So no matter what what goes on, I always make sure that I spend at least 30 minutes outside. So you can do different things. You can if you if you if you want to catch up on your sort of Facebook, take the phone with you and go out outside, have your morning coffee outside, read outside. Don't make the mistake. I think a lot of people say, well, you know what, I'm driving to work. So I'm in the car, I'm outside. The definition of outside is there mustn't be anything between you and the sun. So although a window does let light in, it unfortunately keeps some of the wavelengths out. So you need to actually put yourself outside for they don't really know for exactly how long, but I am for at least 30, 30 minutes every day and try and do it more or less at the same time every day as well. Because obviously, you again, if you do it one morning at six o'clock and the next morning at 11 o'clock, that's not really helping the circadian the circadian rhythm. Whatever you do, make sure it's before 12 o'clock in the day. So it's not going to help you. So all you know what, I'll work in my office all day and you know what, I'll take a walk at five o'clock in the afternoon and I'm outside. That'll that'll do. It won't. You need the light early in the day, not late at night to actually get that rhythm will help you sleep better. But again, it's also going to help with all those other hormones because it's that light that's setting the rhythm. OK, great. So that that's that's that's definitely one thing that I think people should do 30 minutes in the morning, get a listen to a podcast, go for a walk. I guess even if it's even if it's rainy, maybe there is something like a break in the rain that people can do. Do you have any thoughts with regard to food, the big question? And, you know, a lot of people after their gallbladder removal, I've recently started a low fat diet. But one thing you mentioned before we started this interview is you sort of advise a bit of caution around a very high carbohydrate intake. So do you have any tentative suggestions regarding OK, it's a it's a tough one. OK, because essentially the reason why you're putting on weight is you have this thing called insulin resistance. And I've already said to you, well, the problem is that the insulin is high morning, noon and night. And I don't think insulin is a bad guy. The problem is the insulin is high when he's supposed to be low. So then we have to say, well, what controls insulin? So there's obviously a lot of things that can control insulin. But insulin's chief job is to put away sugar. Right. He puts away my in my cartoon world, I talk about him. I say he puts away the groceries. But the grocery that he's most interested in is definitely sugar. He's a little bit interested in protein. He's largely not interested in fat and actual fact. If you sort of think about it, this is how I think about it. You can almost imagine that there's two parallel lines going on. So the one line is to deal with the sugars and the amino acids and insulin is in charge of that. And the other line is the fats and the bile acids are in charge of that. So as soon as you are eating lots of carbs, you are inevitably increasing insulin levels and the higher your insulin levels, the more vulnerable you are to metabolic problems because ultimately that is what they are. You become non responsive to insulin. So it makes sense. So yes, there's the rub. If you are going to eat a high carb diet, just simply by that fact, you're going to have more insulin circulating. Now, on paper, it should only be circulating during the day. When you're eating, it shouldn't be circulating at night. But as the body chemistry breaks, the insulin levels rise at night. And that is where your problem is. All right. So my advice generally is follow a low carb, higher fat diet. Your eyes are going to pop out and say, well, that's great, but I can't do that. So I think it is it's something you just have to be you have to find where your boundary is in terms of how much fat you can eat and how much because if you can't digest it, it isn't going to help. Is it? So that would be the first thing. It would be better to follow a lower carb diet. Do I think you should follow a low carb diet? All right, or an extremely low carb diet, which is the ketogenic. So by definition, a low carb diet is a carnival diet and a low carb diet is a ketogenic. I don't think so. I think you have to understand every time you eat. All of those nutrients are sending messages. So the fat sends messages, the protein sends messages, the carb sent messages. So in order to be at the best when you eat something, you probably want all three. You want a little bit of fat, a little bit of carb and a little bit of protein so that you maximize the messaging. So it's not a case of they just should have no carbs. But you the less you can kind of the more you can get to I call it the rule of thirds. You want a little bit of everything, the better off you are because you're getting all the signaling, does that make sense? The other thing in terms of diet, so the other thing in terms of diet is timing. So I've said to you as we've been going along, the real problem is that the insulin is high at night. The insulin release is triggered primarily by carbs. You don't want to be eating at night. Does that make sense? So I would say that the other thing to do is. Play around with your ratios, try and get to a point where you're eating as low a carb or as high a fat as you can tolerate. But also watch when you when you start and when you stop eating. So the later at night you eat, the more likely you'll have insulin in your system. Insulin will be high during the night doing bad things. If you can move your eating window so that you are not eating so late at night, the insulin will rise and on paper it will fall again so that when you're in bed, the insulin levels are as low as possible. Because ultimately it's the insulin that makes you fat because I said to you, his job is to put away the groceries. So he's putting away the groceries. And when he's putting away the groceries, you are getting better. He's not bad. That's that is his job. Right. You don't want him putting away groceries at night because at night that's when you should be reaching into the cookie jar and burning the things that you've stored during the course of the day. I think also just just to say that anybody that hasn't checked out your YouTube channel, Better Body Chemistry really showed because you have this fascinating cartoon world as you described it with all these all these very sort of hard to understand concepts as caricatures. I absolutely love the Gold Ladder video and the little guys kicking around the nutrients on the soccer field. So yeah, it's really, really, really, really entertaining way of explaining science. Yeah, I think if you the more you can understand the terminology, I think it's easier to do it, isn't it? Yeah. I think if somebody I'm sure it's happening, people don't do this, don't do that, don't do the other. And I think secretly, a lot of us inside just stand up and say, we'll do it anyway. Don't tell me what not to do. But I think the more you can understand it, the more the easier it is to apply the principles. And unfortunately with biology, I think we're all different. It's it's so amazing that we are different, but we all are different. And so what works for one person really may not work for somebody else. Yeah. So the more you can understand the biology, you can start to say, well, how does that biology apply to me, because it might not apply the same to somebody somebody else. OK, great. So those are two two great things in terms of sleep and diet. Any other things you'd recommend? It was a little bit out there, but I think one of the things that you understand what the bio acid does. So I've said to you, they do lots of things via those receptors. And a lot of the things that they're doing are inside the gut, but they also work outside of the gut. And it's the levels that are so important. But one of the things that they do do is they actually help you to burn more fat. All right, literally, they they help you to burn more fat. They increase energy expenditure. So obviously, if you're starting to become a patch, it's because you're not burning quite as much fat as you would like. Part of the problem is going to be that circadian rhythm. I've just said to you, you actually only really burn fat. At night. Or at the time, you're going to burn fat is when there's a big demand, which is when you're doing exercise. I don't think anybody needs to tell everybody that they need to exercise. This is everybody knows, right? It's like the standard advice, eat less, move more. So that's one way to to essentially burn more fat. But a very interesting thing that bio acids actually do is there's different kinds of facts. So we have fact that is kind of the bad facts and called white fat. And then we have fat that is good fat and it's called brown fat. And it's primarily around your neck. That's where it is. So brown fat is what keeps you warm. And it turns out, bio acids actually trigger. That brown fat. So some of them, they many, many jobs that they they do. Now, they're not the only thing that triggers brown fat. But there are other chemicals that trigger brown fat, but there's also behaviors that trigger brown fat. So one of the things that you can do to trigger brown fat is actually just get a little bit cold. So there's all sorts of ways of doing that. So it can be as simple as, you know what, just put the air conditioner on in the office a little bit lower for a period of time. Not you don't necessarily want it to be so low that you and have to put six jerseys on. But a little bit lower just will help you to increase the brown fat. More extreme versions of that. I'm sure you've seen videos of it on YouTube where they dive into ice cold water and do the same thing. But interestingly enough, it probably benefit all of us. But again, remember, once you've got your coat later out, you actually haven't got all the things that the bile assets might be able to do. Right. And this is one thing that they can do. They can actually stimulate thermogenesis. So you could explore a little bit, kind of a little bit out there, but it may be worth it. You can explore actually ways that you can stimulate thermogenesis without using the bile asset. So I'm currently sitting outside, which is unusual for me in the morning. I'm usually very much in my home office and it's absolutely freezing out here. So so far you're getting it so far. You haven't got 16 jerseys on like my days off to an unexpectedly good start from a gold ladder perspective. Then definitely cool. So, Dr. Dr. Sandy, thank you so much for all that information. As I said, I'm to you, I'm going to share this interview, put up on this YouTube channel. I'll be up by the time people watch this and just share it with because I know there's such a there's a huge there's a huge golf or this is what I've observed anyway, between sort of the way the medical community talks about gold ladder surgery, which is basically, you know, I think my surgeon told me you can go back to work tomorrow if you want, which is a complete exaggeration, because I would have been a lot of pain at that point. But, you know, there's just this very dismissive attitude. And then afterward, there's a lot of people like me that are sort of getting fatty, you know, other digestive things I've mentioned in another video. And we're just trying to make sense of this kind of cascade of health problems and sort of get back to where we were before the surgery. So I think you're all the information you've given has given me a ton of insight into what's going on in my body, ways I can do it, whether that's jumping into a lake or also really a lot of things to think about with regard to diets and maybe that low fat is not the right direction for a lot of people to to go down. It's a pleasure. I think the real question is what started it to begin with? So if you go back, you had a goldstone. Am I correct? For me, I kind of had an ache. I it's a it's OK. I might cut this out of the interview. It's a bit dodgy. There is an ache. They're like, oh, we'll send you for an ultrasound. They didn't find any goldstones on the pathology. So I kind of have this feeling I got an organ cut out of me for no reason, but something like that's ludge. Even there is where the problems begin, because they're often telling you that the reason why you've got goldstones is because there's too much cholesterol. But actually, if you have a look at it, gold, the gold, gold bladder or the bile is not just cholesterol. It's cholesterol, phospholipids and bile acids. And if you start to have a look, the problem was probably before it even hit that you actually didn't have enough bile acid. It wasn't that you had too much cholesterol. It was actually that you didn't have enough bile acids to begin with. So it's very conceivably possible that there's already a problem there. You haven't got enough bile acids and then you come along and you actually take the bile acids that you have out the picture and make it even, even worse. That's what a lot of people find is that all their kind of pre-existing health issues just got like kind of drastically multiplied after the surgery. So that makes sense. Yeah, I think there's a lot of why it's safe is because it's such an easy procedure. Whereas if you look sort of in times gone by when they did a surgery like that, it took a long time to recover. That is why they see it as safe. But the consequences are I don't think they're I don't think they're clearly understood. And as I said to you earlier, maybe I should just say it again. You don't know that much about the gallbladder because the models that we're studying don't necessarily do it the same way. So rats don't have a gallbladder mice. They have different, different bile acids. So there's so much information that is not known, which is why you end up having your gallbladder out without the realization of the consequences. Right, that's that's something that I've noticed that this if I'm not mistaken, this kind of research into the metabolic signaling role, the gallbladder that you've discussed in this interview is relatively new. So I was looking at the history of colostectomy that the first open one was in the 19th century. Laparoscopy is relatively newer if I'm not mistaken. So it's not a ton of time that humans have actually been living without gallbladders. So we're kind of guinea pigs or I guess maybe guinea rodents might be a better analogy. Based on what you said about having no gallbladders. Once you've had it out, you are developing this thing called insulin resistance. But right now they don't even know what insulin resistance is. You can ask a hundred experts and they'll tell you it's something different. But what they do know is you are not responding appropriately to insulin. That's what insulin resistance is. But despite all the science and all the studies and the fact they've known this before, so they still don't even know what insulin resistance is. So yes, and the gallbladder is like the. G-part on the side of insulin resistance. So yes, I think it's a lot of it. There's a lot of work still to be done. And yeah, I think a lot of it's not even looking in the right places. But yeah, a lot of work still to be known. But you've given those of us in this situation, I think a bit of a bit of hope and encouragement. Dr. Sandy, if people wanted to find it more about you, you've got a really entertaining YouTube channel, as I mentioned, you've got a website. Can you tell us where to find those? Well, probably the best thing is just to go to my my website. So it's beta body chemistry dot com. And you can then link to the YouTube channel from there. Or I've also got a lot of free resources. Unfortunately, at this point in time, not really designed to help people with their gallbladders out. I was trying to stop you from having it out in the first place. But a lot of resources for people who are insulin resistance and struggling with their weight. So some of them are very much tied to actually managing or dealing with the insulin part of the insulin resistance. But there's also things, not everybody who has a weight problem has a problem with insulin. However, I'm going to say I'll put my head on a block and say everybody who's had their gallbladder out has got a problem with insulin because the bile, the bile acid is actually controlling that insulin loop. OK, makes it good, good and bad to know at the same time. All right, awesome. Thank you very much, Dr. Sandy, really appreciate your time today. It was a pleasure. Thank you.