 The next speaker I'd like to introduce is Dr. John Briffa, MD. He's a naturally-oriented medical doctor, and his work is dedicated to providing honest and trustworthy holistic health advice. He's a blogger at drbriffa.com, has over 20 years of clinical practice, and he's an author of several books, including Escape the Diet Trap. And I always find it really awesome when doctors who have obviously gone through all the rigors of medical school and Western medicine can also embrace the holistic side and can see the whole picture. So I'm really excited to hear what John has to say, so welcome him up. Afternoon, everyone. Afternoon. I'm going to spend about an hour and a half talking about these things here, how to get fit, how to lose weight if that was your objective, how to feel better. I've experienced over the last 20 years lots and lots of people in my clinical practice, but also in my work in the corporate sector, with people who are basically, I suppose you could call them, not quite sick enough to be called sick, but not well enough to be called well either. I see a lot of people with, you know, fatigue-related issues, a lot of people who have fluctuating energy. Some people, for example, who find it difficult to stay awake or, you know, concentrate in the middle of late afternoon. Does anyone here get a lot of energy around 3.30, 4 o'clock and find a bit of a struggle? I see individuals, for example, who say they're in meetings, you know, with valued clients and have to sort of stick sharpened pencils into their leg under the table, you know, to keep themselves awake. And if you've got to that state in your life, usually something has gone wrong. The thing is that the solutions to the sort of problems that I see in practice and also weight issues are usually very simple indeed. You know, when people think about, you know, getting fit, losing weight, for example, they generally think about having to do things that demand quite a lot of effort. So you know, going hungry with your diet may be forbidding certain foods, exercising very hard. Probably a lot of you, I would imagine, do quite a lot of exercise and may like to do that and that's fine. But everyone is like that. Some people like to do it what I would call the easy way, okay? And what I found in practice is that there are very easy ways that individuals can transform their health. And as I'll explain a little bit later, that's particularly true for men. There seems to be certain nuances, differences between men and women that make it actually easier for men very often to achieve their health objectives. So over the next hour and a half, I'm going to go through this in a fair degree of depth. Speaking a lot about nutrition, and the reason for that is that nutrition has a really fundamental role to play in how we feel and how we look. It is really key. The reason that we need to spend a fair amount of time on it is because it's a large subject. You know, you only have to pick up a newspaper or magazine, turn on the radio or the TV to learn something about what we should and shouldn't be eating. But as some of you will know, not all of the information is utterly consistent, right? So you hear one thing, one moment and then a day, a week later you hear something very different. A classic example of that is the idea that our diet should be low in fat, right? Fat's fattening. So if you want to lose weight, you should eat a low-fat diet, which means eating a lot of what? If you're not going to eat fat, you're going to eat what? Sugar and other forms of carbohydrate like starches, that's exactly right. So our government, most health professionals, would advise us to eat a diet that's relatively low in fat, right? And relatively rich in carbohydrate, grains mainly, okay? Not everyone believes that, though, because some people will come along from time to time and say it's not fat that's fattening, it's actually carbohydrate. So some of you here will be familiar with the Atkins diet, do you know the Atkins diet? It's basically a low-carb diet, okay, which can be quite rich in fat. And it argues a completely different point of view of the conventional wisdom around healthy eating, which is the diet should be low in fat and high in carbohydrate. Now, with these very conflicting messages, it can be difficult to know who or what to believe, right? It can be very difficult. So over the course of the next hour and a half, I'm going to use a fair amount of science. I'll warn you in advance, okay? I'll use a fair amount of science to reveal to you what it really means to eat healthily. Now some of you may be interested in science. Some of you not so interested in science, that's absolutely fine because at one point I'm going to reveal to you the one single thing really you need to bear in mind to judge whether a food is healthy or not. It is just one concept to have in your head. One question you need to ask, that's it. You won't miss it, by the way, because before I tell you what this concept is, I'll tell you I'm about to tell you it, okay? And then I'll tell you, and then, of course, I'll tell you I've just told you it, and then I'll tell it to you again about 10 times. So you can't miss it. There's just one very key thing around nutrition that you need to understand. Now, a lot of the information in this presentation has come from a couple of books. This book was published in 2010, and I decided that I would write essentially a fat loss book for men, because my experience with health is that men are very often a bit sort of disenfranchised around this area, and health generally. Not very many men are going to pick up books with titles like Six Weeks to Your Bikini Body or Whatever, okay? So it occurred to me that there's a lot of interest in this area, but also a lot of misinformation in this area, and I wanted to set the record straight and make it easy for men, should they want to to improve their health and have better bodies, basically. That book was superseded this year by this one. You'll notice by the branding this isn't really about men. What this book did was bring up to date the science, so we have about two years' worth of science that wasn't available in waste disposal. And I've also included a lot of techniques in here that I'm going to be discussing with you now that didn't make it into waste disposal. So let's dive in. First of all, this is what I want to talk about, this concept of weight. Now, we're a very weight-focused society, generally speaking, and we as medical practitioners tend to be quite weight-focused. And what we do with weight in order to categorize someone is convert it into something called the body mass index. You'll be familiar with this probably. This is basically your weight in kilograms divided by the square of your height in meters. And then we tell people this, that if their body mass index is somewhere between 18 and a half and 25, that's normal or healthy. However, if it's crept above 25, you're now overweight and above 30 is obese. Now, we generally as health practitioners stick slavishly to this idea that there's a very strong link between our body mass index and our health. And we're often encouraging people who are overweight or obese to get their body mass index into the normal range. However, there's some fundamental problems with the body mass index in terms of its ability to determine what you're likely health is, any thoughts, what sort of limitations it has. No, it doesn't. It doesn't account for muscle mass at all. It doesn't tell you anything about your body's composition. So I don't know what your body mass index is, but I suspect it's above 30. Is that right? 35, right? So if you look here, here's two people, one that looks like you, another one that looks like someone else. They have the same body mass index. One of them is very heavy because he's very well muscled. They may be very fit and healthy, actually. And this person less so. And you see immediately just how limited the body mass index is in terms of its ability to judge our health. There's another problem with it. It also doesn't tell us about this, the distribution of weight in our body. And that's because when men tend to gain weight, it usually ends up around the middle of the body. We call this abdominal fat. I'll talk about it again in a moment. Whereas usually, this isn't exclusively true, but usually with women, when they accumulate weight, it's generally below the waist. So you get men looking more like apples and women looking more like pears. Now, this isn't just an aesthetic difference. And the reason for that is that we know that weight that accumulates around the middle, so we call this abdominal fat is usually associated with fat that has deposited itself within the abdomen, so in the organs and around the organs. We call this visceral fat for those that like technical terms. And the relevance of this is that visceral fat and the proxy for it, if you like, fat around the middle, what you might call a spare tire, has very strong links with health issues like heart disease and diabetes and overall risk of death. So a lot of people, for example, who will accumulate weight around the middle of their body may not like that because it's unesthetic to them and maybe to other people. But the important thing as well is that it has certain health risks associated with it that are probably worth avoiding. Here's the good news about being a man, though. And I alluded to this earlier. This fat here is surplus to requirements. It really doesn't form any particular function for you. So for example, if you're a woman and you aggregated some weight below your waist, you might be able to use that, for example, during pregnancy and breastfeeding, thinking in an evolutionary sense. This does not really do you any good at all. And it appears that this fat is particularly easy to get rid of if you know how. So let's look at how we're going to get rid of that fat or protect ourselves from ever getting that fat, which looks like a more relevant thing for an audience like you. So here's what we generally believe about weight control. It's based on calories going into and coming out of the body. So calories come out of the body through metabolism and also through exercise. Now, if we're consuming fewer calories than the ones that we're burning each day, then we're going to lose weight. That's the basic calorie principle in a nutshell. So in other words, if we want to lose weight, say today, we now want to lose weight for tomorrow, OK, then we need to either eat less or exercise more or hopefully do both. That's the basic principle. Now, there's about 3,500 calories in a pound of fat. So if you imagine being in 500 calories worth of deficit each day, and you can do that either with diet or exercise or both, then over the course of a week, you're going to have accumulated an overall deficit of about 3,500 calories, which is about the same amount of calories that you find in a pound of fat. So that is the calorie principle in a nutshell. But there's one fundamental problem with it. What? Anyone? Carries out does vary. Anything else? Yeah? Yeah, that's true. That is another problem with it. But here's the fundamental issue with it as I see it, OK? And this is quite common, OK? It doesn't work. Let me just caveat this a little bit. It does work in the short term. If an individual who normally eats 2,000 calories eats 1,000 calories a day over the course of a few days, assuming everything else is the same, they almost certainly will lose weight. And they may lose weight for several days or weeks or even months. But we have a wealth of experience now and also a ton of scientific evidence that shows that when individuals take a calorie-based approach, whether that is eating less and or exercising more, it hardly ever leads to significant or sustained weight loss. It hardly ever works. Here's a little bit of evidence in this area. These are all studies, basically, long-term studies where they've done something fairly dramatic for relatively extended periods of time. So the interventions, basically, in these studies were either diet or diet and exercise. Now, these diets are usually low-fat, carbohydrate-rich, calorie-controlled diets, OK? These are quite difficult to stick to, by the way, but they're fairly intense as an intervention. And then on top of that, many of these people in these studies have been doing, I don't know, 30, 45 minutes of exercise, three, four, five times a week. That's a fair amount of exercise. It may not be much to you, but to mere mortals, OK? That's quite a lot of exercise. But let's have a look at this study here third down. This is the result of people doing that for two years, OK? Average weight loss with just diet was about two kilograms, OK? So, I don't know, four and a half pounds. And here, with exercise added on top, it was two and a half kilograms, which is what, about five and a half pounds, OK? Now, you might say, well, that's better than nothing, because if you were five pounds overweight and you got down to your fighting weight, fantastic. But actually, in these studies, the average weight of these individuals was about 16 and a half stones, OK? So that's quite heavy. So if you've spent two years starving yourself and exercising yourself into oblivion, and at the end of it, you've lost just a few pounds in weight, you would generally regard that, I would suspect, as not a great return on investment. It doesn't really work. But here's the other thing. I've worked in practice as a doctor for over 20 years now, and I've realized over the time it doesn't work, because time and time again, we see individuals who have failed to be able to successfully apply the calorie principle. So what's wrong? Well, there's a general assumption that the calorie principle must work. It must work, OK, because it's simple mathematics, it's simple physiology or metabolism, OK? So in other words, if people are not losing weight successfully in the long-term using this approach, there's something wrong with them. Now, either they've been a bit greedy or a bit lazy, you know, they just haven't applied this enough, OK? They don't have enough self-control and they lack. They have a weak will. They've got an inadequate personality. I don't know, all these thoughts. And often these judgments, by the way, are quite self-applied. So over the years, I've seen many individuals who assume, because the calorie principle has not worked for them, that there must be something wrong with them. But let me just tell you, it fails so consistently. I mean, practically no one can make this work for them in the long-term. You might say, maybe there's a problem with the principle. Maybe the issue isn't really that people fail to apply it correctly in a lazy and weak or whatever. It's maybe that the calorie principle is somehow flawed. So I'm going to spend a little bit of time talking to you about what it is about the calorie principle. The cause is people to be trapped in cycles of weight loss and then weight gain and then needing to repeat that cycle with more weight loss and weight gain, OK? Some of you may have possibly flirted with this yourselves, OK? Many individuals will flirt with it once they get a bit older, once they get as old as I am, middle age, basically, people very often are now caught in cycles of weight loss and weight gain. So in a way, a lot of this information might be appropriate to you now, but it might not. It might be appropriate to you in the future. So if you think about weight control in a slightly different way, what it might enable you to do is future-proof yourself from these problems so that you don't turn into your dad. So why do calorie-based approaches not work? OK, I'm going to go through a range of reasons why calorie-based approaches can't really work, OK? And I'm going to start with this. It's really this concept, OK? If you have a certain amount of metabolism, burning, I don't know, 2,000 calories a day, if you only give the body, say, 1,500 calories, the inevitable consequence of that is that the body is going to burn less fuel. It's like a fire. And taking a calorie-based approach is like putting less fuel on the fire. So you would not expect the metabolism to burn quite as well as a result of that. Now, we know from science that when the body is put in this situation, it brings into play a number of mechanisms that put a significant dent in the metabolism, OK? And there are certain changes in the body that can be monitored around. We'll explore some of this in a little bit more depth later, but thyroid hormone levels. Thyroid is a very important organ that produces hormones that stimulate the metabolism. So you get changes in these hormones. You get changes in the levels of a hormone called leptin, which I'll tell you about later. And also, both in animals and in humans, when you put them on calorie-restricted diets, they move less, they spontaneously move less. They become less active. This is all an attempt by the body to stop you starving yourself to death. It's a normal sort of mechanism. But it can make things very difficult because often people will find, after some brisk initial weight loss, that their weight loss slows to a crawl and will plateau at a weight, way above the weight that they wanted to get to. That's a very common thing that we see in practice. So once you've plateaued here, you're a bit hungry, you're a bit tired from your exercise, and you're not getting anywhere. And you know, you've gone down, I don't know, from 13 and a half to 12 and a half stone, but your ideal weight's 11 or something. And you get fed up and you will often default back to your original diet, not surprisingly. Very often though, now you've put a big dent in your metabolism, that weight will return very quickly. It often returns alarmingly quickly and people will often end up at a weight, above the weight that they started with. And this is just one mechanism, okay, by which the body can scupper your attempts at weight loss. It's very difficult to starve the body into submission, essentially. Now, this was studied a long, long time ago, okay. Back in the 1940s, after the Second World War, a lot of people had starved as a result of the Second World War and some American scientists were interested in what you can do to refeed people and get them to put their weight on healthily. So they took a group of men and they, first of all, what they call semi-starved them by giving them 1600 calories worth of food in the form of a high carbohydrate, low fat diet for 24 weeks, okay. Now, actually, these men lost a significant amount of weight. They lost, in total, an average of around 20 to 26% of their body weight, okay. However, overall, the amount of energy that they expended through metabolism and spontaneous activity went down by almost 40%. So you'd expect people to have lower metabolisms as they lose weight. They're smaller, right? But actually, the overall effect was far exceeded what you'd anticipate just as a result of weight loss. And so they hear the picture of a couple of people that were in that experiment and this is what happened to them. And then after that, basically, they started to feed them again, which I'll talk about in a moment. But I just wanna make you aware of this. These individuals were eating a fair number of calories, right? 1600 calories is not a small amount of calories. It wouldn't be what I would recommend, necessarily. But it's not like they're eating 800 or 500 calories. That's a fair amount. Many, many diets, okay, based on the calorie principle, will recommend that sort of order of magnitude to people. Often 1500 for women, 1800 or so for men, right? But the effect of eating in that way on these men was utterly profound. First of all, they were perpetually hungry, perpetually hungry, but not just that. They lost interest in practically every aspect of life. So the libido went, any ambition went, personal relationships went, okay, all of this, okay, is well documented. And they also became cold. They couldn't think straight. They became obsessive about food or they could think about with food and they would, for example, to gum and drink coffee incessantly, okay? And this is all on 1600 calories a day, which is a fair amount of calories, all right? So one of the fundamental problems that we have here is that dieting, if you want to use that term, makes people hungry. And as I'll explain in more depth later, using a relatively high carbohydrate, low fat approach makes people particularly hungry. And one of the reasons for that is that carbohydrate is quite disruptive for levels of blood sugar, which I'm going to explore in some depth a bit later on, okay? Now, when you have disruption in blood sugar, you can drop your blood sugar and that can cause people to be hungrier than they should be. It can cause food cravings and it can cause that mid to late afternoon lull that I mentioned earlier, that causes people to need to jab themselves in the leg with a sharpened pencil, okay? So in the first part of this presentation, we're going to be talking mainly about these and how to get out of this trap if you've ever fallen into it, okay? And then the second half of the presentation, we're going to be talking more about the influence of food and nutrition and also exercise on general health, feeling good, being able to concentrate well and being optimally effective. Now, after starving these men, they started to feed them, okay? And at one point, they gave them unlimited amounts of food so they could eat as much as they like. Now, in response to that, some of them were consuming up to 4,000 calories a day, okay? And it seemed that their eating had a direct relationship to their fat stores in their body. So in other words, as fat stores in the body were replenished, they ate less. But by the time they were eating what you might call normally, right, these men had fat levels that were 75% higher than they were at the beginning of the diet. Now, for 60 years now, we've known that applying a calorie-based, low-fat, high-carbohydrate approach to weight loss has very detrimental effect on the body. It has detrimental effect on physical and emotional well-being and it generally leads people to be fatter at the end of it all than they would have been if they'd done nothing. And yet, this is an approach that often underpins health professionals' advice to people. You need to eat less calories, okay? And you need to make the diet low in fat. That's a common refrain. But there's other problems associated with dieting, okay? Here's another one. When people are counting calories and reducing calories, it raises levels overall of a hormone called cortisol. Cortisol is your main stress hormone. Now, we need cortisol. It's absolutely critical to life, but too much cortisol actually predisposes to fat deposition, but particularly around the middle of the body, which is the form of fat most strongly associated with health issues like diabetes and heart disease. Here's another thing. Our metabolism depends on nutrients. Lots of different nutrients, you know, magnesium, B vitamins, or whatever, okay? If we eat a calorie-reduced, somewhat inadequate diet, we may become a bit low on those nutrients and that may stifle the metabolism, okay? And we have at least some evidence, this was a study actually done in women, that when they induced weight loss and people through these women with a diet, okay, just supplementing them with a multivitamin and minerals significantly improved their weight loss, which provides at least some indirect evidence for this idea that if we don't provide enough in the way of nutrients into the body, it's gonna be difficult for the body to metabolize food fully and lose fat. And here's another thing. I know a lot of conventional nutritional advice is based on the idea that fat is fattening, okay? So we would generally encourage people, therefore, to eat a relatively low-fat diet, okay? But what does the evidence actually show about whether fat is genuinely fattening and how effective are low-fat diets anyway? But let's just start with this. Why do we even believe that fat is fattening? Anyone? So we've been told that, any other thoughts? It's called fat, okay? So that's a little clue, all right? But what else? This is about calories. What about calories? Yeah. That's right, fat has twice as many calories as carbohydrate or protein per gram or whatever. That's right. But actually what the evidence shows is, if you look at populations, people who eat more fat are not necessarily fat at all. And here's the most important thing. If we're gonna recommend low-fat diets to people, then surely they should be effective for the purposes of weight loss. Are they? Absolutely not. There's a few studies that have been done that have looked at this. And over, for example, 18 months or so, the average weight loss on a low-fat diet is about no weight at all. They are stunningly ineffective for the purposes of weight loss. And that's even when people have apparently induced a calorie deficit. It just doesn't seem to work. So, if we just forget about calories for a moment, just stop thinking about calories and start thinking about something else. How could we potentially explain why some people are carrying more fat than they would like? Well, one thing you need to understand is that fat is, at least to some degree, under hormonal control. Hormones, to some degree, influence the storage and the release of fat from our fat cells. Now, there's a few players here that are involved, but there's one important player that I'm gonna talk about now, and it is the hormone what? Insulin, that's right. So, insulin, basically, is a hormone that does a number of different things in the body that basically predispose to fat gain. So, here's a little bit of physiology for you. So, we have fat cells with fat in them, and the aim of the game, really, is not to have too much fat in our fat cells. So, what is it that insulin does that puts fat in fat cells? Well, fat floating around in the bloodstream is mainly in the form of what are called triglycerides, okay? That's also the form that you tend to store that in fat cells. If you can pinch a significant amount of fat, then what you've got, basically, in your hand is triglyceride. Now, triglyceride cannot get into fat cells, okay? They're large molecules, and they need to be disassembled, okay, in order to do that. Now, there's a hormone on the surface of fat cells that disassembles triglyceride, okay? And the activity of that hormone is enhanced by insulin. In other words, insulin helps fat to be disassembled so it can gain access into the fat cell. So, that's the first thing. Once it's there, the action of insulin actually provides something that can help fat basically reassemble itself, okay? Where it then gets, if you like, semi-stuck in the fat cell. Now, of course, you can release that fat again, but in order to do that, you need the action of an enzyme, okay? And insulin inhibits the action of that enzyme. So, in short, what insulin does is facilitate the uptake of fat into the cells. It makes it more likely to form triglyceride where it's essentially stuck and it can't easily get out of the fat cell. And another thing that it does is inhibit the release of fat, what we call lipolysis. It also, to some degree, not a huge degree, stimulates the production of fat in the liver. So, in summary, you could argue that insulin is a fattening hormone and it has some influence on how much fat we're gonna store. The question is, what causes insulin secretion? So, what's the thing that causes most insulin secretion, anyone? Yeah, sugar, and sugar also comes from starch as we'll see later, okay? So, essentially, carbohydrate. Protein does cause insulin secretion, but less so than carbohydrate. And actually, fat, depending on where you look, which bit of the science you look at, has minimal effect on insulin secretion. So, technically speaking, okay? You could drink liquefied butter all day and not accumulate any fat. Now, that's probably a bit of a stretch, but I'll tell you this. There is a way of testing whether or not all calories, someone earlier mentioned this, was it you, you said, you know, there's an assumption that all calories have the same effect within the body. Now, one way of testing this would be to take individuals, split them into different groups, or a couple of groups, and you give them different diets, but you'd keep calories the same. So, for example, you'd feed some people a low-fat, high-carbohydrate diet, and you'd feed other people maybe a low-carbohydrate, high-fat diet, right? And if you keep the calories the same, and all calories are the same in terms of their effect on fat deposition, then effects on weight should also be the same. Now, there are plenty of studies that show that the effect is the same. There's also a fair amount of studies that don't show that, there's about 10 of them, and what they consistently show, when they do show a difference, is that the diet that is most effective for the purposes of fat loss are the ones that actually contain the most what? Fat, that's exactly right. Now, while that doesn't appear to make sense, if you just think all about calories all the time, as we're encouraged to, if you think about it in this way, and if you think about the critical role potentially of insulin here, then it becomes more explicable. Here's another fundamental problem, though. If we eat a very carbohydrate-rich diet, we're going to tend to secrete lots and lots of insulin, and over a period of time, we eventually might become numb to the effects of insulin. In other words, insulin is not doing its job very effectively. Now, the key function of insulin is to take nutrients out of the bloodstream and put it into your cells. That includes fat, we looked at it earlier, but it also includes sugar. Now, sugar for a lot of people is a basic fuel. They demand on getting sugar into their cells to generate energy. So imagine now your cells, your muscle cells and your brain cells, are not able to take up sugar very readily. Now, your muscles and your brain are starved of fuel. How might that feel, anyone? Tired, yeah. Physically tired, mentally tired, and here's another thing. If your brain is starved of fuel, don't be too surprised if you are on the hungry side. But here's the other thing, because sugar's not effectively making its way into the cells, if we eat a lot of foods rich in sugar, so that sugar and starch, then effectively, sugar levels might be high, and high blood sugar levels are very damaging to the body, and it's the reason why diabetics have complications like blindness and kidney disease and the need for amputation, okay? This is not a good situation. Here's another important feature of weight control. It's another hormone, and this one's called leptin. Has anyone here heard of leptin? Very good. There's a few health-aware people here, very good. So leptin is actually secreted by fat cells. So as we get fatter, the body secretes more leptin, and leptin goes through the brain where it has two main effects. It stimulates the metabolism, and it makes us less hungry. It suppresses the appetite. This is fantastic, because if we were to put on weight and secrete more leptin, then the body is self-regulating, okay, and basically telling us not to eat so much, okay, by quelling our appetite, and also getting us to burn off a bit of that fat. Fantastic. It's all fantastic unless leptin isn't working very well. Either we don't have enough of it for some reason, or we're a bit resistant to its effects, like we can be resistant to the effects of insulin. Now, it appears that leptin resistance in the brain, and this is generally viewed as a fundamental problem with weight control with certain individuals, is related to a process called inflammation. So if I go up to, I don't know that table, and I stub my toe on it, eventually that toe might be a bit sort of red and swollen and painful. That is inflammation. That fundamental pathological process, something called inflammation. What we're talking about here is relatively low-grade inflammation in the body. It may not cause pain, okay, but it appears to be one of the factors that is strongly associated with obesity, and possibly through this mechanism. The leptin not working in the brain, so we're a bit hungrier than we should be, and our metabolism isn't working quite as well. Now, there's also some thought that this issue with leptin resistance might be caused by problems with leptin getting into the brain, okay? And one thing that may block or bar their entry into the brain is sudden disease called triglycerides. What are these? These are fats. These are fats in the bloodstream. And what creates triglycerides? Well, a major stimulus for that is our carbohydrate consumption, actually. Here's another thing. Spikes in blood sugar. If we eat foods that are very disruptive to blood sugar, we'll go through them in depth later on. That also induces inflammation. As does, by the way, certain fats called omega-6 fats that are in things like processed foods, vegetable oils, and margarine. Many of these things, including the vegetables and the margarine, are sold to us as fundamentally healthy. So, if you take this all together and you think about this, there are a range of reasons why taking a conventional approach to weight loss is basically doomed to failure for the vast majority of people. And it may not be that we're failing, okay? It might be that the approach fails, right? So let's just summarize this. I know it's depressing, but let's just go through this, all right? So, if you eat less, you're almost certainly gonna put a dent in your metabolism. And overall, it appears that that dent is actually bigger than the dent that you would predict just through weight loss, okay? Reduced energy expenditure because of spontaneously lowered levels of activity. Both animal studies and human studies show when you put them on calorie restricted diets, overall, they move less. They burn less calories through movement, quite spontaneously. You might get nutrient deficiencies. You know, something that might be low calorie, but it doesn't mean it's nutritious. You know, these carpet tiles on this stage, you know, may well be low calories and may well induce weight loss, but they're not very nutritious. And the problem is, is that we might run into problems with nutritional deficiencies that again, stifle the metabolism. Hunger. Let's not underestimate the effect of this because this often has a very profound effect on people's mental wellbeing and physical wellbeing, okay? A lot of people find it very, very difficult to sustain any approach that causes hunger. Of course, the other side of this, okay, is that if you like, avoiding hunger is a prerequisite to success and we'll build on that theme a little bit later on. Okay, so raised cortisol levels, that's one thing that happens when people go on calorie reduced diets, the impact there, cortisol causes fat deposition around the middle generally. If you're eating a lot of carbohydrate and a low fat diet, you might also be having a lot of insulin swimming around in your system that predisposes to fat gain. You might also find that it's very difficult for you to state your appetite properly because of the impact that carbohydrates have on blood sugar balance and their innate ability to satisfy the appetite has been shown to be relatively limited. I'll show you some more stuff on that a bit later on. We haven't finished, okay. Increased insulin resistance potentially, where effectively the fuel like glucose in the body is not getting into the cells so now we're tired and hungry. Leptin may not be working very well so now we've got more hunger and less metabolism than we should have and maybe reduced leptin intake into the brain. Once it's there, it doesn't work very well either. Why? Because we're eating a lot of carbohydrate that's barring its entry through the production of triglycerides. So I would say good luck with that, okay. If you want to use that as your mainstay approach to losing weight and controlling your weight in the long term, you might think there are possibly better ways of doing that. So a lot of people think, well I'm not really bothered about my diet, I'm gonna do it with exercise, okay. So let's just have a look at this for a bit, okay. Here's my question, does exercise really promote weight loss? Now when exercise is promoted for weight loss, normally what people are being advised to do is to take aerobic exercise so that could be cycling or running, jogging, those sorts of things. The idea is you've upped your calorie output, haven't you? So if you've upped your calorie output and you're eating the same amount of food, you're gonna lose weight. What is the actual evidence show though? Forget the theory for a moment, what is the evidence show? So let's imagine you take people, you put them on a weight reducing diet that lasts for six months, okay. Let's say they lose 20 pounds for argument's sake, not bad at all. Let's say instead of just getting them to change their diet, you've also asked them to exercise and I'm talking about say 45 minutes of exercise three or four times a week. In other words, a fair amount of exercise. What is the average amount of weight loss now? It's not 20 pounds, it's what? Does anyone know? Or has it a guess? It's what? You're very close. It's 22 pounds. That's the average amount of weight loss that you'd see. In other words, what the study show is that the additional weight loss on top of what weight loss you would achieve with diet is just about a kilogram or two pounds, okay. Now let's just think about this for a moment because if you change your diets and lost some weight, say over a six month period, okay. And you lost, I don't know, let's call it 10 pounds, wouldn't be bad at all. And I said to you, well, we could get another couple of pounds off you, okay. Easy. But you're gonna have to do what is essentially about 70 hours worth of exercise to get that additional benefit. Honestly now, unless you were really into exercise, what do you think most people would say to that? Usually there's a very short word involved in that answer, okay. Okay, so the problem is is that the evidence suggests that exercise as we generally prescribe it, running, jogging, walking, cycling, isn't really very effective for weight loss. Now, let's not struggle with this. Let's explore it and I'll tell you some things that work better a bit later on. But let's just have a look first of all, why might this not be a very effective way for losing weight? Why am I running for 30 minutes, five times a week, not really accelerate your weight loss? Anyone? What? Makes you hungry? So some people get very hungry when they exercise. Some people reward themselves with food after exercise or drink. Anyone done that? Played a bit of footy. Let's have a few beers. What other things? It's not efficient. It's not efficient at all. It isn't efficient. Absolutely right. It is horrendously inefficient. Has anyone here ever exercised on a piece of equipment that counts calories? Was it you at the back there? Was it a joyful experience for you? Were you, yeah, you weren't ripping through calories. You think, oh, you know, at the end of your 40 minute run, I've burnt 2000, 200, 300 maybe. Just not that many. About three apples worth seeing as you're eating an apple, you know what I mean? Not a huge amount has been burned there, right? So you're right, it's not efficient. And there's another thing. Okay, that's a bit of a problem with exercise. And it is this. I know we tell people that it stimulates the metabolism, but actually there's very good evidence to suggest that overall exercise suppresses the metabolism. Now this, I know it sounds counterintuitive, but it makes sense, doesn't it? We found out that when the body has less calories going into it, it puts a dent in the metabolism. It's a survival mechanism. If you exercise the body more, it does the same thing. It basically reduces its output, okay? Because it doesn't know you're not going to exercise it to death. Here's the other two things. The calorie burn during exercise is depressingly small and people who tend to exercise more will often eat more too. So let's think about weight control in a different way, okay? Forget about calories. Forget about eating less than exercising more. And start thinking about maybe doing these things, okay? How about eating in a way that would have effects on our hormone levels in the body that would just allow us to lose weight very naturally indeed, thank you very much, okay? So we'll look at some more detail around that in a moment. That would mean basically having lower levels of insulin. It would mean optimizing our leptin functioning. It would not mean starving ourselves and going on anything that resembles a diet, okay? And how about this? Because hunger, I have to tell you, is the enemy when it comes to eating healthfully and weight control. I can't tell you how fundamental this fundamental thing is, okay? It is almost impossible for people to regulate what they eat and their weight by going hungry. Let me put this another way to you. If individuals want to eat healthfully, lose weight, feel better, this is a prerequisite. They really do need to be able to not struggle with hunger and feelings of deprivation in the long term. This is critically important. In fact, I sometimes say to people, say in practice or if I'm working with a corporate client, the less hungry someone is, the more weight they'll lose if they need to lose weight and the easier they will find it to maintain that weight loss. That is almost universally true. It's the exact opposite, in my view, of what we've basically been taught to believe. So what's satisfying? So out of carbohydrate protein and fat, one of those seems to shake the appetite more than the other two. What is it? It's protein, that's right. So relatively protein-rich diets, okay? You don't have to go mad, but some protein in it, hopefully with every meal. So that could be some meat or fish or eggs, possibly some nuts if you're using nuts as a snack food, would be a generally good idea. Also, fat for some people is very satisfying. You know, it's why they don't get a lot of satisfaction necessarily from a chicken breast, but a chicken leg or a piece of duck, for some people is much more satisfying and much more sustaining. So one of the fundamental problems that we have with conventional nutritional advice, in my view, is that it basically pushes people towards a diet that is relatively low in fat, relatively carbohydrate-rich, that is inherently unsatisfying. Now, if you eat, I don't know, a bowl of cereal in the morning, you might be momentarily satisfied with that, but I can tell you, time and again, you'll see people in practice who say, well, you know what? When I eat cereal and toast in the morning, by about 11 o'clock, I'm starving again. So I've realized that it's better for me to eat nothing because I'm actually less hungry at 11 when I eat nothing than I am when I eat cereal or toast. So why is that? Well, these foods are not inherently satisfying and also, and I'm going to build on this later, they are inherently disruptive to blood sugar in ways that can cause highs and lows of blood sugar that stimulate appetite that really shouldn't be there. It's a fundamental problem. Shift the emphasis away from those foods towards foods that are more stabilizing for blood sugar, that are a bit richer in the way of sustaining satisfying portions of the diet like protein and fat. And this is usually what allows people to fundamentally, when they eat right, to eat less. Now, this is not just my experience in practice, okay? There are studies that show when individuals who are eating a standard Western, relatively low-fat, carbohydrate-rich diet as we're encouraged to eat, move their diet away from that to more of the diet that we're looking at here, they will spontaneously eat several hundred calories less each day. That is common. Not because they're consciously restricting how much they're eating. They're not as hungry. They're not as hungry because they've stabilized their blood sugar level. Number one. And number two, they're eating much more satisfying foods. So they just naturally eat less. Now, if you could get yourself to a state where you're eating healthily, eating well, enjoying what you're eating, and if you wanted to lose weight and you've lost weight and there's no hunger, wouldn't that be a kind of nirvana? I would say it would. Can this be achieved very, very rarely does this approach not work in men? Very rarely indeed, okay? They're really in the minority. If you have a look on Amazon, so Waste Disposal, as I say, it was published a couple of years ago, but it's got a hundred reviews on Amazon and most of them are five star, and then a few four stars. There's a few lower stars as you will always get. Lots of people who haven't read the book that just says this is bunk and that sort of stuff. Anyway, ignore all of that for a moment. Going to those positive reviews when you look at them, here's a very constant refrain, right? I lost loads of weight. I feel fantastic. This is totally sustainable, okay? Because I'm enjoying what I'm eating and I'm not hungry. Why didn't someone tell me before? Trust me when I tell you, when people apply the sorts of principles that we're talking about here, usually they will get the result they're looking for very easily, which is why I said the easy way in the title slide. So here's a table of studies where they have pitted low carbohydrate diets or lower carbohydrate diets with low fat diets. Now in these studies, what they've typically done is with people on the low fat diet, they have restricted their calories, so they said don't eat more than 1500 or 1800 calories or whatever. Here's the food you need to eat and they're all the sort of low fat foods, grain based foods, that sort of thing. In the low carbohydrate groups, so they have not done that. They've just said don't eat all this rubbish carb, right? But you can eat as much as you like. So this really mimics in my view what real life is like for people, okay? Who don't want to constantly restrict calories. And here's the results of these studies, okay? So this is the duration of the study. This is weight loss on relatively low carbohydrate diets. This is the weight loss on low calorie, low fat diets, okay? And then we've got something here called statistical significance. So statistical significance is a human-generated thing. It's basically we're telling people whether or not the any difference was likely to be real or due to chance, okay? Now, one of the reasons that something may not be statistically significant is because there wasn't a lot of people in the study, okay? And also, I have this thing about statistical significance. First of all, it's utterly arbitrary what you call significant or not, okay? But the other thing is that, you know, for example, if you did a study where people on a low carb diet lost an average of 15 pounds and on the low fat, they lost an average of 10 pounds, okay? It doesn't really matter to people whether that is statistically significant or not. They'll take the 15 over the 10, do you understand? In the real world, it doesn't have as much validity as you might imagine. But anyway, I'll put it in here for the sake of completeness. Now, look at the results of all of these studies, okay? These were not cherry-picked. These were all the studies that I could find where low carb were pitted against low fat. And in every single case, the low carb wins over low fat. And remember, these people eating the lower carb diet were not restricting calories. They were not going hungry. So I don't know. I suppose you could have a little go at the concept of low carb. But if you look at the totality of the evidence, it's pretty clear that overall, it wins out over low fat. And it's also something that I've found in practice that is way more sustainable than people going hungry and counting calories. Now, there's other approaches you could take to push this on a little bit, okay? And one might be something called intermittent fasting. Has anyone here heard of this, ever applied it, tried it? Okay, there's a few very health-aware people, okay? So one of the concepts behind intermittent fasting is this, okay? Is that we have insulin in the body, and it's a good idea not to have too much insulin, okay? Because it, first of all, probably predisposes to fat deposition, but it also may predispose to problems like diabetes and heart disease. Now, one way you could get insulin levels down would be not to eat foods that cause lots of insulin secretion, like those, excuse me, crappy carbohydrates we're encouraged to base our diet on, like bread, potatoes, rice, pasta, and breakfast cereals. We're gonna look at them in more depth later, okay? But another way to do it, of course, would be not to eat. Because if you don't eat, you don't have spikes in blood sugar that are gonna cause you to create much insulin, right? Obviously not. So intermittent fasting is this idea of going for relatively long periods of time without eating. Two, we hope, lower insulin and get benefits from doing that, okay? Now, there are some very extreme forms of intermittent fasting out there, okay? I'm not saying people shouldn't do them, but they can be a bit scary. So for example, there are some people who will not eat outside a, say, four to six hour window in a day. So if they start eating at noon, right, no breakfast, they start eating at noon and they're all done by four or six and they don't eat at any other time. It's fairly hardcore, okay? People do do that, not against it necessarily, but do you need to do that? No, here's a thought. First of all, do we need to eat by the clock and three meals a day? Now, up until about two years ago, and I've been at this a long time, I generally believed that people usually needed to eat three meals a day. Is that true, though? I mean, first of all, does it even make sense? Does it make sense that we are programmed to need to eat by the clock regularly like that? Because I tell you what, if we were programmed to be like that, we probably wouldn't be here, would we? Because we wouldn't have been able to go for more than a day or two without eating before we get a sort of keel over and die. It doesn't make sense that we need to eat very regularly. And it turns out that some people can be incredibly healthy and eat very irregularly. So, is there anyone here who doesn't really eat breakfast and doesn't really like to eat breakfast? It's just not the... Yeah, right, fine, okay. By the way, all of you are slim, okay? So, there's a little clue there, okay? So, here's the thing, right? Why should you eat breakfast? Because you've been told you might need to. But if you wake up in the morning and you're not hungry, okay, and you get through to 11, 12 o'clock, and you're still not very hungry before lunch, why would you eat? You must be living off something. And the chances are, you are living off your fat. Why? Well, partly because I would hope you're not eating a rubbish diet that's causing fat to be trapped in your fat cells so you can mobilise it relatively efficiently. And you're not very hungry. If you're not very hungry, you're probably living off your fat, right? So, what is wrong with that? Well, fundamentally, there's nothing wrong with that. So, about two years ago, I decided to try intermittent fasting in my own life. Now, I'd eaten breakfast, I think, pretty much every day for about 20 years. And a patient of mine had lost about 100 pounds in weight, but she'd plateaued, and she said, what shall I do now? So, we discussed intermittent fasting, and I said, I'll do it with you, okay? Now, she did something different. What I did was challenge the notion that I needed to eat breakfast. So, what I started to do was delay my breakfast. So, instead of having it at, I don't know, seven o'clock, I don't even remember when it was in those days because it was a couple of years ago, but about seven o'clock, I just pushed it back and pushed it back. And within a week, I realized I was getting to lunch without being very hungry, and I was thinking, is this affecting my performance or my mood or anything like that? Is it diverting my attention for what I need to do in terms of my work or anything else? And I actually found, if anything, I was probably functioning even better without breakfast. So, it made me think, well, is it okay for individuals to go for extended periods of time without eating? And then I started to see this in people that I work with in the corporate sector. So, a lot of the people that I work with in the corporate sector are lawyers, accountants. They're usually very, very high-functioning people. And every so often, someone would come in and they would say something like, I'm a bit worried about my eating habits, okay? Because they're a bit all over the place. And my wife's worried about me because she thinks I should have breakfast and I never do. And you'd hear this very, very commonly. And then you ask them about their lives and how they function. No hunger. When they do eat, they eat very well. Hugely high-functioning. No evidence, for example, in their biochemistry that there's anything going wrong. And it kind of convinced me that there is some legitimacy to this. And I'm not saying everyone needs to do it, but delaying or skipping a breakfast, maybe having an early evening meal and a later breakfast, for example, will, technically speaking, extend the time that insulin is low and that overall is likely to be good for a number of things, including fat loss. The caveat here is that you cannot allow your hunger to get out of control. This is not an endurance exercise. This is not how long can I go before I buckle and eat a foot-long baguette for lunch. That is not the name of the game. You still need to be eating fundamentally healthy if you want to get the benefits of that. So the caveat here is, if you want to try this, go for it. Just do not do it in a way that allows your appetite in any way to run out of control and make it harder for you to eat healthily. Now, with regard to exercise, I'm not a huge fan of endurance exercise. Now, I used to run a lot, okay, up until about 12, I think 12 years ago. I used to run 30 or 40 miles a week very often. Was quite into my running. I would run, you know, regular 10Ks, odd half marathons and things like that, okay. And I was really into it, okay. I've come to realize it is really not the best way for people generally to stay in good shape. In my case, my problem was, it gave me a lot of running-related injuries. Okay, so I had ankle problems, knee problems, hip problems, a sacroiliac problem. That's sort of, it's not really a joint, but it's where two bones meet in the pelvis. And some back problems. And I spending about as much time on the osteopast couch as I was running, okay. And it convinced me that it's probably not the right thing. And then obviously I have been able to justify the fact that I don't run like that anymore by looking at research that shows that it is, number one, not great for weight control. And number two, has anyone seen, there's recent evidence coming out that endurance exercise can cause scarring in the heart muscle. Anyway, it's out there now, okay. So, in the heart muscle. Yes, the cardiac muscle. Yes, scarring, yeah. Because it's very hard, you know, running marathons and stuff like that is really hard work. If you have, and by the way, I had all these running injuries, but even though I say so myself, I have a very easy running gate. And as you can see, I'm built for running. No doubt about that. And yet I was having lots of problems. I don't know whether I've scarred my heart muscle or not. But let me just tell you, in order to be fit and healthy, you don't need to do endurance exercise. If you want to do it, go for it, okay. But if you wanted to feel good, look good, okay. One thing that you might contemplate doing is some resistance exercise. So I'm sure by the looks of you, there's a few of you that do that sort of stuff in here. Now, you can go to a gym and do that, but you don't necessarily need to. So both of my last two books contain very brief, 12-minute exercise programs that you can do in the comfort of your own home with only some dumbbells, okay, or what's called a diner band. So it's essentially a giant elastic band. And if you just do that for 10 or 12 minutes a day, it's about the time it would take you to shave, okay. Then there's a very good chance that you're gonna be able to maintain your strength and your tone, okay. So that you look good if that's important to you. Now there's another form of exercise that can actually promote fat loss and it comes in the form of what is called high-intensity intermittent exercise or what we used to call interval training, okay. So does anyone here engage in any of this? Okay, very good, you're a great group, okay. So high-intensity intermittent exercise is what it says, okay. It's basically periods of very intense activity interspersed with periods of little or no activity. So for example, you might sprint for 10 seconds and then jog or walk for 20 or 30 seconds and then repeat that cycle five, six, maybe 10 times. You can do it on a rowing machine, you can do it on a bike, spinning classes are very often based on this basic concept. And what's very interesting is this is that the evidence shows that relatively short duration activity can have massive benefits in terms of improving things like fitness at least in some studies, fat loss compared to steady state exercise like just running at six and a half minute mile pace for 10 miles, okay. It can be massively beneficial. It is a very time efficient and effective way to be fit and strong basically, particularly if you couple these two things together. So here's a little summary for you, okay. Here's some dos and don'ts of fat loss, okay. Number one, first of all, do not judge your weight by your body mass index or your weight. It doesn't tell you anything, okay. You're not old enough for me to say this, but basically in front of other audiences, I would say if you've got a bit of a gut, you probably want to get rid of it. It's as simple as that. And everything else around this, in my view, is irrelevant and I strongly advise you to ignore it. So I advise people not to consciously restrict calories, not to look at calories, count them, monitor them in any way, but just to eat food, which we're gonna come onto in a moment. So I'll show you how to practically apply this. Don't eat a low-fat diet. A low-fat diet very often will not satisfy and it also puts the emphasis where on carbohydrates, which is a fundamental part of the problem as I see it. Please do not allow yourself to get very hungry. I can't tell you how important this is. I mentioned it earlier. I'm mentioning it again now. As I say, and this is very important, the less hungry you are overall, the easier this will be to do, the more weight you're likely to lose and the more likely you are to sustain that weight loss. And we've just been talking about this. I generally encourage people not, unless they really want to, to engage in prolonged periods of aerobic exercise, okay? Yes, if you really love your triathlons and your marathon running, you could continue doing that if you want to, but do you need to do that to be fit and healthy and relatively low in terms of body fat? No, absolutely not. Here's a few dos. Focus not on the quantity of the food that you eat and the calorific value, but the quality. So we're gonna build on this in the next section. I would generally encourage people to put more focus on protein and fat and a bit less on carbohydrate than is traditionally advised. It's very important that when you approach meals that you're not famished, okay? Because that makes it very difficult to eat healthily. So for example, let's say you work and you come in from work, okay? And it's, I don't know, seven, seven, 13, you're starving hungry. It becomes very difficult to make controlled choices about what you're gonna eat at that stage, right? When people are less hungry, they find it much easier to control what it is that they eat. Now generally I advise people on a scale of naught to 10, so naught is no hunger. 10 is I'll eat this stage, okay? You wanna be about a six or a seven, okay? You might engage in some resistance exercise and maybe some high intensity intermittent exercise. You might contemplate intermittent fasting. You don't have to do that in an extreme way, but it's often very effective for accelerating fat loss or helping people through a plateau. And here's the other thing, see whatever changes that you make here as positive, enjoyable experiences. This is not a diet. This is not something to get on and get off. It's something to basically do where you just eat like this and keep eating like this. Now does it matter if you have the occasional slip-up? No, of course it doesn't matter if you have the occasional slip-up because it's not slip-ups. Things that you do some of the time determine what your long-term health and weight will be. It's what you do most of the time. And so when the focus is there and you're enjoying what you're eating and you're happy with that, if you have occasional treats, slip-ups, indiscretions or whatever, it really doesn't matter. And that's how, for example, you can eat healthily, get the benefits of that in the long-term. As Anthony said, he thinks long-term when he's thinking about his exercise, not thinking about the benefits he'll get from that weekly session. He's thinking about the cumulative effect of those weekly sessions over 50 years, for example. You might think the same way. But does it matter if he misses a session one week? Of course it doesn't matter in the grand scheme of things. I went out for dinner last night, okay? I didn't eat perfectly by any stretch of the imagination and I drank, okay? Does it matter? No, because I just don't do it that often so it can't matter. So the next thing that I want to talk about is this because a lot of people say, you know, if you eat relatively carb-restricted diet that's relatively rich in fat, then that's gonna be bad for your health. Oh yeah, you may look good, but inside it's gonna wreak some sort of havoc. So what I'm gonna do now is quickly go through the impact of different foods on not our weight now but our health, okay? So that we understand this is not just a way that you can optimize the way you look and feel but also optimize your long-term health and reduce your risk of illness. And I'm gonna start with this group of foods here called the carbohydrates. Now carbohydrates are sugars and starches, okay? Now why do we call these foods that look and taste quite different? One thing, the reason is they are one thing. Starch is sugar, it's chains of glucose molecules. That's all it is, okay? So when you eat starch, you break it down into sugar so whether you eat a sugar or a starch or both the effect is the same. You'll get a rise in blood sugar and in response to this, as we know, the body secretes a hormone called insulin. Now, this is all good as long as we're keeping blood sugar levels stable but if we falter here and have instability here, okay? Then this can be really damaging to our long-term health. Now, first of all, in the short term when we drop our blood sugar, what might happen? We need sugar generally for energy, okay? So if we drop our blood sugar, we can get what? Tired, yes. And when in the day are we most likely to get this, by the way? Yes, the afternoon. That 3.34 o'clock lull is almost always caused by this fundamental problem. What else may happen? Your brain is only about 2% of your weight but it uses about a quarter of the sugar in the bloodstream at rest. So if it doesn't get that sugar, guess what happens to your brain? It goes to sleep. So if you lose concentration, lose focus, all of a sudden, around 3.34 o'clock, this may well be an issue. Here's another thing. Low blood sugar can precipitate food cravings. Why? Because if blood sugar levels are low, then it's natural for your body to crave foods that replenish sugar quickly into your bloodstream like what? Cakes. Cakes. Donuts. Donuts. Biscuits. Biscuits. Sweets. Sweets, yeah. Now a lot of people think that when they succumb to this, they lack self-control and they've got a weak will. That might be true. They may be very inadequate people overall. I don't know. But usually when people are craving these foods and succumbing to them, it's because of physiological reasons, this fundamental imbalance, not psychological reasons. And here's another thing that can happen. This can wake you up in the night because when we drop our blood sugar level, it turns on the stress response. And that is not good for restful sleep. So we've got these problems there. Up here though, if you make a lot of sugar, you're going to make a lot of insulin. And I've been telling you, you don't want a lot of insulin in the body, okay? So one of the things that we know is that high levels of insulin are associated with things like cardiovascular disease, like heart disease and stroke. An increased risk of diabetes, specifically type 2 diabetes over time. There's quite strong links between this range of issues and something called dementia. And of course, we covered this earlier. One of the things that may happen is that we're going to deposit fat. And when insulin is involved, very often that fat will be in or around the middle of the body, okay? Just where we don't want it for a variety of reasons. So one of the things that you might think about in terms of having a diet that's going to work better for you, both in terms of your short and long-term health, is one that stabilizes blood sugar and moderates insulin. So one way we could do that, of course, is to not, for example, I don't know, skip breakfast, eat a sandwich at lunch, and then eat half your weight in food with three beers in the evening. Because if you eat like that, irrespective of what you've eaten, it's going to be destabilizing for blood sugar and possibly insulin, okay? But the other thing, of course, would be to place some emphasis on foods and the diet that release relatively slowly. So you get more of this, less of this going on. Now, how do we know how quickly a food releases sugar into the bloodstream? Anyone? We can test it, and we have a measurement known as the... GI, or the glycemic index. So here's the glycemic indices of some of the faster-releasing carbohydrates. Now, glucose, that's pure sugar, is given a value of 100. Just so you know, when we put sugar in our coffee or tea or on our cereal, that is called sucrose. It's half fructose and half glucose. And the glycemic index of sucrose, table sugar, is 65. Okay? Just bear that in mind. Now, French bread up here has a glycemic index of 95. So if you get to lunch and you're starving and you eat baguette, what's going to happen? Well, you're probably going to get a significant peak of sugar. You'll feel fine, you know, the one they have in prayer with the sort of pastrami and the mustard. Yeah, it's fantastic. It tastes lovely. But you've got a very good chance of having a peak of sugar and insulin that may dump you with low blood sugar at, say, I don't know, three or four o'clock in the afternoon. So if you feel rubbish at three or four o'clock in the afternoon after eating a baguette-based lunch, it's because you've eaten a baguette-based lunch, probably. Okay? Baked potatoes, they're like icons of healthy eating. Are they really healthy? So why do we say baked potatoes are healthy? Because they're high in fiber and low in fat. These carpet tiles are high in fiber and low in fat. It doesn't make it good to eat, does it? But the bulk of what you're eating there is actually quite fast-releasing carbohydrate. So if you eat a baked potato of about this size, it's a bit like spooning that much sugar into your mouth, which is actually quite disruptive. Wholemeal bread, shredded wheat are down here. Then we've got pasta. It's not as bad, but it's still relatively fast-releasing. And one of the problems with these foods is this, is that it's not just that they're relatively fast-releasing. It's that when we eat them, we often eat a lot of them. Okay? So if you look at, you know, pasta and kiwi fruit, they have similar glycemic indices, but they're not similarly disruptive necessarily. Anyone here ever come home quite hungry, quite late at night and needed something quite quick to eat and then eat a big bowlful or plateful of pasta? Has anyone here ever done that? So this is relatively fast-releasing. You've had it in significant quantity. It's going to be quite disruptive. Who here, however hungry you've got, have come home and polished off a big bowlful or plateful of kiwi fruits? Anyone? You at the back. There's always one. Usually female. Anyway, so most people when they eat kiwi fruits will have one or if they're going for it two, there isn't very much food there. Can't be very disruptive, do you see? Also, kiwi fruits are reasonably nutritious. I don't think they're fantastic. For me, something more nutritious might be a piece of meat, but they're not bad. Pastry is ostensibly made from refined wheat and what's in refined wheat other than carbohydrate and the answer to that is nothing. It's basically a bowl of sugar, not much else. That's more fodder than food. Rice, white rice, what's in it? It's a bowl of sugar really, just so you know. Now, if we were thinking about eating carbohydrate, how about slow-releasing carbohydrates that are more nutritious? Would that make sense? Probably. So what have we got? This is a bit depressing, but just so you know, beans and lentils, fruits and vegetables other than the potato, pretty much fall into these categories. But you might be looking at this list and saying, I don't mind eating broccoli and chickpeas and butter beans, but if my diet is going to be based on these foods for me to have a nice, long, healthy life, I may as well be dead. And if you feel that way, I empathize with you, but I've got some good news for you. And that's because there's a whole bunch of foods that we haven't discussed in this section because they don't contain sugar and they can't disrupt blood sugar. And these are foods rich in what? Protein, that's exactly right. So foods rich in protein include things like what? Meat, fish, eggs, if you like plant foods and nuts and possibly seeds. So if we're thinking about eating these foods, yeah, then we're going to have stable levels of blood sugar, less likely to be hungry, not huge peaks of insulin causing fat deposition in our fat cells. It's fantastic. So I said I was going to present to you the one single thing you need to bear in mind to judge whether a food is healthy or not. Here it comes. What is common sense dictate would be the best diet for us as a species? Probably a diet based on the foods we've been eating the longest, right, in terms of our time on this planet. Those are the foods we've evolved to eat. They're going to be the best foods for us because we're best adapted to those foods. So how long have we been on this planet? It depends who you ask, but evolutionists roughly agree on this figure of about two and a half million years. Now for most of that time, we've been hunter-gatherers, right, eating hunted and gathered foods, these foods. When do we start to eat grain? Anyone? About 10,000 years ago, that's right. Relatively recent in evolutionary terms, but it's not just a theory because we saw generally how disruptive grains can be to our chemistry. We saw they're not fabulously nutritious either generally speaking. Now if you go along with this theory, you might be looking at this and then say, well how come meat is bad? Because we're told not to eat much meat, particularly red meat, particularly fatty meat, eggs, heart attack on the plate, don't eat nuts, they're very fattening because they're full of fat. So something's wrong. Either the primal and evolutionary theory is true or these foods are unhealthy. You cannot have both. So let's go back to the science, okay, away from the common sense for a moment and back to the science to look at saturated fat. Now you'll all have heard of this. This is in red meat and eggs and dairy products and we're told two things. It's fattening, okay, and if we eat enough of it, we're going to get what? Heart disease, that's exactly right. Well, we've just explored this. Fat is not inherently fattening. Neither do low-fat diets work for the purposes of weight loss. But why do we think that saturated fat is a cause of heart disease? Because someone basically said that in the 1970s, okay? But let me just tell you, we have had literally dozens of studies over the last 30 or 40 years that show no relationship basically between saturated fat and heart disease. But the most important thing is this. What happens when people eat less saturated fat? And the answer is nothing. No reduced risk of heart disease, stroke, diabetes, any form of cancer, and it does not extend life by a single day. Now, there's pretty good evidence to suggest that saturated fat does not cause heart disease, all right? That's what the bulk of the evidence shows. And while that might be a bit of a surprise sometimes, think of it in terms of primal and evolutionary nutrition. So, saturated fat is a constituent in red meat. Let's say we've been on this planet two and a half million years. How long have we been eating saturated fat for? And the answer is all the time. That's exactly right. And therefore, something we should be relatively well adapted to by now. Now, could you take this principle and apply it to other foods? Here's some oily fish. These are sardines, but mackerel, trout, herring also contain what are called omega-3 fats. They appear to be good for the heart. Another part of the body, where am I thinking? The brain, that's exactly right. They appear to reduce the risk of things like depression and dementia, for example. Could we have worked it out for ourselves? Yeah, probably been eating them for a very long time. Relatively natural food, likely to be good, right? How about nuts? What have we told about nuts? Don't eat too many? They're very fatty. They must be fattening. There are over a dozen studies that have looked at the impact of nut eating on weight, and one of them found that they cause weight gain. Why not? So first of all, eating nuts is like putting the right fuel on the fire. They actually stimulate the metabolism quite effectively as well. Number two, probably not going to get huge surges of insulin from nuts because there isn't a huge amount of sugar or carbohydrate in them. And finally, they satisfy people. Whether a food is fattening or not depends on how much you eat of it to a certain degree and what you go on to eat later on. And there's a couple of things that seem to be important here. One is the glycemic index, the slower the better, and also protein appears to be more satisfying and nuts are relatively rich in protein. So one thing that happens when people eat nuts very often is that they just naturally eat less of other foods because they're less hungry because they've eaten something that's satisfied their appetite. Nuts also are a supremely nutritious food and quite strongly linked with the reduced risk, for example, of heart disease. Could we have worked it out for ourselves? Probably. Let's try another food, margarine. So what do we hear about margarine? It's better than butter. Why? It's low in saturated fat. But saturated fat doesn't appear to cause heart disease or anything. So that's a bit of a non-starter. The fact is margarine is generally made from processed vegetable oils. So one way you can process them is to bubble-hydrate them through them at very high temperature and pressure to make oils that are now solid so you can spread them. And it also extends their shelf life. But they've only been in the diet, I don't know, a few decades. So what's the likelihood that we're well adapted to these? Not high, right? Turns out that they're strongly linked with heart disease. So is margarine really better than butter? Is it? Yes or no? Well, saturated fat is a non-starter, but then we're told margarine reduces cholesterol. Well, when people take dietary steps to reduce cholesterol, it doesn't reduce the risk of heart disease. That's what the studies show. But even if it did, does the fact that something reduced cholesterol make it automatically healthy? If in this glass of water here I had a mixture of arsenic and cyanide and I found this to be an effective cholesterol reducing agent, would it make sense for me to recommend that we all have arsenic and cyanide every day? And the answer is no. Because the important thing is not the impact that a food has on cholesterol. It's the impact that it has on, on what? Health. And it's not the same thing. Now, there is no evidence that I can find in the scientific literature that margarine is healthier than butter. In fact, there is some evidence that points in the opposite direction, okay? Now, can we explain this somehow? Butter is not a primal food. It just isn't, okay? You don't see early man, do you, sitting around campfires, slathering butter onto it. You don't see bread either, but you don't see butter. But the good thing about butter is it's got two main constituents, two main fats in it, saturated fat, which has been in the diet forever, as well as mono-unsaturated fat that's in things like nuts and seeds and avocado, that's also been in the diet forever. So it's relatively primal from that perspective. Can you say that for margarine? Not really. You take a blend of vegetable oils that you partially hydrogenate, say, to make a class of fats never before known in the human diet until about, I don't know, 50 years ago. It's not something that is grain stings. To make that edible, and I use that term very loosely indeed, you would have to, number one, bleach it chemically, then deodorise it chemically, colour it chemically, flavour it chemically, stabilise it chemically, add an emulsifying agent, stop it separating out, and then you'd extrude that into a plastic tub and sell that to us, the unsuspecting public, as something healthier than we've basically been consuming for all of our time on this planet. It doesn't really make sense. The chemical processing of margarine, just so that you're aware, I'm just going to show you the chemical processing now of butter, and that more or less tells you everything you need to know. Now, most of you will know and will have gleaned from this that another relatively new food that we don't want to be eating too much of is sugar that's taken out of sugar beet or sugar cane or now corn and then added into whatever, a can of cocoa or chocolate bar. Now, there's links between sugar consumption and a variety of health issues. Most people are familiar with a lot of this, but maybe not heart disease, which has been out there for quite a long time, but it hasn't really got so much attention because of our focus on fat. So is there a healthy alternative to sugar? Well, we're told that artificial sweeteners are better because they're sweet, but they contain no calories. So we'll look at that in a moment. Are they effective for the purposes of weight loss? But let's choose one artificial sweetener here as spartane. Look at the chemistry of it. It's actually got three molecules in it, aspartic acid, phenylalanine, and methanol. And all of these are potentially toxic to the nervous system and actually are associated with some adverse effects on health. So there is at least some scientific evidence linking them with problems such as depression. There's lots and lots of anecdotal evidence that suggests that these things can be damaging to health, but also there is some evidence that's generally supplied by the industry that tells us that everything's fine and we don't need to worry about the links with headaches or depression or whatever. The fact is that whether a study is funded by the industry or not appears to have a very important bearing on the results that you get from that study. So every single industry funded study says it's fantastic and more than 90% of independently funded work says there's cause of a concern here. We don't need to get too bogged down in this and the reason is that ultimately you need to ask yourself this question. Is this going to be effective for the purposes of weight loss? To know that you'd have to conduct what are called placebo controlled studies and there is not one of these in the scientific literature. So why not? Well they either haven't been done or they have been done and maybe haven't been published. I don't know the answer. What I do know is this. There is independently funded work in animals that shows when you feed them artificially sweetened foods compared to when they're eating sugar sweetened foods they get hungrier, eat more and get fatter. Could we have worked this out for ourselves? Probably. Here's how. Is this a relatively newer and old food? New or old? It's new. It's very new. Likely that we have the biochemical metabolic machinery necessary to deal with this stuff is low. Likely that this might be actually quite problematic to health. It's actually quite high overall. So when should we eat? So what we told? Eat three meals a day. We looked at that earlier. That may not be the best way for you and also don't eat in between meals. Why? More calories means more weight. However, sometimes if you have your lunch at 12.30 and dinner isn't going to be till 8.30 you might want to eat something to stop yourself getting very hungry, right? This is a very important tactic that some people can use to control their diet and control their weight much more easily. It is not necessarily a good thing to sit in a restaurant or on a plane or in your home starving hungry. So if you are going to snack on something, OK, save between your lunch and your evening meal to keep you from running into problems what might it be? What food specifically? What snack food? Nuts. That's exactly right. And probably not fruit. The reason being mainly for many people fruit does not effectively shake the appetite. You know, some people they'll get hungry, eat half a bunch of grapes and an apple and be as hungry 10 minutes later as they were before they had anything, OK? It's not really doing its job then. So what should we drink? Water. We're two-thirds water. It's all we drank for about two and a half million years. So what happens when we don't drink enough water? We get dehydrated. What happens then? There's lots of things that can go wrong when we get dehydrated, but one particular thing is it can affect brain function, OK? And some people become mentally lethargic quite quickly when they become dehydrated, OK? So one of the things that you might want to consider is keeping an eye on something that will tell you what your state of hydration is. What is that thing? No, not first. No? Focus. What? Focus. Not focus, no. Any athletes or ex-athletes here, because you'll probably know this, how do you judge your state of hydration by? Not by thirst, because it's usually too late, OK? The colour of your weed. The colour of your weed, that's exactly right. So the trick is to keep it pale yellow throughout the course of the day. If you do that, you're drinking enough fluid. If on the other hand it strays into darker tones and you start to make urine that resembles a wolf would use to mark its territory, OK? Then you have become dehydrated and you will probably do well to up your water intake, OK? And in response to that, you're likely to feel better, literally, within about half an hour. Is it the only healthy fluid? No. There's actual evidence linking tea and coffee consumption with improvements in health, OK? It seems a bit far-fetched that coffee, which generally doesn't have the healthiest of reputations, would be beneficial to health. It's actually associated with a significantly reduced risk of diabetes. That doesn't mean that it causes diabetes risk to be reduced, OK? Just that they're associated. However, both tea and coffee are rich in substances called polyphenols. Polyphenols have what we call antioxidant function in the body. In other words, disease-protective function. So if you steep these in hot water, it may not be such a mad thing, OK, that these things are beneficial to health. The problem with them is that they contain stimulants, and stimulants can stop people sleeping and mess up their health in other ways. So you might want to have some, but not too much. So how are you going to cope with this? Well, I would generally advise people who like tea and coffee to have something they really like, because a lot of people who are drinking too much of this stuff will drink anything, instant machine stuff, stuff served into meetings that they didn't ask for, or don't want, and only drink because it's there. If you get rid of that, and it's, I don't know, in my case, when I'm in town, it's kind of near rows or nothing. That's just my thing, OK? I've got an espresso machine at home, which I think is great tasting coffee, OK? So I might have that, OK? But everything else has gone. My capacity now to drink this stuff is significantly reduced, and what I do have, I genuinely enjoy. So one thing before we close is alcohol, OK, so most of us would generally like a drink, and we can justify this because alcohol consumption is associated with the reduced risk of heart disease compared to people that don't drink. Here's the problem. In these studies, sometimes they've included reformed alcoholics and people that don't drink because they've been told don't drink because they've got heart disease. Plus, heart disease, OK, is of no interest to us, maybe, in the long term, but it's not as interesting as this, and the reason that I mention this is that alcohol appears to increase the risk of things like cancer and other conditions that can kill us, so we need to look in the round, and when we look in the round, we need to look in the round rather than that curve we had up earlier. In other words, it doesn't appear that alcohol is really very beneficial to health, OK. Now, I'm not saying we shouldn't drink. I was drinking last night, but we might want to do something that enables us to drink less without any sacrifice or deprivation. So imagine you drink, I don't know, three glasses of wine, OK, instead of thinking about drinking less alcohol, you might think about bolting a nice healthy habit alongside that, which might be what? Have a glass of water with it and you've got also water diluting the alcohol, plus you've had some water you wouldn't have had otherwise. And the overall effect there might be, I don't know, a drink a day without conscious restriction. Here's another thing that's very important. If you want to drink less without conscious restriction, please do not be what when you start drinking. Don't be what? Thirsty, good, and also don't be what? It's over. Don't be what? Hungry, that's exactly right, because hunger is a major driver of alcohol consumption. So one very simple thing, whether it's beer or wine or whatever, just match it with water and it will keep you out of a lot of trouble. Now, we've gone through a hell of a lot of science and technical detail here, OK, around how you can manage your weight, OK, feel better, look better, and also manage your long-term health in a way that can reduce your risk of chronic disease and even death. You could really add some years to your life or you're going to remember it all, probably not. There's only one thing you need to remember, really, OK, it's this basic concept, just eating in accordance with the food that we've evolved to eat, OK, most of the time, not all of the time, we can still have a drink occasionally, might have the occasional piece of cake, bar of chocolate, OK, but generally, if you keep your diet based on these natural, unprocessed, what you might call primal foods, it's going to keep you out of a lot of trouble, almost certainly, OK. If you want more technical detail, thank you very much for listening. Any quick questions? Yes, OK, you, sir. Talking about insulin and keeping the levels down, with people who train and exercise a lot, one of the generally held wisdoms is that the best thing to do is to eat a protein-rich diet, maybe about seven small-ish meals with a lot of green veg and stuff per day, which is generally speaking what I tend to do. Yeah. How does that impact the conversation in terms of keeping the insulin levels down? Well, why would you do that? What's the thinking behind having to eat relatively protein-rich food six times a day? Because, in all honesty, that's what I've read and understood. So, I don't have an issue with a high protein element, because I think that's particularly good if you were seeking to build muscle, which I think is one of your, I was going to say priorities, things that you have clearly done and probably want to continue to do. But you could apply some intermittent fasting, for example, or some slightly irregular eating around that, but also reserve, make sure that immediately after exercise, I say immediately within half an hour or so, you're having something that's going to replenish your muscles with protein. So that could be something protein-rich, even a protein shake if that was your thing and some, I don't know, branch-chain amino acids or whatever. I would just challenge the notion that you need to eat six times a day. And in fact, I suspect you'll get better results not doing that in time. Yeah, okay. You had a question. With regards to insulin, you touched on this, I'm curious to know more. What happens if you do eat excess fat and insulin is low, so say if you do eat butter all day and very low insulin, what happens to that fat? Well, you can probably store fat without having like high levels of insulin. You can probably still store fat. It's just harder probably to do than when insulin levels are higher. But here's the thing. In a way, what a lot of people find is when they adjust their diet in a way that I would suggest here, they often are thinking, I think I'm eating more and yet I'm losing weight. What's happening? Well, where do those spare molecules go? Those fat molecules, what's happened to them? I don't know, but I suspect what's happened to them is they have been taken up so you've released them from your fat cells. They have gone into your, for example, muscles where they can be burned as fuel because that's the other major fuel other than sugar, isn't it? Fat. So in other words, you have basically fed your muscles with a bit of your own fat and some people believe actually that that is one of the reasons why this sort of dietary approach causes people to eat less spontaneously because what they're not eating but it appears they're not eating is now being supplemented with their own fat. Now, one thing that I've noticed in practice over the years is that when individuals eat in this way it might take them a week or two to sort of adjust a bit, flipping over from being predominantly sugar burners to fat burners. But when they do that, they're usually very, very highly energized and warmer. You see that a lot with people, they say, do you know what, I feel warmer in my hands and warmer, I just feel like a, you know, and I suspect what's happening here is through lower insulin what fat you're eating, ok, is being metabolized more efficiently plus if you're mobilizing fat that is also being metabolized potentially in your muscles giving you energy and heat. And that's probably a healthy situation all around than eating a very carbohydrate-rich diet which is potentially trapping your fat in your fat cells and chronically starving you so that you need food from the outside all the time. That's the basic principle. Yes, there's a couple of questions here. Yes? What are your thoughts on the assertion that like, you know, high protein diets particularly meat, especially people that are against meat say that it causes kidney overfunction it causes especially kidneys and also colon cancer and things like that. Ok, so there has been a thought that high carb, sorry, high protein diets are detrimental to certain aspects of health like bone, bone is one that's constantly quoted and kidneys. Well, there's no evidence for that. In individuals that have normal kidney function like I would imagine everyone in this room it doesn't appear that eating a relatively protein-rich diet has any hazards either there or on bone health either. It's just a sort of myth. With regard to colon cancer, the problem is there the link appears to be with red meat and particularly processed meats. Now these studies are what we call epidemiological studies. They look at associations between things. They can't tell you whether the red meat is causing the colon cancer. Actually there's quite a lot of studies that don't link the two. Never mind that. Let's focus on the ones that do show a link. Here's a fundamental problem with this sort of evidence. Let's imagine 30 years ago you tell people not to eat red meat because it's unhealthy. Now people respond to that in basically one of two ways. They either go, ooh, I'm careful with my health and they've told me I shouldn't eat red meat so I'm not going to or people a bit like me that say I don't really care what they said. Ok, I'm going to do what I like and they go off in this direction. Now down here on this strand of people you also have people that will not listen to any health advice that smoke and drink and ride fast motorcycles and whatever. People that aren't very health conscious. Now after 30 years you do a study and you look at the relationship between red meat and colon cancer and you find that these people have a higher risk of colon cancer. Was it the red meat that caused the problem? You have no idea. It could have been that but it could have been the fact that they smoke and they drink and they don't eat any vegetables or whatever do you see. So it's a bit of a mess. The other thing is that I'm really interested in not the impact that a food has on any single disease but its impact on the overall health. So one way you would do that is to look at vegetarians and meat eaters and go when we compare these people is there any significant difference in health and the answer to that is no there isn't. Ok, which would lead you to conclude if vegetarians are not living any longer or have less heart disease for example than people who eat meat. Meat can't be that bad. If you eat nothing but meat that's probably bad. But if you're including meat in your diet that probably isn't bad and may well be good. So the one in the middle then. Sorry. My question is about hunger because sometimes when I get hungry and then I have to lunch during the day but I have a course to follow. The hunger is over. What kind of mechanism is that of the body? So what's happened? You've got hungry. You haven't eaten and then you've... And I can't eat because I have a course. So I can't eat lunch. So you can't eat because you're busy. Yeah exactly and then after like the hour of the course of the lecture the hunger is gone. What kind of mechanism is that? Ok. Sounds good doesn't it to be able to do that. I think you'd be a natural intermittent faster if you wanted to try that. You don't need to I don't think but if you wanted you'd like to do that. What's going on there? Ok so one thing that can happen basically when we get hungry is that the body recognise that it's starved of fuel and then will attempt to fuel itself right. So you have for example sugar stored as glycogen in the muscles in the liver you've also got fat stored in your tissues. Now can you mobilise that somehow? Yeah one way that it appears that we mobilise fuel stores in the body to satisfy ourselves internally is through the stress response. So it might be that you've just turned on your stress response a bit the body says oh I'm hungry I'll turn on the stress response mobilise some internal stores and therefore that has allowed you to get through this is a normal adaptive response remember you should be able to do that if individuals can't push through a little bit of hunger like that not necessarily ravenous hunger but like I'm getting a bit peckish and also once you're sat at college concentrating on something so I'm not saying stressful but it challenges the body and also may help mobilise fuel stores internally for you. I suspect that's the mechanism. Thank you very much for listening.